Primary Care at Children's Hospital Colorado Deals with Childhood Mental Health Issues
Children's Hospital Colorado Child Health Clinic (CHC) is a full-service pediatricpractice for children living in the Denver metropolitan area.
CHC offers outpatient appointments for children from birth to 21 years of age, with an emphasis on disease prevention and health maintenance. The clinic sees over 18,000 patients annually, most of whom are under-insured, uninsured or Medicaid and SCHIP participants, though most managed care plans are also accepted.
The CHC serves as the home of the Foster Care Clinic, helping to meet the physical and psychological needs of foster children and their families and the International Adoption Clinic that supports the often unique health issues of adoptees from foreign countries.
In addition to its clinical mission, the Child Health Clinic has a strong commitment to both resident and parental education.
Each year, more than 60 pediatric and family medicine residents and more than two dozen physician assistant trainees aid attending physicians in the clinic, extending caregivers’ ability to manage care.
Residents and medical students receive primary practice experience and help facilitate parental and patient education. Several educational programs were recently highlighted at the Pediatric Academic Societies’ international conference including the CLIMB (Consultation Liaison in Mental Health and Behavior) program, Breastfeeding Study and Asthma Care Education.
CLIMB Program: Integration of mental health screening into primary care setting
Mental health-related services delivered in
the Child Health Clinic in 2006 and 2007
indicate increased awareness of the need for
early detection and treatment of childhood
mental illnesses, developmental and
behavioral disorders.
The U.S. Census Bureau estimates that in 2006, there were 74 million children under 18 years of age in the United States. The American Academy of Child and Adolescent Psychiatry (AACAP) estimates that between seven and 12 million American youth suffer from mental, behavioral or developmental disorders at any given time.
A conservative cross-referencing of these numbers indicates one in ten kids have some form of behavioral or developmental disorder. The AACAP reports that the number of residents being trained in child and adolescent psychiatry has dropped six percent over the last decade.
The CHC is working to close the gaps between increasing numbers of kids needing behavioral and developmental services and decreasing the number of new doctors trained in these services.
The Consultation Liaison in Mental Health and Behavior (CLIMB) program encourages early identification of childhood mental illnesses or behavioral problems through a series of on site quick didactic lectures.
The series includes such topics as ADHD: Current Pediatric Approaches, Depression: Screening and Assessment Strategies, Mental Health Surveillance, Screening and Assessment in Primary Care and The Pediatrician’s Role in Postpartum Depression.
Initial evaluation of such conditions as autism, anxiety, ADHD, developmental delays, depression, bipolar disease and speech and language delays often fall to the child’s primary care provider. In collaboration with the Child Psychiatry section, the Child Health Clinic has begun specialized training for residents and medical students in early detection of mental illness or behavioral and developmental problems in younger patients.
By incorporating child and adolescent psychiatry training into the everyday operations of the Child Health Clinic, tomorrow’s physicians are being trained to intentionally screen kids during routine and sick-child visits for potential problems and initiate early treatment when it is most effective.
Breastfeeding Study: Impact of early formula supplementation on length of breastfeeding period
Early supplementation of breastfeeding with formula has been associated with shorter duration of breastfeeding. The study at the Child Health Clinic determined that more than two supplementary formula feedings per 24-hour period during the first week can indicate a likelihood to shorten the duration of breastfeeding overall.
Three or more supplemental feedings can indicate breastfeeding problems in young mothers who are reluctant to report or who minimize problems. Intervention, education and support for mothers who frequently supplement breastfeeding can extend the breastfeeding period.
Asthma Care Improvement
The Children’s Health Clinic sees approximately 750 young asthma patients, most of whom are Medicaid or under-insured. In an attempt to decrease hospitalizations, implement formalized treatment plans and increase use of appropriate controller medications, the CHC implemented quality process improvements including:
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Monthly asthma education (one-hour sessions) for attendings, residents and students
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Check-in staff screening of patients
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Parent asthma history questionnaires
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Electronic health record templates for asthma history
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Electronic health record templates for action plans
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Collaboration with high risk asthma clinic for lung function testing, allergy testing and asthma education
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Phone call follow-up for all ED visits and hospitalizations
Though education, better communication and follow up seem intuitive to good treatment practice, by formalizing and standardizing the process, the CHC was successful in improving treatment efficacy for young patients.
For more information
For information on Child Health Clinic studies or educational interventions contact:
Maya Bunik, MD, Medical Director, Child Health Clinic
Mary Navin, Ambulatory Practice Director
The Child Health Clinic at (720) 777-2740
