Thinking Differently about Pediatric Mental Health
It is no surprise that pediatric mental health issues are a rising concern in the United States. Consider a few recent statistics taken from survey data analyses:
70% of teenagers (age 13-17 years) surveyed said “anxiety and depression is a major problem among people their age in the community they live in” (Pew Research Center, 2019)
A significant linear increase occurred between 1999-2017 in the percent of high school students indicating they felt sad or hopeless on the Youth Risk Behavior Surveillance System survey (Centers for Disease Control and Prevention, 2018).
Analysis of the National Survey on Child Health data indicated that the national prevalence of children (age 0-18 years) with at least one mental health disorder was 16.5%. Furthermore, nearly half of children with a mental health disorder did not receive needed treatment or counseling from a mental health professional. (JAMA Pediatrics, 2019).
What Makes Pediatric Mental Health different?
Mental health access and treatment are foundational to improving population health across the lifespan. But diagnosis and treatment of children and adolescents’ mental health needs requires a different approach from that of adult or senior care.
Children’s mental health care requires a family-centered approach.
Mental health disorders can be scary for children, who naturally may turn to parents for support. It can be exhausting to constantly deal with the symptoms of a child’s mental health issue. Not only is it important to provide access to mental health treatment to individual children, it is important to support parents to both improve their own wellbeing and to maximize their ability to support their children. An hour with a certified mental health counselor on a weekly basis will greatly help a child navigate mental health, but if the family is not set up to support that child and their mental health needs for the other 167 hours in the week, the mental health treatment may not be understood to “work”.
Furthermore, navigating the mental health care landscape is overwhelming. Providing logistic support in terms of understanding diagnoses and treatment, dealing with insurance, advocating for their children are necessary services that can bolster parents. Additionally, understanding how to support parents emotionally is an often-overlooked component of pediatric mental health care. Connecting parents to peer supports can bolster loneliness that often accompanies. Parents often reach out to other parents first before connecting to their health care system. If health care systems can facilitate these connections, the health outcomes of both children and parents will be improved. A systematic review of such family support programs can be found here.
Children’s mental health care requires developmentally-appropriate strategies.
The “typical” progression of child development is non-linear, complex and challenging at times for both children and parents. The spectrum of age-appropriate behaviors is broad, and sometimes behaviors that can be difficult to manage (e.g. tantrums in a toddler) are mischaracterized as atypical or abnormal by parents and caregivers who are struggling to manage them. In an effort to “make it better,” there is a risk of pathologizing developmentally-typical behaviors in children. A trained pediatric mental health clinician can help parents understand what behaviors are typical based on a child’s age, and can coach parents and teachers on developmentally-appropriate strategies to help set reasonable expectations and build greater self-regulation of behaviors.
In balance, it is important to recognize that some children do have mental health conditions, and that diagnosis of these conditions can be particularly challenging in children. One reason is that children’s brains process experiences – particularly trauma – differently from older children and adults. In these cases, early diagnosis and intervention is critically important to reduce short- and long-term risks to developmental progression, school attendance, safety and overall health and well-being. We like the metaphor of the wobbly table used by the Harvard Center on the Developing Child which states, “Just as small “wobbles” in a table can become bigger and more difficult to fix over time, the effective management of mental health concerns in young children requires early identification of the causes and appropriate attention to their source, whether they reside in the environment, the child, or (most frequently) in both.”
Children’s mental health care requires creative strategies to deliver services.
There is a well-recognized shortage of pediatric mental health providers in the United States, which leads to long wait times to get an appointment, forgoing care, and a “crisis-focused” approach to care. Typically, parents’ first clinical resource for mental health concerns is their child’s pediatrician. Research has shown, however, that pediatricians struggle to provide front-line mental health care to their patients, noting a lack of confidence in their ability to diagnose, and a lack of local resources for mental health referrals. If a parent or physician is able to secure mental health care for their child, the recommended course of treatment is likely to require multiple clinic visits during school and business hours. Research shows that school attendance matters to child health, particularly for mental health. More and more systems are designing innovative care delivery methods to assess and support child and family mental health needs in schools and community centers, and during non-traditional service hours, like evenings and weekends. In our next blog post, we will describe some these innovative approaches to pediatric mental health care, and highlight how these models may be transferrable to different communities.
We also recognize that there will never be enough professionals to meet acute mental health treatment needs of children unless we work to reduce modifiable drivers of mental health challenges. One of the most promising ways to prevent or mitigate experiences like trauma, anxiety, or depression is by helping children build resilience. A number of studies have identified evidence-based practices and programs that create safe, stable, nurturing relationships for children, and policies that support healthy environments for children and families. In addition, several cities across the United States have already begun investing in efforts to build trauma-informed, resilient communities.
Genesis Health Consulting has deep experience in helping health systems think differently about pediatric health care. Please email us at firstname.lastname@example.org to learn more about our work in this area.