When parents are concerned about their child's mental health, the first professional they will likely discuss these concerns with is their child's pediatrician, according to research on pediatricians' role in addressing behavioral disorders. This supports the ever-increasing awareness of the importance of establishing "medical homes" for pediatric patients. Medical home refers to a comprehensive approach to primary care that focuses on partnerships between caregivers and patients and their families. One of the many benefits of establishing these medical homes is the increased emphasis on the integration of mental health into routine pediatric practice. As such, pediatricians are uniquely positioned to identify patients who are experiencing psychological difficulties.
Unfortunately, pediatric practices often under-detect mental health issues in children, particularly when medical providers rely on clinical judgment or poorly constructed screening measures. For example, pediatric providers who rely solely on clinical judgment to identify patients with mental health concerns will only positively identify approximately 30% of clinical patients, whereas 70% of these patients are accurately identified when using a validated screening measure.
Recognizing the importance of mental health as a key determinant of overall well-being has markedly increased over the past decade. In fact, the Surgeon General's national health goals recommend that pediatric primary care providers should routinely screen for mental health concerns in their patients. Below you will find practical suggestions to support pediatricians in implementing behavioral health screenings in their practice.
Universal behavioral health screening
Prevalence data suggest that approximately 1 in 5 children and adolescents will experience a diagnosable mental health disorder at some point during their childhood. Given the high prevalence of childhood mental health concerns, pediatric providers should consider having all patients complete a brief behavioral health screening at their well-child visits.
The Pediatric Symptom Checklist (PSC-17) is an excellent universal screener that is widely used in pediatric practices and has been endorsed for use as a national standard of care by the National Quality Forum. A positive score on the PSC (15 or greater) indicates the presence of possible mental health issues and the need for further evaluation by a qualified medical or mental health provider.
Narrow band screening
If a provider suspects the presence of a specific disorder (e.g., ADHD, depression), consider administering a narrow band screening. Information obtained from these screeners can help confirm a diagnosis and can be re-administered over time to track changes in response to treatment.
Common narrow band screening measures used in primary care settings include:
Clinical tips when performing behavioral health screenings
It is critical that medical providers discuss mental health in a destigmatizing manner. Emphasize that mental health concerns are common and that seeking support for these concerns is a positive step towards promoting overall health and well-being. When discussing mental health concerns with a patient, provide empathic statements such as, "I can see that you're really hurting right now," or "It sounds like you're worried a lot these days." Show genuine interest and concern for the patient. Start by talking with the patient about a low-threat topic, such as their hobbies. Children are more likely to open up to adults if they feel comfortable and understood.
During the screening, pay attention to signs of possible mental health concerns. These behaviors could include:
- Minimal eye contact
- Appearing withdrawn
- Complaining of unexplained medical symptoms (e.g., stomachaches, headaches)
In addition to the screening and discussion with your patients, be sure to obtain additional information from parents, school personnel and other medical providers.
Behavioral health referrals
If screening reveals mental health issues, healthcare professionals can support the family in accessing high-quality mental health services within the community. Children's Hospital Colorado's Pediatric Mental Health Institute provides evidence-based comprehensive mental health services.
For more information, providers can call (720) 777-6200. Additional Colorado mental health services can be found through the Colorado Department of Human Services.
Additional behavioral health resources
Peer reviewed care guidelines from a professional association:
Peer reviewed care guidelines from a state-sponsored workgroup:
Free access screening measures: