At annual checkups, pediatricians monitor a child's growth and administer vaccines. Someday, they may also screen for incipient mental health problems with a procedure described in the journal Pediatrics (Vol. 118, No. 5, pages 1,896-1,906).
According to the U.S. surgeon general, 20 percent of American children are diagnosable with a psychological disorder in any given year. However, many are left undiagnosed--without the early intervention that could make a big difference in their well-being. Some of the barriers to diagnosis include time--patients are usually allotted only 15 minutes for well-child visits--and the difficulty of traveling to another location to visit a mental health provider, researchers say.
"From my perspective, it's important in primary-care practice to take on responsibility for mental heath," says lead researcher Karen Hacker, MD, assistant professor of medicine at Harvard Medical School and executive director of the Institute for Community Health, which is funded by the Cambridge Health Alliance, Mount Auburn Hospital and Partners HealthCare.
During annual well-child visits, Hacker and colleagues asked parents of 1,850 children, ranging in age from 5 to 19, to complete the Pediatric Symptom Checklist (PSC). The PSC asks parents 35 questions about their child's behavior and emotions and about topics including sleeping problems, feelings of sadness and anxious behavior. Pediatricians scored the checklist in the exam room, and they immediately referred patients with potential mental health problems to an onsite social worker. In addition to immediately discussing the patient's psychological concerns, the social worker also helped the family schedule a follow-up visit with other mental health providers.
The study shows that it is possible to implement mental health screening in pediatric practices, says Hacker.
Pediatricians were pleased with the system as well. In fact, none felt that their screening system before the study was effective, yet after the study, 77 percent reported that the screening worked. In addition, providers felt that the level of mental health awareness throughout the practice increased post-study.
The next step, says Hacker, is to convince people to attend their follow-up mental health appointments. Only 17 percent of referred children in Hacker's study made it to their initial mental health appointment.
Hacker hopes that pediatric mental health screening will ultimately reduce stigma.
"Having a screening tool begins to normalize the process, in that you aren't asking one family mental health questions, you're asking all families," says Hacker.
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