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Children and Youth

Children and Youth

Planning and delivering integrated primary and behavioral healthcare services for children and youth has unique considerations from providing care for adult populations. By implementing integrated care systems, your organization can position itself to have the greatest impact on the whole health of children, adolescents, their families, and your communities. CIHS reviews the latest resources and research related to integrated care for children and youth, and compiles the most helpful resources, below.



from cihs 

Integrating Behavioral Health and Primary Care for Children and Youth: Concepts and Strategies provides robust information on models of organizing service delivery for youth, five core competencies of integrated care systems for children with behavioral health problems, and financing mechanisms that support integrated care systems for children with behavioral health problems. This report is designed specifically for community behavioral health and health centers to learn an approach to delivering care that comprehensively addresses the primary care, specialty care, and social support needs of children and youth in a continuous and family-centered manner. For a quick highlight of the key topics discussed in the paper, view the overview.


RESOURCES
Integrating Behavioral Health into Primary Care

The Bright Futures Tool and Resource Kit, from the American Academy of Pediatrics, has materials for health supervision care for infants, children, and adolescents. Materials include practice management tools, documentation forms, screening forms, and information for parents and patients to reinforce topics discussed during pediatric visits. Materials are available for download and certain forms can be incorporated into electronic health record systems. Bright Futures, a national health promotion initiative from HRSA, is dedicated to the principle that every child deserves to be healthy and that optimal health involves a trusting relationship between the health professional, the child, the family, and the community as partners in health practice.

Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit is a resource from the American Academy of Pediatrics’ Task Force on Mental Health to provide primary care clinicians guidance in enhancing mental health care, including some substance use conditions. The toolkit, available for purchase from AAP, recommends eliciting family concerns at every visit, using routine screening with a common factors approach and motivational interviewing techniques.

Integrating Mental Health in Pediatric Primary Care Resource Center, from the National Alliance on Mental Illness (NAMI), provides materials for families and primary care providers on integrated healthcare. Materials include a report of a family survey regarding their experiences with primary care, brochures to explain what integrated care is and how it works for families, and information for providers on how to create a primary care setting that is more welcoming to conversations about mental health.

Screening, Triage, and Referral of Patients Who Report Suicidal Thought During a Primary Care Visit, a study in Pediatrics, found that pediatric primary care is a feasible setting to screen for suicidal ideation in youths and link them with mental health services and describes successful strategies for overcoming barriers. The study includes a downloadable chart on the care-coordination process if a client shows suicidal ideation as a result of the screen.

Suicide and Self-Injury Among Children and Youth With Chronic Health Conditions examined the association between chronic conditions and suicide risk. The study found that chronic physical conditions are associated with a slightly elevated risk for self-harm, suicidal thinking, and attempted suicide; chronic mental conditions are associated with an increased risk for all 3 outcomes; and co-occurring disorders present additional elevated risk.

Alcohol use is a major problem from preadolescence through young adulthood in the U.S. Alcohol Use by Youth and Adolescents: A Pediatric Concern outlines the policy statement of the American Academy of Pediatrics on the integration of alcohol use prevention and treatment in primary care.

Evaluation of the PHQ-2 as a Brief Screen for Detecting Major Depression Among Adolescents examined the validity of the Patient Health Questionnaire 2 (PHQ-2), a 2-item depression-screening scale, among adolescents. Authors found that the PHQ-2 has good sensitivity and specificity for detecting major depression, making it a promising first step in screening for adolescent depression in primary care. 

One Location, One Visit describes a model for integrating behavioral health services into pediatric primary care. The integration process is divided into six sections: education of stakeholders; identifying specific site logistics; developing integrated procedures; adjusting workflow; evaluating integration procedures; and replicating as necessary. For more information on this guide, reach out to Michelle Duprey at Starfish Family Services.


Health Homes

Best Principles for Integration of Child Psychiatry into the Pediatric Health Home presents a framework for integrated Pediatric Health Homes based on levels of severity and complexity of a child’s mental health needs. 

Customizing Health Homes for Children with Serious Behavioral Health Challenges
examines specific policy and practice considerations for states when developing Medicaid health homes for children with serious behavioral health challenges. 

Medical Home Innovations: Where do Adolescents Fit?
presents findings from interviews conducted with senior leaders of 12 medical home programs across the country, focusing on how the model has benefitted adolescents thus far and what challenges remain.

For more information, visit our health homes page.


