Do adolescents know where to find help for mental health problems? A brief report

Objective: Few previous studies have investigated adolescents' knowledge of the services available to provide help with mental health problems. This is an important omission as knowledge about the availability of mental health services may significantly influence the extent to which adolescents with mental health problems receive appropriate help for their difficulties. The purpose of this study was to investigate knowledge of mental health services among socio-economically disadvantaged adolescents.
Methodology: Students attending the participating high school completed a questionnaire describing mental health services in South Australia.
Results: The results suggest that the adolescents had little knowledge of mental health services and they primarily discussed their problems with other family members or friends. The results also suggest that the adolescents prefer to obtain information about mental health problems from education programmes in schools or on television.
Conclusions: There is a need to make adolescents and their families more aware of the services available to provide help for mental health problems.     

School-based mental health services

More than 20% of children and adolescents have mental health problems. Health care professionals for children and adolescents must educate key stakeholders about the extent of these problems and work together with them to increase access to mental health resources. School-based programs offer the promise of improving access to diagnosis of and treatment for the mental health problems of children and adolescents. Pediatric health care professionals, educators, and mental health specialists should work in collaboration to develop and implement effective school-based mental health services.     

American Academy of Pediatrics: Health care for children and adolescents in the juvenile correctional care system

Over the past decade, there has been a dramatic increase in the population of juvenile offenders in the United States. Juveniles detained or confined in correctional care facilities have been shown to have numerous health problems. Such conditions may have existed before incarceration; may be closely associated with legal problems; may have resulted from parental neglect, mental health disorders, or physical, drug, or sexual abuse; or may develop within the institutional environment. Delinquent youths are often disenfranchised from traditional health care services in the community. For these adolescents, health care provided through correctional services may be their major source of health services. Pediatricians and correctional health care systems have an opportunity and responsibility to help improve the health of this underserved and vulnerable group of adolescents.     

Patterns of medical, educational, and mental health service use in a national sample of US children.

BACKGROUND: Special services are provided to children by the medical, educational, and mental health service systems, but it is unknown whether the same group of children receives different types of services or whether discrete subgroups predominantly receive these services. OBJECTIVE: To determine the proportions of children who receive special medical, educational, and mental health services, individually and in combination. DESIGN/METHODS: Using data from the 1994 National Health Interview Survey (NHIS) and its concurrent Disability Supplement (NHIS-D), we determined the proportions of children under age 18 (N = 30 032) who received each of 3 types of special services (medical, educational, mental health). We also examined the proportions of children who used combinations of these services. Finally, we determined whether the patterns of service use differed across age, sex, socioeconomic, or racial/ethnic groups. RESULTS: Overall, 9.6% of children used some type of special services. Somewhat greater proportions of children used specialized health services (5.5%) or educational services (5%) than mental health services (1.5%). About one third of children receiving services in each of the special medical and educational sectors are users of another type of services as well, but among children receiving mental health services, the majority also are recipients of another type of services. Highest rates of overall service use and of use in all 3 sectors were found among subgroups of children who were elementary school-aged or adolescents, male, of white non-Hispanic race/ethnicity, and living below the federal poverty level. This pattern is consistent with the literature on service utilization within the 3 systems of care and with the greater prevalence of children with chronic conditions in these same subgroups. CONCLUSION: These findings underscore the importance of communication in the planning of services for children across the medical, educational, and mental health sectors. Further research is needed to assess the actual degree of overlap among the various systems providing this care and the degree to which children and their families would benefit from more integrated systems.     

Mental health referral: a weak link in comprehensive care of children with chronic physical illness

Although children with chronic medical conditions are at increased risk for mental health problems, they and their families receive few mental health services. For a number of reasons, it is unusually difficult to refer these youngsters to traditional mental health resources and this may contribute to the paucity of services that they receive. Significant barriers to referral are contributed by each participant in the process: families, medical staff, and mental health providers. Alternative approaches to the delivery of services to this high-risk population are suggested.     

Liaison and co-operation between paediatrics and mental health

Mental health liaison with paediatrics is vital but often misunderstood. Anxiety about the stigma of a referral to mental health cannot be entirely eradicated. The best antidote to this inevitable tension is to have mental health staff working in the same premises as paediatrics, so that colleagues can get to know and learn from each other. When this is achieved there is a far greater opportunity for enriching the care that children and their families receive in hospitals and clinics, and for promoting liaison more widely. Paediatric liaison is not only for mental health problems.     

ADad 11: Needs and Service Provisions for Anxiety Disorders Among Adolescents in a Rural Community Population in India

Objective

Despite the need to have adolescent-centric policies and mental health services, India is yet far from having one. The authors aimed at generating opinions on the need to have adolescent focused policies and clinical services using the data on Anxiety Disorders they collected from the community.

Methods

This qualitative study used Focus Group Discussions (FGD) to generate opinions on the various needs to enhance better mental health services and policies for adolescents in India. A Modified Delphi technique was used with experts in mental health to prioritize these needs. Experts gave their plans on how to approach the needs during the in-depth interviews.

Results

The mental health professionals viewed scaled-up mental health services to include adolescent mental health services; improve the consumer opinion about public sector health providers; strengthening the government hospitals; capacity building among the health sector and non-health sector; research in service delivery models and policy changes as the needs. The parents felt the need to address the stigma associated with their children’s mental illness, minimize the barriers in approaching mental health services and involve non-medical agencies in mental health care. These needs were prioritized and solutions to these problems were discussed.

Conclusions

India-centric and adolescent specific mental health policies and services need to be developed as well as integrated into the existing health system in India.

     

Racial and ethnic disparities in health care for adolescents: a systematic review of the literature

OBJECTIVE: To identify the extent of racial and ethnic disparities in primary care, mental health care, reproductive health care, and asthma care for adolescents independent of socioeconomic status (SES). DATA SOURCES: Systematic review of the scientific literature using standard bibliographic databases. STUDY SELECTION: Inclusion criteria were (1) studies published in the past 12 years, (2) analyses included children and adolescents aged 17 years and younger, and (3) data analyzed by racial/ethnic groups while accounting for SES. A total of 203 studies were reviewed, of which 31 met the criteria for inclusion: 14 of 65 studies on primary care, 11 of 61 studies on mental health care, 2 of 50 studies on reproductive health, and 4 of 27 studies on asthma services. DATA EXTRACTION: Data from tables in the selected studies were used to determine whether minority children and adolescents received fewer, greater, or the same health care services as white children and youth after taking into account SES. DATA SYNTHESIS: Black youth received fewer primary care services in 8 studies, whereas in 4 studies no disparity was noted. Hispanic youth received fewer primary care services in 6 studies, whereas no disparity was noted in 5. One study did not include Hispanic subjects. In 2 studies minority youth, combined into a single category, received fewer services than did white youth. In a total of 6 studies black youth received fewer mental health services, whereas in 3 studies no disparity was noted and in 1 study black youth received a greater number of services. In 3 studies Hispanic youth received fewer mental health services, and in 3 studies there were no group differences. In 1 study, with racial and ethnic groups combined in a single category, minority children and youth received fewer mental health services than white subjects. Three studies did not include Hispanic subjects. Too few studies of reproductive and asthma care were available to draw conclusions. CONCLUSIONS: These results suggest that racial and ethnic disparities, independent of SES, exist in selected areas of adolescent health care. More studies are needed to better understand the extent and causes of these findings.     

Treated prevalence of and mental health services received by children and adolescents in 42 low-and-middle-income countries

