by Cason Benton, MD, FAAP

Teen Mental Health

Before the pandemic, mental health challenges were the leading cause of disability and poor life outcomes in young people with one in five adolescents having a mental health disorder. Moreover, Alabama youth, when compared to national samples, are more likely to have attempted suicide in the last 12 months and to have been treated medically as a result. Early data from emergency room usage and hospitalizations point to an alarming increase in adolescent mental health concerns during the pandemic.

The Role of the Pediatrician

To address this mental health emergency, pediatricians need to be a part of the solution. The Guidelines for Adolescent Depression in Primary Care (GLAD-PC) recommend universal depression screening and follow-up for 12- to 18-year-olds, when the following can be pursued:

1. additional training regarding issues such as advances in screening, diagnosis, treatment, follow-up, liability, consent, confidentiality, and billing;

2. practice and systems changes, such as office staff training and buy-in, EMRs, and automated tracking systems, whenever available; and

3. establishing linkages with mental health services. An exciting partnership between the PATHS program (Pediatric Access to Telemental Health Services) housed at Children’s of Alabama and ACHIA’s quality improvement collaborative will help the practices “check off’ the GLAD components.

QI Learning Collaborative

Participants in the QI collaborative will engage in PATHS’ behavioral health training using Project ECHO, a guided practice model of telementoring that brings specialty knowledge to primary care practices (visit https://bit.ly/3xeIe33 for more information). Additionally, these practices will also use ACHIA quality improvement coaching and data platforms to assess the reliability of the clinician’s universal screening and follow-up systems. Those interested practices can learn more about the 2023 Teen Mental Wellness QI Collaborative at the AL-AAP’s Annual Meeting in September during a session with a teen mental health speaker. Practices may also contact Project Coordinator Rachel Latham at rlatham@alaap.org.

Rural Providers: Start the PATH to Improving Behavioral Care for All Ages Now!

While not part of the 2023 Teen Mental Wellness Collaborative due to grant stipulations, the PATHS program has behavioral health supports in addition to the ECHO training for primary care providers in Alabama’s rural communities through the following:

• care coordination for patients of all ages with complex behavioral conditions;

• referrals to behavioral health resources in the patient’s communities where available;

• provider-to-provider consultation with a member of the PATHS mental health team, when caring for a patient with behavioral health needs; and 

• behavioral health services via telemedicine in the pediatrician’s office when specialist intervention is needed.

PATHS is working on expanding these supports more broadly in Alabama. Rural providers interested in learning more, including opportunities in 2022, should visit https://www.childrensal.org/paths or contact Susan Griffin at susan.griffin@childrensal.org or at 205-638-5673.

References
Perou, el al., & Centers for Disease Control and Prevention (CDC) (2013). Mental health surveillance among children—United States, 2005-2011. MMWR. Morbidity and Mortality Weekly Report Supplements, 62(2), 1–35.

Ghandour, R. M., et al. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics 206, 256–267.

Centers for Disease Control and Prevention. (2019) Youth Risk Behavior Survey Data. Available at: www.cdc.gov/yrbs. Accessed on 2021.

Rachel A. Zuckerbrot, et al; Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics March 2018; 141 (3): e20174081. 10.1542/peds.2017-4081

This article first appeared in the Second Quarter 2022 Edition of the Alabama Pediatrician Newsletter.