AAP Mental Health Activities

AAP Mental Health Activities 

By Jane Meschan Foy, MD, FAAP
Chair, American Academy of Pediatrics Task Force on Mental Health 

Over the last several years, the American Academy of Pediatrics (AAP) has been working on a number of activities to integrate mental health into the primary care setting.  

The revised Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition, provides recommendations for health promotion and prevention during health supervision (i.e., well-child) visits. The Bright Futures Guidelines highlight and suggest opportunities for promoting mental health with every child, from birth to age 21. Later this month, the AAP Bright Futures will be releasing the Bright Futures Tool and Resource Kit to assist practitioners in implementing these guidelines. Focusing on child and family strengths and support, the guidelines and tools assist practitioners in addressing the psychosocial factors that influence health and well-being. 

In addition to Bright Futures, in 2004 the AAP formed a Task Force on Mental Health (TFOMH) to assist primary care clinicians (PCCs) in enhancing the mental health care of children and adolescents both in the medical home itself and through the medical home. The TFOMH determined that three goals will contribute to enhancing the mental health care of children and adolescents: 

Goal 1: Facilitate system changes

Improving children’s mental health requires PCCs and professional organizations to adopt a population perspective that gives them an understanding of the collective mental health needs and resources of their communities; to work collaboratively with other stake-holders; and to understand and participate in changing system characteristics such as financing, availability of mental health specialty care, communication mechanisms, and stigma. To this end, the TFOMH focused its first efforts on facilitating AAP chapter- and state-level efforts to effect systemic changes by disseminating  Strategies for System Change in Children’s Mental Health: A Chapter Action Kit * to AAP chapter leaders.  

Recognizing that financing is a central issue in improving mental health care, a joint paper authored by the AAP TFOMH and the American Academy of Child and Adolescent Psychiatry was published in the April 2009 issue of Pediatrics: Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration.* This paper offers recommendations and strategies to assist PCCs and their partners in discussing the importance of educating policy makers, health insurance payers, and health insurance purchasers to improve mental health benefits, pay PCCs and mental health professionals appropriately, support children’s access to mental health services through administrative policies and procedures, and promote collaboration among providers.  

The TFOMH also proposes that PCCs work with their partners at the community level, collectively, to foster resilience in children, to address factors that increase their risk of developing mental health problems, and to facilitate systemic changes that foster collaboration among PCCs and others important to children’s mental health and care. Strategies to accomplish these community-level changes will be summarized in a report – Enhancing Pediatric Mental Health Care: Strategies to Prepare a Community - to be published in an upcoming supplement to Pediatrics 

Goal 2: Build skills

Enhancing mental health practice in primary care settings will depend on PCCs acquiring skills complementary to the skill set of mental health professionals, built on PCCs unique strengths, role, and setting. To coordinate efforts toward this goal, the TFOMH collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to identify the competencies requisite to providing mental health services in the primary care setting. The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care policy statement outlines these recommended competencies. By articulating these competencies, the TFOMH hopes, over the long term, to provide educational goals for residency training, board certification, and re-certification; in the near term, the TFOMH has developed a number of educational programs keyed to the competencies, many of which are outlined on the AAP Mental Health Initiatives website. 

Goal 3: Incrementally change practice

The TFOMH envisions that PCCs, by achieving changes in community systems and acquiring (or honing) skills, will gain the capacity to make practice enhancements necessary for effective mental health care. These enhancements will be described in a report - Enhancing Pediatric Mental Health Care: Strategies to Prepare a Primary Care Practice – to be published in an upcoming supplement to Pediatrics 

With practice enhancements in place, PCCs can implement a process for mental health care that builds on their unique opportunities to assist families in building resilience in their children, to recognize emerging mental health problems, to provide mental health services in the medical home, to serve as an entry point for youth and families seeking, or in need of, mental health specialty care, and to coordinate care for those children with chronic mental health conditions, as for other children with special health care needs. The process envisioned by the TFOMH will be described in a report - Algorithms to Guide Primary Care Clinicians in Promoting Mental Health, Identifying and Addressing Mental Health and Substance Use Concerns in Pediatric Primary Care – to be published in an upcoming supplement to Pediatrics. Through the pictorial of clinical algorithms, this report describes an idealized process for mental health care of children in the primary care setting.  

The TFOMH is developing Addressing Mental Health in Primary Care: A Clinician’s Toolkit to assist PCCs with implementation of the process described by the algorithms. To begin the process of practice improvement, a Mental Health Practice Readiness Inventory will be provided to assist PCCs in assessing the extent to which their office systems promote and support mental health practice.  

Finally, a Pedialink module (an AAP online educational resource) on collaborative models of mental health practice in primary care- Providing Collaborative Care of Children’s Mental Health- will be released by the Summer of 2010. The clinical algorithms and some of the tools from the toolkit will be incorporated throughout the module to assist PCCs in applying the TFOMHs guidance. This online module will be available here following the release of the toolkit. 

For more information on mental health activities, contact Linda Paul or visit here. For more information on Bright Futures activities, contact Jane Bassewitz or visit the Bright Futures website

 

* Funded through a grant (G95MC05434) from the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (MCHB), to the AAP. Its contents are solely the responsibility of the authors and do not necessarily reflect the views of the US Department of Health and Human Services or the Health Resources and Services Administration.
† Produced by the AAP under its cooperative agreement (U04MC07853) with the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Its contents are solely the responsibility of the authors and do not necessarily reflect the views of the US Department of Health and Human Services or the Health Resources and Services Administration.