Background: Little is known about the treated prevalence and services received by children and adolescents in low‐ and middle‐income countries (LAMICs). The purpose of this study is to describe the characteristics and capacity of mental health services for children and adolescents in 42 LAMICs. Methods: The World Health Organization Assessment Instrument for Mental Health Systems (WHO‐AIMS), a 155‐indicator instrument developed to assess key components of mental health service systems, was used to describe mental health services in 13 low, 24 lower‐middle, and 5 upper‐middle‐income countries. Child and adolescent service indicators used in the analysis were drawn from Domains 2 (mental health services), 4 (human resources), and 5 (links with other sectors) of the WHO‐AIMS instrument. Results: The median one‐year treated prevalence for children and adolescents is 159 per 100,000 population compared to a treated prevalence of 664 per 100,000 for the adult population. Children and adolescents make up 12% of the patient population in mental health outpatient facilities and less than 6% in all other types of mental health facilities. Less than 1% of beds in inpatient facilities are reserved for children and adolescents. Training provided for mental health professionals on child and adolescent mental health is minimal, with less than 1% receiving refresher training. Most countries (76%) organize educational campaigns on child and adolescent mental health. Conclusions: Mental health services for children and adolescents in low‐ and middle‐income countries are extremely scarce and greatly limit access to appropriate care. Scaling up of services resources will be necessary in order to meet the objectives of the WHO Mental Health Gap Action (mhGAP) program which identifies increased services for the treatment of child mental disorders as a priority.     

Recognizing and managing long-term sequelae of childhood maltreatment

Childhood maltreatment is a serious public health problem and represents a significant challenge to pediatricians. Maltreated children present with a variety of emotional and behavioral problems. Pediatricians should screen for risk factors associated with maltreatment and psychiatric sequelae associated with maltreatment. Because of the complexity of psychiatric sequelae in childhood maltreatment, children who have been maltreated will likely require multidisciplinary treatment in mental health care settings. Therefore, pediatricians need to be knowledgeable about mental health services in their communities and actively assist the family in obtaining services. Although we are gaining a more sophisticated understanding of the impact that maltreatment has on the mental health of children and adolescents, much remains to be done. It is critical for pediatricians to work within their professional organizations and their individual communities to address the systemic issues that create barriers to care for patients who have suffered maltreatment. It is also critical for pediatricians to encourage their professional organizations to establish good working relationships with other organizations in areas where they share interest, need, and commitment. Such collaborative relationships at local, state, and national levels can facilitate governmental policy changes that are needed to protect and care for children and adolescents. Only through such efforts can we bring about lasting changes that will support the health and well-being of children and adolescents.     

Child sex differences in primary care clinicians' mental health care of children and adolescents

BACKGROUND: Sex differences in the medical and mental health care of adults are well established. OBJECTIVE: To study the effect of child patient's sex on whether primary care clinicians (PCCs), including pediatricians, family physicians, and nurse practitioners, found or treated mental health problems in primary care settings. DESIGN: The data were collected by clinicians and parents from 21 065 individual child visits (50.3% girls) in 204 primary care practices. METHODS: Each PCC enrolled a consecutive sample of approximately 55 children and adolescents aged 4 to 15 years. Parents filled out questionnaires, including the Pediatric Symptom Checklist, before seeing the clinician. Clinicians completed a survey after the visit about the psychosocial problems and recommended treatments, but they did not see the results of the Pediatric Symptom Checklist or any other data collected from the parents. RESULTS: Boys were more likely to be seen for a mental health-related visit and by a clinician who identified them as "my patient." Boys with parent-reported symptom profiles that were similar to those of girls were more likely to be identified as having attention-deficit/hyperactivity problems or behavior or conduct problems and less likely to be identified as having internalizing problems. Adjusting for parent-reported symptoms, PCCs were more likely to prescribe medications for boys. Child sex differences in referrals to mental health specialists and the provision of counseling to families were not statistically significant. CONCLUSION: There are substantial sex differences in the mental health care of children in the primary care system.     

Children and adolescents in foster care: health problems and guidelines for their health care

In Spain, between 8,000 and 10,000 children and adolescents enter foster or residential care every year. This article aims to provide a review to increase knowledge of the health problems of minors in foster care.Sixty-five percent of the studies consulted were performed in the USA, 25 % in Spain and 10 % in other developed and industrialized countries. These studies report that a high percentage of these minors present complicated and serious physical, mental, and/or developmental problems. However, no appreciable qualitative differences in the most frequent health problems presented by these minors have been observed and there is general consensus that the high-priority health needs are the provision of preventive and/or therapeutic psychopedagogic, psychiatric, dermatologic, dental, nutritional, ophthalmologic, respiratory and immunization services. Failure to identify and provide early treatment of the health needs of these minors not only adversely affects their quality of life and future physical, emotional and intellectual development, but can also increase their difficulties in adaptation while in foster care and their future social adaptation. Their permanent relationship with the biological or adoptive family when foster care stops could also be jeopardized. Therefore, all children and adolescents in foster care should receive initial health screenings, comprehensive assessments and monitoring of their physical, mental health, and developmental status. We provide guidelines for the healthcare of these minors, which should be of use to healthcare professionals taking care of these children and adolescents while they remain in foster care.     

