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As we begin to navigate our way through year 3 of the COVID-19 pandemic, it's time to question whether mental and behavioral concerns have been ignored.
The title for the March 2022 edition of Contemporary Pediatrics, says it all: Children’s Mental Health Crisis…We can’t ignore it anymore. Have we, as pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs) who care for children and their families, been ignoring mental/behavioral health problems? PNPs and FNPs can make a difference in the mental and behavioral health as we begin to navigate our way through year 3 of the COVID-19 pandemic. I highly recommend that every PNP and FNP read the special report on mental health and the 4 articles on behavioral health for the pediatric and adolescent populations and ask these critical questions: 1.) What must I know to diagnoses and treat children and adolescents presenting with mental/behavioral health problems? 2.) What can my practice do to identify, diagnose, and treat children and adolescents who are presenting with mental/behavioral health problems?
Screenings shine the light on mental and behavioral health problems
PNPs routinely screen for mental and behavioral health problems from an early age using a variety of age-appropriate evidence-based screening tools. In addition, PNPs screen parents and caregivers for adverse childhood events (ACEs)1,2 which help identify parents and/or caregivers who were exposed to ACEs during their childhood that may affect their parenting style.
In their article, “Screening adolescent for psychosocial concerns,” Dr. Michael Jellinek and co-author Talia Benheim discuss implementation of evidence-based screening tools for adolescents with an emphasis on identifying depression by using a tool that includes a measure for possible depression. During these stressful times, it is important to not only use the recommended tools routinely in clinical practice but to also analyze the results in relation to the responses to history questions. PNPs and FNPs may have known parents, children, and adolescent well before the start of the pandemic and previously documented a well-adjusted family, but today must recognize that all of the pandemic adversities may have totally altered family dynamics as well as the mental and behavioral health of children and adolescents.
The loss of a parent of caregiver
Another overwhelming concern is the article authored by Dr. Candice Jones, “Helping children grieve the loss of a caregiver due to COVID-19.” A significant number of children have lost a parent or caregiver over the past 2 years due to COVID-19. The question PNPs and FNPs must ask themselves is: “Am I prepared to talk with a child or adolescent about their loss and have a meaningful conversation about their personal feelings while providing guidance that will be helpful to the child or adolescent?” These are difficult conversations and require thoughtful preparation that is not the usual norm for pediatric practices. PNPs and FNPs can also access school-based resources for the child and adolescent by referring to school-based social workers or psychologists that are experienced with working with children who have experienced the loss of a parent. Dr. Jones provides recommendations for improving communication and recognition of grief and ways to help children and adolescents develop positive coping skills.
Mitigating the mental health crisis
The article, “How pediatrician can help mitigate the mental health crisis,” by Dr Janine A. Rethy and Dr. Elizabeth M. Chawla asks what pediatricians can do to advocate for change? The authors present several valuable suggestions in which pediatricians ‘care for the whole patient.’ Likewise, PNPs and FNPs need to ask the same question as well as analyze their practices to determine if, at present, they are meeting the totality of both physical and mental/behavioral health needs of children and adolescents or if change is needed to achieve a goal of meeting these needs. PNPs and FNPs who have provided care to children in primary care practices and to children and adolescents who present with mental and behavioral health needs can take a certification examination to be recognized as a Pediatric [primary care] Mental Health Specialist (PMHS).3 This recognition provides opportunities for PNPs and FNPs to offer an integrated approach to primary care in which a child/adolescent can receive their primary care and also schedule an appointment to talk with a PNP or FNP who holds the PMHS credential about their personal mental or behavioral health problems. This is also an opportunity to make referrals for children and adolescents who need additional services to help resolve their problems.
It is more than time for PNPs and FNPs to join the advocacy movement to improve the mental and behavioral health of children and adolescents who have been adversely affected by the COVID-19 pandemic. The pandemic has upended their world, including but not limited to their routines, the comfort and security of their homes, their friendships, their socialization, their feelings and emotions, their participation in recreational and competitive sports, and their abilities to interact in ways that support normal growth and development. Take time to consider the impact of the pandemic on our children and adolescents. Establish practice goals to help pediatric patients and their families emerge from the pandemic with mental and behavioral health tools to go forward strong, confident, and as leaders making a positive impact in the ‘new norm.’
1. Stop Abuse Campaign Corp. What does your ACE score mean? Adverse Childhood Experience. (2022). Retrieved March 21, 2022 https://stopabusecampaign.org/take-your-ace-test/what-does-your-ace-score-mean/
2. National Center for Injury Prevention and Control, Division of Violence Prevention. Adverse Childhood Experiences (ACEs). Reviewed April, 2, 2021. Accessed March 21, 2022 from https://www.cdc.gov/violenceprevention/aces/
3. Steps to PMHS Certification. Pediatric Primary Care Mental Health Specialist exam information. Accessed March 21, 2022 from https://www.pncb.org/pmhs-certification-steps