Screening is critical to identify behavioral and mental health problems

Mental health is a critical component of pediatric overall health. Early recognition of subtle signs and symptoms of mental health problems followed by immediate treatment is an equally critical element to ensure the establishment of normal mental health throughout development.¹

This issue of Contemporary Pediatrics contains articles on mental health over the continuum of the pediatric population, beginning with prenatal development. Drs. Bass and Bauer present an overview of the adverse effects of postpartum depression (PPD) on the mother and infant. Ms. Nierengarten presents on the need to screen new fathers for PPD. An article by Drs. John and Schuman describes insightful ways to include the integration of mental health services, including telepsychiatry, within pediatric practices.

Are you practicing using an integrated primary care/behavioral health model?

The statistics reveal how many children have behavioral health problems and the lack of mental health providers supports an integrated model of practice. Thus, the questions become, how many nurse practitioners (NPs) are using integration of mental health services in their pediatric primary care clinical practices, and how many are educationally prepared to integrate these services?

To date, no data are available on the number of NPs who practice using an integration model for mental health services in their practices. The Pediatric Nursing Certification Board (PNCB) offers an examination that “addresses the need to strengthen care to children and families experiencing developmental, behavioral, and mental health care concerns” with data available on their website about the need for certification and the numbers of NPs who are currently certified, and ways to achieve certification.

Screening is critical for identification of behavioral health problems

The foundation for NP pediatric practices is grounded on the implementation and interpretation of valid and reliable screening tools, with immediate corrective strategies to address and reverse problems often using shared decision-making with parents for young children and directly with school-aged children, adolescents, and their parents.

The American Academy of Pediatrics recommends screening for PPD at the 1-, 2-, 4-, 6-, and 12-month visits to identify at-risk women and provide referral for treatment. This strategy is so essential for the normal social-emotional development of infants,¹ which is a major goal for all pediatric primary care practices. Are you using the recommended Edinburgh Postnatal Depression Scale (EPDS)² to screen for PPD? Additionally, are you using the age-appropriate screening tools to screen all children in the practice for well-known behavioral problems?

As previously mentioned, early identification of problems is critical to changing known adverse trajectories when problems are not identified in a timely manner and no interventions are implemented. Are you practicing on the forefront of integrating pediatric primary and behavioral/mental health care? 

References:

1. Hallas D. Behavioral Pediatric Healthcare for Nurse Practitioners. A Growth and Developmental Approach to Intercepting Abnormal Behaviors. New York: Springer Publishing Company; 2018.

2. Thombs BD, Benedetti A, Kloda LA, et al. Diagnostic accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for detecting major depression in pregnant and postnatal women: protocol for a systematic review and individual patient data meta-analyses. BMJ Open. 2015;5(10):e009742.