The organization of services for chronically ill children and their families

Despite a political climate that deters optimism for rapid growth in the field of maternal and child health, we believe that there are reasonable steps that can and ought to be taken in the years immediately ahead. These steps would lead to important and lasting changes in the delivery, organization, and financing of services to chronically ill children and their families. Furthermore, pediatricians can play important roles--as they have historically--in reshaping care for children with special needs. First, children with chronic illness and their families require a set of services substantially different from those required by the majority of the nation's children. Just as there is no escaping the presence of a chronic illness for a child and family, the health care system cannot escape its responsibility to provide these services. This nation has been extraordinarily attentive to the medical services that these children need. Advances in the diagnostic and medical treatment procedures for many chronic illnesses have been remarkable, allowing many children to live far longer and in much better health than anyone would have expected two decades ago. This nation has not been so attentive to other services. A child with diabetes may have the finest medical care available in the region, yet her family lacks the money for gas to visit her in the hospital. The cystic fibrosis specialist may develop a comprehensive management strategy for his patient, but it fails to have full effect because the family's local pediatrician remains uninformed. These and many other examples convince us that the first step toward improving the organization of services for these children and their families must involve sustained national attention to their broad and special needs. Pediatricians are in an excellent position for this effort. Though most pediatricians will not have in their practice many children with the same chronic illness, they are likely to be the only medical practitioners who will get to know a broad spectrum of chronically ill children and their families. Because of this perspective they can be a truly informed and effective voice, articulating to their local communities the need for special services for this population of children. Second, services should be organized in such a way as to de-emphasize dependence on expensive tertiary care hospitals and instead to foster the delivery of care closer to the child's and family's own community.(ABSTRACT TRUNCATED AT 400 WORDS)     

A Job Task Analysis of the Expanding Role of the Pediatric Mental Health Specialist and the Nurse Practitioner in Pediatric Mental Health

Lack of access to support, services, and providers for children and adolescents with mental health conditions is a serious problem in the United States. Fewer than half of the children who need services obtain them. To meet this demand, the Pediatric Nursing Certification Board launched a new specialty certification in 2011 for advanced practice registered nurses called the pediatric primary care mental health specialist (PMHS). In 2016, a job task analysis of the role of the PMHS and nurse practitioners practicing in pediatric mental health and developmental/behavioral pediatrics was conducted. Surveys were completed by 293 respondents. Demographic characteristics, tasks performed in practice, diagnoses made, assessment and screening tools used, and types of pharmacologic and nonpharmacologic interventions were obtained and are reported. The roles of the PMHS and nurse practitioner in pediatric mental health are well established and key to expanding services and access to children and their families.     

Aging adult children with developmental disabilities and their families: challenges for occupational therapists and physical therapists

The purpose of this article was to review the literature about families of adult children with developmental disabilities, the impact of culture on access to health care services, and community-based health care services for adults with developmental disabilities to answer the following questions: (1) How do parents of adult children with mental retardation and other developmental disabilities describe their caregiving experiences?, (2) What are frequently identified unmet service needs by the parents/families?, (3) Does the family's culture or ethnic background influence how they view their caregiving experiences?, and (4) What are the unique challenges facing families when attempting to access health care services? Currently little information exists about the needs of parents and other family members who live with adults with developmental disabilities. Longitudinal studies and studies to assess the influence of culture on care giving are especially needed. Therapists need to use approaches that will empower children and their families so they can better meet their current challenges and provide a foundation for the skills they will need to meet future challenges as adults.     

