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AAP: More nonpharmacological therapies needed for children with emotional, behavioral problems
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The AAP’s Council on Early Childhood released a policy statement encouraging pediatricians to advocate for increased access to care and additional evidence-based therapies, especially nonpharmacological therapies, for children with emotional or behavioral problems.
Jointly issued with the Committee on Psychosocial Aspects of Child and Family Health and the Section on Developmental and Behavioral Pediatrics, the policy statement addressed the clinical interventions available for the treatment of emotional or behavioral problems in children, as well as current barriers to care, including available resources and education.
“Beyond assessment, effective treatment of clinical disorders requires the following: (1) access to evidence-based treatments; and (2) primary care providers’ sufficient familiarity with evidence-based treatments to implement first-line approaches, make informed and effective referrals and collaborate with specialty providers who have expertise in early childhood emotional and behavioral well-being,” Mary Margaret Gleason, MD, FAAP, associate professor of psychiatry and director for Tulane Infant Mental Health Services at Tulane University, and colleagues wrote. “Currently, most young children with an emotional, relationship or behavioral problem receive no interventions for their disorder.”
According to the researchers, evidence-based treatment reduces the symptoms of emotional, behavioral and relationship problems and provides therapeutic value long after treatment has ended.
Co-located care, a new model transition that involves mental health professionals and medical care providers working together in the same space, has demonstrated improved care coordination, referral success, decreased stigma and reduced symptoms.
“A first step in reducing the barriers to evidence-based treatments is to ensure that primary care pediatricians are familiar with these approaches, which should be available to young children with emotional, behavioral or relationship problems,” Gleason and colleagues wrote.
Enhancing pediatric mental health care
Additionally, the policy statement provided recommendations to advocate for mental health coverage and further medical education, including:
- Pediatricians should advocate at the legislative level for funding programs with a role in the development of evidence-based treatment, especially in resource-limited areas; provide incentives for training in the early childhood mental health workforce; decrease third-party payor barriers to accessing quality mental health services for children; and promote accountable care organization regulations to protect early childhood mental health services;
- Pediatricians are encouraged to collaborate with child-focused organizations to advocate for comparative effectiveness studies between psychotherapeutic and psychopharmacologic interventions, mental health service delivery approaches and studies that examine treatment effects in children with emotional, behavioral and relationship problems to guide management and policy decisions;
- Pediatricians should collaborate with local government and private agencies to identify services and innovative service delivery options for children with behavioral problems;
- Primary care physicians and developmental-behavioral pediatricians are encouraged to create educational materials for trainees and providers to improve the care young children receive;
- Mental health carve-outs are discouraged and pediatricians should legislate for adequate payment for early childhood preventive services; and
- Graduate education and continuing medical education should include opportunities for training that ensure pediatric providers are well-equipped to provide adequate services and treatment options to children with behavioral and emotional problems.
“Even when a trained provider of an evidence-based treatment is identified, communication, coordination of care with primary care pediatricians and adequate payment can be challenges,” the researchers wrote. “Many health care systems do not pay for, or underpay for, necessary components of early childhood care such as care conferences, school observations, discussions with additional caregivers, same-day services, care coordination and appointments that do not include face-to-face treatment of the child.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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