New Policy Helps Pediatricians Sharpen Psychiatric Skills

Of the estimated 13.7 million children and teens in the U.S. suffering from a mental disorder, 70 percent to 80 percent are not getting the professional treatment they need in part because there are just not enough psychiatrists—especially child psychiatrists—to help them (Psychiatric News, May 1). The solution, say a growing number of child health experts, is to fully harness the resources of primary care clinicians, especially pediatricians, to help tackle the problem.

Of course, that's easier said than done, considering the typical pediatrician's already tight schedule conducting routine physical exams, managing childhood immunizations, tracking developmental milestones, and attending to the daily stream of childhood illnesses and injuries.

So what's a pediatrician—poised to become a frontline warrior against mental illness—to do?

A new policy statement by the American Academy of Pediatrics (AAP) released in late June and posted online in the July Pediatrics offers pediatricians broad guidance from which to get started (see Mental Health Care Recognized as Integral to Primary Pediatric Care). They are encouraged to read the 14-page policy statement and use it as a self-assessment tool to review their knowledge, skills, and attitudes related to child mental health. Based on the assessment, doctors can determine what “competencies” they need to acquire or enhance their clinical skills.

The statement was issued by the AAP's 2007-2008 Committee on Psychosocial Aspects of Child and Family Health and its 2007-2008 Task Force on Mental Health. The American Academy of Child and Adolescent Psychiatry and other medical and health-professional groups also provided input as the statement was being developed.

“Pediatricians have a special interest in preventing or intervening early in a condition before it rises to the level of a disorder,” said Jane Foy, M.D., chair of the AAP Task Force on Mental Health, in the July AAP News.

The statement names the baseline “competencies” that pediatricians should have if they are to be frontline assessors of mental health in children or providers of care for patients exhibiting mental health problems. It also will help pediatricians evaluate whether they need to consult with or refer patients to psychiatrists or mental health professionals.

The statement also advocates “system enhancements” that should improve clinical practice. These include strengthening child mental health training in pediatric residency programs and continuing medical education, improving the financing/reimbursement of mental health care, and establishing collaborative relationships with psychiatrists and mental health providers. The latter is reflected in the AAP's collaborating with psychiatrists on the development of the statement, said Michael Houston, M.D., chair of APA's Council on Children, Adolescents, and Their Families.

“This new policy is welcome and an important step forward,” Houston told Psychiatric News. “Due to workforce shortages, ignorance, and stigma, only 1 in 5 of the children and adolescents who need mental health care receives it.”

He added that the policy statement fits in well with the work of APA's Ad Hoc Work Group on the Integration of Psychiatry and Primary Care, which is discussing ways to improve access to mental health services for both children and adults.

“The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care” is posted at<http://pediatrics.aappublications.org/cgi/content/full/124/1/410>.▪