Children and Trauma

Helping Children and Youth Who Have Experienced Traumatic Events, a fact sheet by SAMHSA, provides an overview of childhood trauma and behavioral health. 

The Poverty Clinic profiles pediatrician Nadine Burke-Harris’ work with San Francisco youth who have experienced trauma and psychological distress, using the Adverse Childhood Experiences (ACE) score (New Yorker 21 March 2011).

The American Academy of Child and Adolescent Psychiatry’s Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder reviews the evidence from research and clinical experience and highlights significant advances in the assessment and treatment of posttraumatic stress disorder. It presents evidence to support trauma-focused psychotherapy, medications, and a combination of interventions in a multimodal approach.

For more information, visit our trauma page.


Other Resources

Alcohol Screening and Brief Intervention for Youth - Online Course 
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, produced a new course jointly with Medscape, a leading provider of online continuing medical education.The course presents three engaging case scenarios of youth at different levels of risk for alcohol-related harm. The scenarios illustrate a streamlined, 4-step clinical process outlined in Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. NIAAA produced the guide in 2011 in collaboration with the American Academy of Pediatrics (AAP), which recommends screening all adolescents regarding alcohol use. CME/CE credits are available at no charge. Access to the CME course requires a username and password, which users can set up for free. For more information, contact CME@medscape.net

The National Technical Assistance Center for Children's Mental Health works with states, tribes, communities at the policy level and offers a range of opportunities, publications, and resources to assist them in adopting new policies. NTAC provides the leadership, knowledge base, training and technical assistance to the field to build comprehensive community service delivery systems for children with mental health and/or substance abuse needs, and their families.

The Administration for Children and Families, in collaboration with many agencies including SAMHSA, created Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care. The guide—written specifically for youth in foster care with input from youth and professionals—includes useful information, questions to ask, worksheets, tips on considering your options, and making decisions about how to stay healthy.

A report from the Commonwealth Fund, State Case Studies of Infant and Early Childhood Mental Health Systems: Strategies for Change, examines states’ early identification and intervention models for children with mental illness, and offers suggestions to improve financing.

A report from the Detroit-Wayne County Community Mental Health Agency is a good example of a local system’s strategy, and reviews best practices and provides recommendations for creating integrated care services for children and youth.

Call Our Helpline: 202.684.7457

Children and Youth

Planning and delivering integrated primary and behavioral healthcare services for children and youth has unique considerations from providing care for adult populations. By implementing integrated care systems, your organization can position itself to have the greatest impact on the whole health of children, adolescents, their families, and your communities. CIHS reviews the latest resources and research related to integrated care for children and youth, and compiles the most helpful resources, below.



from cihs 

Integrating Behavioral Health and Primary Care for Children and Youth: Concepts and Strategies provides robust information on models of organizing service delivery for youth, five core competencies of integrated care systems for children with behavioral health problems, and financing mechanisms that support integrated care systems for children with behavioral health problems. This report is designed specifically for community behavioral health and health centers to learn an approach to delivering care that comprehensively addresses the primary care, specialty care, and social support needs of children and youth in a continuous and family-centered manner. For a quick highlight of the key topics discussed in the paper, view the overview.


RESOURCES
Integrating Behavioral Health into Primary Care

The Bright Futures Tool and Resource Kit, from the American Academy of Pediatrics, has materials for health supervision care for infants, children, and adolescents. Materials include practice management tools, documentation forms, screening forms, and information for parents and patients to reinforce topics discussed during pediatric visits. Materials are available for download and certain forms can be incorporated into electronic health record systems. Bright Futures, a national health promotion initiative from HRSA, is dedicated to the principle that every child deserves to be healthy and that optimal health involves a trusting relationship between the health professional, the child, the family, and the community as partners in health practice.

Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit is a resource from the American Academy of Pediatrics’ Task Force on Mental Health to provide primary care clinicians guidance in enhancing mental health care, including some substance use conditions. The toolkit, available for purchase from AAP, recommends eliciting family concerns at every visit, using routine screening with a common factors approach and motivational interviewing techniques.

Integrating Mental Health in Pediatric Primary Care Resource Center, from the National Alliance on Mental Illness (NAMI), provides materials for families and primary care providers on integrated healthcare. Materials include a report of a family survey regarding their experiences with primary care, brochures to explain what integrated care is and how it works for families, and information for providers on how to create a primary care setting that is more welcoming to conversations about mental health.

