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MNAAP Newsletter

Screening for Mental Health Problems with the PSC-17 Tool

By Calla R. Brown, MD, Tom Scott, MD, and Iris W. Borowsky, MD, PhD

Mental health conditions are prevalent in the pediatric population, and identification and treatment at an early age can lead to improved long-term outcomes. Primary care clinics have long been promoted by the Bright Futures Guidelines for Health Supervision as the optimal site of screening for mental health conditions in the pediatric population given pediatricians’ sustained contact with children and families.

Diagnosis of mental health conditions in children through improved screening rates has been identified by the Minnesota Department of Health as a core measure in pediatrics, and there are several tools available to the general pediatrician for screening. This Minnesota goal is in line with national objectives to increase screening and treatment for mental health conditions, and Healthy People 2020 includes specific screening and treatment goals for depression in adolescents.

 

One of the most widely used and validated screening tools is the Pediatric Symptom Checklist-17 (PSC-17). While this tool is recommended in the state of Minnesota as a screening questionnaire for psychosocial problems in the pediatric population, screening rates for mental health conditions across the state as reported by the Minnesota Department of Health currently average around forty percent.

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Screening for Adverse Childhood Experiences, Psychosocial Risk, and Resilience

AndyBarnesbw150TomScottBy Andrew J. Barnes, MD, MPH, Assistant Professor, Developmental-Behavioral Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota and Tom Scott, MD, Clinical Professor, Developmental-Behavioral Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota

Although there are normative challenges during childhood – for example, separating from parents for daycare – many children experience frequent or ongoing stress that is overwhelming. Such stress, including Adverse Childhood Experiences (ACEs) and extreme poverty, can lead to modified gene expression, problems with cognitive and social-emotional development, and chronic health conditions. These negative outcomes are less likely for children with ample protective factors, whether internal (such as self-regulation) or external (such as a consistent, nurturing adult caregiver). These factors improve children’s capacity to succeed and develop well in the context of threat or challenge – i.e., resilience.

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Social Emotional Screening in Early Childhood

CatherineWrightbw150Glenace-Edwallbw150TomScottBy Catherine L. Wright, PsyD, MS, LPCC, Glenace E. Edwall, PhD, PsyD, LP, MPP, and Tom Scott, MD

Social emotional screening in primary care identifies infants, toddlers, and preschoolers in need of referral for mental health services. This screening process is currently receiving increased clinical and public health attention because of concerns about low rates of detection and treatment of behavioral and emotional problems in the United States.

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Providing Care for LGBTQ Youth

By Tom Scott, MD, FAAP, Interim Director, Developmental-Behavioral Pediatrics Residency Program, U of M…

Suddenly in Minnesota marriage can be in the future for Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) young people! Just over a year ago MNAAP was strongly opposing a constitutional amendment that would have precluded this possibility. And now, LGBTQ youth can see role models of committed people in same-sex relationships who love each other and are marrying. They will know that they can find a life partner and that their relationships will be supported by society just as the opposite-sex relationships of their peers are.

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What is Developmental-Behavioral Health Pediatrics?

By Tom Scott, MD, FAAP, Interim Director, Developmental-Behavioral Pediatrics Residency Program, University of Minnesota

The care of all infants, children and adolescents involves Developmental-Behavioral Pediatrics (DBP), whether by primary pediatricians or DBP specialists. Composing a relatively new sub-specialty, DB pediatricians provide care for a range of patients with developmental, learning, emotional, and behavioral disorders. Similar to primary care pediatricians, DB pediatricians also focus on healthy child and adolescent development, identifying strengths, promoting resilience, and reducing risk.

DB pediatricians work as individual consultants or in teams. Team members from other disciplines may be on site or in the community and include speech and language pathologists, audiologists, psychologists, nurses, education specialists, occupational therapists, physical therapists, nutritionists, neurologists, geneticists, and child psychiatrists. Sometimes primary care pediatricians consult directly with these other team members.

Whether a patient should be referred to a DB pediatrician, a child psychologist, or child psychiatrist and whether to an individual consultant or to a team depends on the nature and complexity of the problem and availability of specialty resources. Sometimes a referral to a person on the team will result in a recommendation for additional assessment by other team members. There may be overlap in the clinical expertise of specialists on the team, and in complex cases, additional perspectives may be particularly helpful diagnostically. DB pediatricians in Minnesota have varying areas of specialization, including autism, early childhood issues, ADHD, learning disorders, Down’s syndrome, sleep, self-regulation, and hypnosis. Also, some general pediatricians have special interests in DBP and serve as resources for other clinicians.

The following are general guidelines in making referral and consultation requests to DB pediatricians, child psychologists, and child psychiatrists:

Referral/consult request to Developmental-Behavioral pediatrician:
- Complicated school learning,attention, and behavior problems
- Questions of autism spectrum diagnosis and management
- Anxiety and depression
- Persistent somatic symptoms
- Persistent elimination and soiling problems
- Sleep issues

Referral/consult request to child psychologist:
- Questions of co-morbidity with learning and attention problems
- Questions of cognitive status
- Differential diagnosis of anxiety, depression, behavioral issues
- Questions of autism spectrum diagnosis and management
- Individual or family therapy
- Cognitive behavioral therapy

Referral/consult request to child psychiatrist:
- Out of control behavior
- Suicidal issues
- Questions of bi-polar disorder
- Questions of psychosis

Pediatricians in Minnesota, like those throughout the country, have concerns about the availability of DB pediatricians and long waiting lists. At present, almost all DB pediatricians in Minnesota are located in the metro area. A recent study found 86 percent of primary care pediatricians in the United States reporting too few DB pediatricians and 95 percent reporting too few child/adolescent psychiatrists to meet the needs of patients in their practices. In 2011 only 35 first-year DBP fellows were in training in the United States.

In order to address the shortage of DB pediatricians, advocacy at a federal, state and local level is essential.

References:
The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, Third Edition, Marilyn Augustyn, Barry Zuckerman, Elizabeth B. Caronna, editors, 2011.
Encounters with Children, Pediatric Behavior and Development, Fourth Edition, Suzanne D. Dixon and Martin T. Stein, 2006
Primary Care Pediatricians’ Satisfaction with Subspecialty Care, Perceived Supply, and Barriers to Care, Journal of Pediatrics, 2011, Vol. 156, No. 6,1011-1015