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AAP policy statement stresses pediatricians’ role in mental health care

Jane Meschan Foy

An updated policy statement and a technical report issued by the AAP highlighted the need for increased involvement among pediatricians in their patients’ mental health care and increased mental health care training in medical education programs.

“Pediatricians — whether in primary care or subspecialty practice — typically have longitudinal, trusting relationships with their patients and families and, as a result, unique opportunities to promote social-emotional health and identify and address emerging mental health problems,” Jane Meschan Foy, MD, FAAP, a professor of pediatrics at Wake Forest University School of Medicine, told Infectious Diseases in Children.

“By enhancing practice systems, acquiring a set of universally applicable communication skills, developing the capacity to recognize and manage common mental health conditions, and establishing collaborative relationships with mental health professionals to comanage patients with psychiatric emergencies and severely impairing conditions, pediatricians can partner with patients and families to reduce the distress of mental health problems, improve patients’ functioning, and increase the likelihood of patients’ receiving the care they need.”

The policy statement and the technical report updated recommendations made in 2009 by the AAP based on recent research into early brain development, trauma-informed care and team-based approaches to care.

 

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According to Foy, many pediatricians are involved in the treatment of their patients’ mental health conditions and have sought additional training and ways to enhance their practice for these conditions. However, she said that barriers to pediatricians’ involvement in mental health care need to be addressed.

“Many pediatricians do not feel well prepared to meet their patients’ mental health needs and face barriers such as lack of payment structures to support their mental health services,” Foy said. “Thus, they have not yet become as involved as they want to be. We hope these two reports will stimulate their interest and provide resources that help them to address barriers and increase their involvement.”

Findings recently published in Pediatrics showed that approximately one in five high school students in the United States report suicidal ideation, and more than one in 10 have a suicide plan. Another study published in JAMA Pediatrics suggested that of the estimated 7.7 million U.S. children with mental health conditions, nearly half do not receive treatment or counseling.

In the technical report, Cori M. Green, MD, MSc, FAAP, a pediatric hospitalist at Weill Cornell Medicine, and colleagues added that the barriers that keep children and adolescents away from mental health care — including a lack of mental health specialists, stigma associated with these conditions and cost of care — place pediatricians in a unique position to treat these conditions.

However, Green and colleagues reported that a 2011 survey of pediatric program directors showed most were unaware of the 2009 competencies to provide and improve mental health care for children, demonstrating that it is “unlikely that training programs have enhanced their curriculum to prepare future pediatricians to achieve them.”

Foy said that she hopes medical schools and residency programs will take steps outlined in the technical report to improve mental health care training.

The AAP recommends the following ways pediatricians can become more involved in the treatment of their patients’ mental health conditions and improve access to mental health care:

• Advocating for appropriate payment to pediatricians and mental health specialists for mental health services with insurers and payers;
• Identifying gaps in their community’s access to mental health services and advocating for strategies to address these gaps;
• Seeking quality improvement and upkeep of certifications that improve their ability to provide mental health care, with an emphasis placed on suicide prevention;
• Examining collaborative care in practice, which may include integrating a mental health specialist as a part of the medical home team, consulting with a pediatric psychiatrist or developmental-behavioral pediatrician or using telemedicine to improve access to specialty care;
• Building and improving relationships with mental health specialists, which include school-based providers, to collaborate and improve their own mental health knowledge and skills to better identify those in need of emergency care;
• Comanaging with these specialists to help children presenting with primary mental health conditions and physical conditions that result in mental health comorbidities;
• Advocating for the inclusion of mental health competencies in medical school, residency and fellowship training, as well as additional continuing medical education activities, to increase knowledge and skills for future pediatricians; and
• Researching how mental health services are delivered in pediatric primary care and subspecialty settings.

“For pediatricians already in practice, there are a number of promising educational approaches that have been shown to increase pediatricians’ confidence and capacity to deliver effective mental health care,” Foy said. “Collaborative models have the advantage of improving access to mental health care while enhancing pediatricians’ knowledge and skills through cross-disciplinary learning.”– by Katherine Bortz

References:

Foy JM, et al. Pediatrics. 2019;doi:10.1542/peds.2019-2757.

Green CM, et al. Pediatrics. 2019;doi:10.1542/peds.2019-2758.

Lindsey MA, et al. Pediatrics. 2019;doi:10.1542/peds.2019-1187.

Whitney DG, et al. JAMA Pediatr. 2019;doi:10.1001/jamapediatrics.2018.5399.

Disclosures: The authors report no relevant financial disclosures.