The Case for Mental Health Check Ups
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1 The Case for Mental Health Check Ups Mary Gabriel, MD Division of Psychiatry and Behavioral Sciences Children s National Medical Center June 15, 2016
2 Disclosures *None
3 Objectives Assess the burden of mental illness Examine the efficacy of pediatrics on public health and preventive care Explore the multiple factors that contribute to mental well-being Create a framework for mental health checkups in pediatrics
4 Figure 1: Contribution by different non-communicable diseases to disability-adjusted life-years in 2005
5
6 Lancet, 2007; 370;859-77
7
8 How do pediatricians do with mental health? 2004 AAP periodic survey Stein, et al, Amb Ped 2008 Barriers fall into 3 main categories: organizational, maternal, and child issues Pediatrician issues
9 2004 AAP Periodic Survey Table 3. Condition by Agreement That Pediatricians Should Be Responsible for Identifying, Treating/Managing, and Referring Child's Problem/Condition Attentiondeficit/hyperactivity disorder Child/adolescent depression Behavior management problems Agree Pediatricians Should Be Responsible for: Identification, n (Weighted %) Treating/Managing, n (Weighted %) 595 (91) 452 (70) 352 (54) 577 (88) 158 (25) 560 (86) 552 (85) 136 (21) 551 (85) Referring, n (Weighted %) Learning disabilities 382 (59) 101 (16) 581 (89) Anxiety disorders 536 (83) 180 (29) 509 (79) Substance abuse 576 (88) 133 (21) 584 (90) Eating disorders 597 (91) 204 (32)
10 2013 AAP Periodic Survey: the follow up Horowitz, et. al, Academic Pediatrics 2015;15(6)
11 What about Trainees? 2007 AAP Graduating Resident Survey >90% completed Developmental and Behavioral Peds rotation, but <50% rated competencies at very good or excellent Just like AAP PS, most 2/3 agreed they should identify and treat ADHD but rarely agreed for other mental health problems Horowitz et al. Acad Ped 2010;10:
12 Trends in Office-Based Medical Visits by Young People With Mental Disorder Diagnoses, JAMA Psychiatry. 2014;71(1):81-90
13
14 Resilience Positive adaptation; the ability to maintain or regain mental health, despite experiencing adversity Deficient parenting Poverty Homelessness Traumatic events Violence Physical illness War Natural disasters Personality traits Biological Factors Family Culture Friends School Spirituality/Religion Community
15 Resilience: 2 main points Various factors and systems contribute It may be context and time specific and may not be present across all life domains INTERACTIVE AND DYNAMIC RELATIVE Herrman et al, Can J Psychiatry 2011;56(5)
16 Protective Factors: Individual Psychological Factors Personality traits Internal locus of control Mastery Self-efficacy Self-esteem Cognitive appraisal Optimism Intellectual functioning Cognitive flexibility
17 Protective Factors: Individual Biological Brain size Neural networks Sensitivity of receptors Synthesis and reuptake of neurotransmitters
18 Protective Factors: Family Secure attachment to mother/caregiver Maternal mental illness Family stability Parenting skills
19 Protective Factors: Community Friends School Extracurricular activities Culture Spirituality/Religion Safe neighborhoods/domains
20 Multiple Domains Focus on competence across stage-salient developmental domains of functioning Behavioral Educational Emotional Competence in one domain does not guarantee competence in another
21
22 Part of a check-up is Teaching Most presentations originate from parental concern Assess perceived needs by the parent Teach parents what to be concerned about, what should be perceived as a problem Godoy et al. Adm Pol Ment Health 2014;41(4):
23 Parent appraisals of child behavior problems and help-seeking pathways Godoy et al. Am J Orthopsych 2013;83(1):73-88
24 Model of parent appraisals, thinking about seeking help, and service receipt Godoy et al. Adm Pol Ment Health 2014;41(4):
25
26 What do you do with the information you ve gleaned? Know your resources!!!
27 Conclusions Neuropsychiatric disorders have a significant impact on burden of disease Pediatric providers are the front line in prevention of disease in this population Contributions to mental health are multifaceted, dynamic, and change over time Like WCC, Mental Health Check-ups (MHC) can assess, screen, and educate children and their caregivers about pediatric mental health
28
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