Annotation: Pathways to care for children with mental health problems

BACKGROUND: Although many children with mental health problems are in contact with primary health care services, few receive appropriate help. METHODS: Using a pathways to care model, this paper systematically reviews the literature relating to access to services. It separates out the various stages of help-seeking: parental perception of problems, use of primary care services, recognition within primary care, and referral to or use of specialist health services. RESULTS: Following parental awareness of child symptoms, parental perception of problems is the key initial step in the help-seeking process. Although children with mental health problems or disorders are regular attenders within primary care and most parents acknowledge that it is appropriate to discuss concerns about psychosocial issues in this setting, few children are presented with mental health symptoms even if their parents have such concerns. Subsequently, less than half of children with disorders are recognised in primary care. Amongst recognised children, about half are referred to specialist services. Overall, up to one-third of children with disorders receive services for mental health problems. Factors such as the type and severity of disorder, parental perceptions, child age and gender, and family and social background factors determine which affected children access services. CONCLUSIONS: As there are inequities in patterns of service use, a greater emphasis on developing resources at population and primary care levels is required. Barriers involving parental perceptions and expression of concerns within consultations should be minimised at these levels. This requires both public education approaches and improved training and specialist support for primary care services to enhance their ability to provide for these children.     

Prevention of mental health problems: rationale for a universal approach.

BACKGROUND AND OBJECTIVE: Mental health problems are a public health issue affecting as many as 20% of children in modern communities. Risk factors for externalising and internalising problems can occur in infancy. Infants at high risk live in stressed families with parent mental health problems, substance misuse, relationship conflict, social isolation, financial problems or infant temperamental difficulty. Although current prevention programmes target services to high-risk groups, targeting can stigmatise families and miss many children in need. The addition of universal prevention programmes for all families could address these concerns. This survey assessed the prevalence of infants at risk attending a primary care service as a delivery point for universal prevention. DESIGN: Survey of mothers of 6-month-old infants attending well-child clinics across six government areas of Melbourne, Victoria, Australia, between August and September 2004. A brief survey measured sociodemographic characteristics and the following family risks: maternal depression, anxiety, stress, substance misuse, violence at home, social isolation and infant temperamental difficulty. RESULTS: The survey was completed by 733 mothers, representing 69% of infant births presented to the primary care service. Of these, 39% of infants were classified as at risk for developing mental health problems. The percentage of infants classified as at risk was not markedly dissimilar across socioeconomic levels (low, 42%; middle, 40%; high, 35%). CONCLUSIONS: A substantial number of infants attending routine universal primary care are at risk of developing mental health problems. This primary care setting could provide an ideal platform for preventing early externalising and internalising problems via a universally offered, evidence-based parenting programme.     

The adolescent and young adult with Klinefelter syndrome:ensuring successful transitions to adulthood

As many adolescent and young adult males with Klinefelter syndrome move into young adulthood, they will require long-term medical and mental health care for their complex and specific health care needs. Adult general medical providers and endocrinologists may feel ill-prepared to meet the medical needs of this population. In turn, many pediatric primary care and subspecialty providers may find themselves struggling to determine how best to transition the older adolescent to adult-oriented services. Working with families and their teens to consider and address current and future medical, mental health, educational and vocational needs will enhance that young adult's independence and functioning. This chapter addresses general transition issues and those that are specific to adolescents with Klinefelter syndrome. The prognosis for these young patients is good, and can be further enhanced by supportive families and a medical team that is informed about how best to facilitate the transition to adult-oriented services.     

Improving health insurance and access to care for children in immigrant families.

Children in immigrant families now comprise more than one-fifth of all children in the United States. Low-income children in immigrant families, particularly children who are themselves immigrants, are more likely to be uninsured and to have poor access to health care than low-income children from native-born families. Differences in insurance coverage are related to restricted eligibility for public insurance coverage and to limited access to employer-sponsored insurance. The combination of poor insurance coverage, language barriers, and other factors contributes to reduced access to medical care services for immigrant children. This article reviews the literature, examines some common misconceptions regarding immigrants and the nation's health care problems, and describes potential federal, state, and local policies that could improve or weaken children's access to insurance and health care.