Pediatrics pushes collaboration

Pediatricians are being urged to treat child mental health less like a handoff and more like a team sport with psychiatrists, therapists, and care coordinators. (psychiatrictimes.com) A June 29, 2023, Psychiatric Times continuing-education article by Dr. Mary Margaret Gleason and Dr. Elise Fallucco said pediatric practices can use “coordinated,” “co-located,” or fully integrated models instead of sending families into a separate specialty system. The piece framed those models as a response to a shortage of child psychiatric clinicians and to untreated behavioral health needs that often show up first in primary care. (psychiatrictimes.com) The basic idea is simple: a pediatrician keeps seeing the child for routine care while a mental-health specialist helps with assessment, brief treatment, medication advice, and referrals. A 2023 American Academy of Child and Adolescent Psychiatry clinical update said collaborative care ranges from loose coordination to one multidisciplinary team working inside primary care. (jaacap.org) That push comes as the need keeps rising. Federal survey data show more than 5.3 million adolescents ages 12 to 17 — 20.3% of that age group — had a current diagnosed mental or behavioral health condition in 2023, up 35% from 15.0% in 2016. (mchb.hrsa.gov) The same 2023 federal brief found anxiety was the most common diagnosis at 16.1%, followed by depression at 8.4% and behavior or conduct problems at 6.3%. It also estimated that 20.9% of adolescents needed treatment or counseling from a mental-health professional in the prior year, whether or not they had a formal diagnosis. (mchb.hrsa.gov) Among high school students, the Centers for Disease Control and Prevention said worsening mental health predated the pandemic and remained a national concern in its November 29, 2024 update on the 2023 Youth Risk Behavior Survey. The agency said female students and lesbian, gay, bisexual, transgender, and questioning students were more likely to report persistent sadness or hopelessness and suicide attempts. (cdc.gov) The pediatric case for collaboration is partly about where families already are. The American Academy of Pediatrics said in its mental-health guidance that pediatricians have long-term, trusted relationships with children and families and should build ties with mental-health specialists, school providers, and social-service agencies. (healthychildren.org) The American Academy of Child and Adolescent Psychiatry review said integrated care has the strongest evidence among these models for improving clinical outcomes and patient satisfaction while holding down costs. The same review said the hardest parts are reimbursement, limited training, lack of specialist backup, and the continuing shortage of specialty care for severe cases. (jaacap.org) The federal government has already built one version of that backup system. The Health Resources and Services Administration says its Pediatric Mental Health Care Access program now has 54 programs reaching 46 states, the District of Columbia, several territories, and tribal and Pacific jurisdictions with phone consultation, training, and care coordination for pediatric clinicians. (mchb.hrsa.gov) In practice, the thread running through all of these models is speed and proximity: help the pediatrician manage common mental-health problems early, and reserve scarce specialists for the most severe and complex cases. That is the same logic the Psychiatric Times article used when it argued that child mental-health care works better when the medical and behavioral sides stop operating in parallel. (psychiatrictimes.com)