Let’s Talk Children’s Mental Health Wellness

Today is National Children’s Mental Health Awareness Day. I am participating in national campaign activities as one of the panelists discussing the importance of communication among families, primary care providers and behavioral health specialists. I am honored to be able to share my voice and passion about this topic tonight.  Check out the event, which will be streamed live at 7:00 pm ET at https://nvite.com/HeroesofHope/gxlr3n.

Helping families, providers and the larger medical team (including child care providers and schools) be a part of the conversation when it comes to children’s health is key because we all know that kids don’t live in vacuums. They live and play at home, school and in their communities. It is important to acknowledge the impacts each of these spheres play in promoting the wellness of children and to work together to ensure optimal, safe and nurturing environments for them. It is therefore important to help families establish their “teams” when certain conditions are identified and therapies and services are needed. This includes enlisting the help and valuing the input of the child’s daycare provider, teacher, tutor or therapist.

As a pediatrician, I am a believer in prevention and anticipatory guidance. Helping new parents understand their critical role in shaping their children’s health and wellness is what pediatricians do during well child visits. Each encounter is a chance to ensure children are thriving and developing as expected, provide reassurance, answer questions, administer vaccines and hand out children’s books. These visits allow providers to monitor the health of the parent-child relationship by observing interactions in the office (albeit a tiny snapshot). It also affords the chance to conduct routine developmental and behavioral screening and to monitor any other potential health risks. The screening tools become opportunities for pediatric providers to discuss things that are going well and to probe a little more about potential areas of concern so together, a plan of care can be made with the family to connect to helpful services or therapy. We can help guide and activate families to understand the roles and responsibilities each person on their team has so that in times of stress, they know who exactly to turn to. Coordinated care and communication among the larger team ensures everyone is on the same page and working towards the same goal. It also limits redundancies and inefficiencies, which can go a long way to alleviate caregiver/family stress.  It is also important to model shared decision making, communication and care coordination to trainees so that they can be prepared to continue and expect this as standard of care when they go out on their own.

Universal and consistent screening for behavioral challenges and circumstances that can affect the overall wellbeing of families is especially crucial because these challenges are even harder to mitigate if left untreated or undiagnosed. I previously posted a blog about why pediatric providers need to ask questions about exposures to domestic violence and trauma. Exposures such as these disproportionately affect children in poverty.  Too many children don’t have access to mental health care. Among those with identified issues, too few actually access services. This is partly to do with insurance, the limited sub specialist workforce,  and need for care coordination.  Luckily national professional organizations continue to advocate and support systems-wide changes by publishing policy statements and releasing toolkits, and continuing medical education opportunities. In fact,  the American Academy of Pediatrics has established a new Screening Technical Assistance and Resource Center (STAR) along with a new quality improvement learning collaborative to help primary care providers increase rates of early screening, referral and follow up for developmental milestones, maternal depression and social determinants of health.  In April, an updated Bright Futures Periodicity Schedule was released, which is essentially the roadmap of recommended preventive services during well child visits and can help standardize practice to improve rates of consistent screening, as well as help providers advocate for improved reimbursement providing recommended preventive care during pediatric visits.

This month is Mental Health Awareness month and I will be tweeting on conditions that are especially important to me–either because of the work I do or because I know and love someone with a certain diagnosis. But I hope we can continue the hard work towards finding cost effective and evidence-based strategies that are financed and target the prevention of mental health and behavioral issues before they arise. We must all work together to continue our efforts to train the future workforce, talk about the realities of physician burn-out and find ways to promote self-care within our professions. We must continue to provide opportunities to expand skills of the existing workforce and tirelessly advocate for no more cuts to Medicaid and CHIP and advocating for more money invested in early child care and to our teachers, family support systems and home visiting programs. The list goes on. There is much work to do and I am ready to keep going…are you?

#Tweetiatrician #HeroesofHope #PutKids1st #KeepKidsCovered

For more information:

Children’s Mental Health: What Every Policy Maker Should Know by National Center for Children in Poverty

AAP resources help to improve rates of screening, referral and follow up in AAP News (March 22, 2017)