Screening, Triage, and Referral of Patients Who Report Suicidal Thought During a Primary Care Visit, a study in Pediatrics, found that pediatric primary care is a feasible setting to screen for suicidal ideation in youths and link them with mental health services and describes successful strategies for overcoming barriers. The study includes a downloadable chart on the care-coordination process if a client shows suicidal ideation as a result of the screen.

Suicide and Self-Injury Among Children and Youth With Chronic Health Conditions examined the association between chronic conditions and suicide risk. The study found that chronic physical conditions are associated with a slightly elevated risk for self-harm, suicidal thinking, and attempted suicide; chronic mental conditions are associated with an increased risk for all 3 outcomes; and co-occurring disorders present additional elevated risk.

Alcohol use is a major problem from preadolescence through young adulthood in the U.S. Alcohol Use by Youth and Adolescents: A Pediatric Concern outlines the policy statement of the American Academy of Pediatrics on the integration of alcohol use prevention and treatment in primary care.

Evaluation of the PHQ-2 as a Brief Screen for Detecting Major Depression Among Adolescents examined the validity of the Patient Health Questionnaire 2 (PHQ-2), a 2-item depression-screening scale, among adolescents. Authors found that the PHQ-2 has good sensitivity and specificity for detecting major depression, making it a promising first step in screening for adolescent depression in primary care. 

One Location, One Visit describes a model for integrating behavioral health services into pediatric primary care. The integration process is divided into six sections: education of stakeholders; identifying specific site logistics; developing integrated procedures; adjusting workflow; evaluating integration procedures; and replicating as necessary. For more information on this guide, reach out to Michelle Duprey at Starfish Family Services.


Health Homes

Best Principles for Integration of Child Psychiatry into the Pediatric Health Home presents a framework for integrated Pediatric Health Homes based on levels of severity and complexity of a child’s mental health needs. 

Customizing Health Homes for Children with Serious Behavioral Health Challenges
examines specific policy and practice considerations for states when developing Medicaid health homes for children with serious behavioral health challenges. 

Medical Home Innovations: Where do Adolescents Fit?
presents findings from interviews conducted with senior leaders of 12 medical home programs across the country, focusing on how the model has benefitted adolescents thus far and what challenges remain.

For more information, visit our health homes page.


Children and Trauma

Helping Children and Youth Who Have Experienced Traumatic Events, a fact sheet by SAMHSA, provides an overview of childhood trauma and behavioral health. 

The Poverty Clinic profiles pediatrician Nadine Burke-Harris’ work with San Francisco youth who have experienced trauma and psychological distress, using the Adverse Childhood Experiences (ACE) score (New Yorker 21 March 2011).

The American Academy of Child and Adolescent Psychiatry’s Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder reviews the evidence from research and clinical experience and highlights significant advances in the assessment and treatment of posttraumatic stress disorder. It presents evidence to support trauma-focused psychotherapy, medications, and a combination of interventions in a multimodal approach.

For more information, visit our trauma page.


Other Resources

Alcohol Screening and Brief Intervention for Youth - Online Course 
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, produced a new course jointly with Medscape, a leading provider of online continuing medical education.The course presents three engaging case scenarios of youth at different levels of risk for alcohol-related harm. The scenarios illustrate a streamlined, 4-step clinical process outlined in Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. NIAAA produced the guide in 2011 in collaboration with the American Academy of Pediatrics (AAP), which recommends screening all adolescents regarding alcohol use. CME/CE credits are available at no charge. Access to the CME course requires a username and password, which users can set up for free. For more information, contact CME@medscape.net

The National Technical Assistance Center for Children's Mental Health works with states, tribes, communities at the policy level and offers a range of opportunities, publications, and resources to assist them in adopting new policies. NTAC provides the leadership, knowledge base, training and technical assistance to the field to build comprehensive community service delivery systems for children with mental health and/or substance abuse needs, and their families.

The Administration for Children and Families, in collaboration with many agencies including SAMHSA, created Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care. The guide—written specifically for youth in foster care with input from youth and professionals—includes useful information, questions to ask, worksheets, tips on considering your options, and making decisions about how to stay healthy.

A report from the Commonwealth Fund, State Case Studies of Infant and Early Childhood Mental Health Systems: Strategies for Change, examines states’ early identification and intervention models for children with mental illness, and offers suggestions to improve financing.

A report from the Detroit-Wayne County Community Mental Health Agency is a good example of a local system’s strategy, and reviews best practices and provides recommendations for creating integrated care services for children and youth.

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