Integrating Child Psychology Services in Primary Care

W. Douglas Tynan, Ph.D., ABPP
Kathryn Woods, Ph.D.
Johanna Carpenter, Ph.D.

Childhood is an important time for promoting healthy social and emotional development, identifying developmental and behavioral problems, and intervening before problems become severe. Yet, few children have access to mental health services that promote development of the social and emotional skills or help prevent emotional or behavioral problems before they start. Nearly 1 in 10, or as many as 6 million children and adolescents, suffer from a mental illness that severely disrupts their daily functioning at home, in school or in the community (U.S. Department of Health and Human Services, 1999). In any given year, fewer than 20 percent of these children and adolescents receive mental health services (U.S. Department of Health and Human Services, 1999). Even greater numbers of children exhibit transient emotional or social difficulties that may not develop into a diagnosable mental disorder.

There is no single public or private system that has as its sole responsibility the promotion of children's social and emotional development or the treatment of children's mental health problems. Although children's mental health needs are addressed by numerous public and private systems, there frequently are missed opportunities to promote children's optimal social and emotional development in places where children and families most commonly spend time — schools, child care and primary care facilities to name a few. In particular, primary care can play a unique role in promoting children's social and emotional development.

Primary care is one of the key child-serving systems with which many children, particularly young children and their families, regularly come into contact (i.e., through well-child visits and other routine health care). Primary care settings emphasize prevention and early intervention within a child health and development context and medical home. Primary care providers (e.g., pediatricians, family physicians) are a trusted source of guidance, information and expertise on child health and development, child rearing and mental health treatment. Families often first seek help for mental health issues with their primary care provider and, when they do so, find it less stigmatizing than in other settings (Kelleher, Campo, Gardner, 2006). Indeed, treatment for mental health issues in children is increasingly being provided by primary care providers. In the past 25 years, the rate of psychosocial problems identified by primary care providers has more than doubled (from 7 percent to 18 percent; Kelleher, McInemy, Gardner, Childs & Wasserman, 2000). Approximately 20 percent of all children seen in primary care settings have significant developmental, emotional or behavioral health issues (Schroeder, 2004).

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