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We’re Proud to be at NAPNAP: Working with Pediatric Nurse Practitioners

Posted on March 30, 2012 by Laurie Flynn

Adolescent mental health needs are growing, but there are too few mental health professionals to meet the demand. Patients and their parents are turning to primary acre for help, and practices are now on the front lines of teen mental health care.

National Association of Pediatric Nurse Practitioners President-elect Susan Van Cleve, DNP, CPNP-PC has said that the “Integration of mental health into pediatric primary care is essential if we are to treat our children and teens in a holistic way. The need is great and the time is now for providers and practices to make changes so our nation’s children can be treated appropriately.”

We could not agree more. With their focus on preventive care, patient management and follow-up, nurse practitioners are well-suited to help drive this practice initiative. We are proud to be partnering with NAPNAP on issues of adolescent mental health. Our joint webinar drew hundreds of attendees, and we’re proud to be speaking this week at NAPNAP’s 2012 Conference. Our Primary Care Program Manager Christina Newport is joining Patricia Jackson Allen, RN, MS, PNP, FAAN of NAPNAP, Yale University School of Nursing to discuss the prevalence of mental illness in adolescents, risk factors related to mental disorders and suicide and how screening can help identify mental health issues.

It is because the majority of teens get their health care at the primary care office that we are committed to offering providers information and resources that can support them in incorporating screening into their adolescent practice.

For more information on how primary care providers can help to help improve early detection of mental illness, check out our resources.

Posted in Depression Screening, Mental Health | Tagged , , | Leave a comment

Health Care Reform, the Supreme Court, and Teens

Posted on March 27, 2012 by Laurie Flynn

The Supreme Court has begun taking up the legal questions around the Affordable Care Act – health care reform. And, we are again reminded of the volatility of the health care policy debate and the very real impact of health law on our young people.

In a statement on the pending decision, the American Academy of Pediatrics (AAP) was unequivocal in its support of the Affordable Care Act (ACA).

“This law has already helped maintain or improve access to preventive services for more than half of America’s children,” said AAP Immediate Past President O. Marion Burton, MD, FAAP, who spoke at a news conference in front of the Supreme Court. “As the Supreme Court hears arguments this week for and against the ACA, remember the reality that pediatricians see every day: This law has already begun to help millions of Americans, and in particular, children.”

Dr. Burton also stated the facts: The ACA is ensuring better access to vital health services, age-appropriate benefits and affordable health insurance coverage for millions of children, adolescents and young adults. These benefits provide critically important developmental and behavioral screenings free of co-pays, including coverage for adolescent mental health screenings.

The value of preventive mental health screenings cannot be overstated. Research tells us that mental disorders typically develop by age 14. By removing financial obstacles, we can promote greater access to screening, identify more problems early, and reduce the enormous health burden of these illnesses on our young people.

This information, and more, can be found on the new Policy section of our website. With an eye towards bringing some clarity to a confusing, and polarizing debate, we revamped this section to make it easier to find the information you need on adolescent mental health policy, when you need it. Our Fact Sheets, White Papers, and Case Studies offer summaries and key information on health reform, adolescent suicide prevention, health care delivery, mental health parity and screening.

Health policy may indeed be complex, but its impact on our young people is very straightforward. The ACA safeguards and protect the health of our children, shaping and defining access to services they need to grow into healthy and productive adults.

Like our colleagues at AAP, we share the hope that the health and well being of our young people will not be forgotten in the midst of this momentous decision.

Posted in Health Reform, Mental Health, Screening, Teen Depression, Teen Suicide | Tagged , , , | Leave a comment

Dying Young: Can we help people with mental illness live longer?

Posted on March 26, 2012 by Laurie Flynn

At TeenScreen National Center, we’re working hard to prevent the disability and death that can result from unrecognized and untreated psychiatric illness. We know that screening can help identify mental health problems early and may prevent the development of a full-blown mental disorder. And, we’re committed to making sure that all teens have access to a mental health screening and receive the treatment that they need. But there is a disturbing set of facts that challenges us.

Did you know that people with serious mental illness like depression, bipolar disorder and schizophrenia are dying 25 years earlier than the average American? And they aren’t dying of suicide, but rather heart disease, cancer, diabetes. This troubling fact has been well documented, most recently in a 2006 survey of medical directors of State Mental Health Programs.

This is a public health crisis, but for me it is also personal. My daughter is among those with a serious mental illness. Her disorder is being treated effectively, but I am forever concerned about how her mental disorder can impact her lifespan. There’s a lot we don’t know about why people like my daughter are so much more likely to die before their time. But, it’s clear we need focused research to better understand what causes this situation and how to change it.

The best epidemiological estimates indicate that far from being rare, the 12 month prevalence of serious mental illness among adults is 5.8 percent or 1 in 17 people. National Institute of Mental Health (NIMH) director Tom Insel has stated that people with mental illness in this country have the same life expectancy as a citizen of Bangladesh!

I joined small group of mental health leaders who met with National Institutes of Health (NIH) director Dr. Francis Collins and the directors of four other key federal research institutes—the National Institute on Drug Abuse (NIDA), the National Heart, Lung and Blood Institute (NHLBI) and the, the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK). These research leaders — along with Dr. Insel– listened to our concerns and agreed to consider our request for action. As a first step, we want to see NIH lead the way in developing a cross- institute collaborative research agenda. Since mental illness is not the reason our people are dying young it makes no sense for only NIMH to study this problem. What is the interaction between depression and cardiac illness? Why does psychosis treatment make some patients more vulnerable to diabetes? Dependency on substances including nicotine and alcohol is very common among persons struggling with a psychiatric illness but little is known about why this is true. Just as we need to learn more about the basic science underlying co-morbidity, we also must invest in clinical research to improve the treatments and medications needed to treat people successfully. And in a fast changing health care system, we must learn how to structure our interventions so patients access the full array of services and supports they need to maintain their health.

The brain controls every organ system in the body. But we haven’t studied what to do when a person with mental illness develops another serious disorder. At a time when we are moving to integrated health care we need a matching commitment to integrated research. I am heartened that our nation’s top research leaders heard the case for a new priority. Now I’m waiting for action. My daughter’s life depends on it.

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Why I Use TeenScreen: A Pediatrician’s Story

Posted on March 22, 2012 by John Genrich MD

I started using TeenScreen materials in 2009 after learning about the program through Kaiser Permanente Southern Colorado. Previously, I based my mental health assessment of patients on what I termed as the “hunch technique” – essentially using my gut to determine whether the child/adolescent may have a mental health disorder. I would ask a few questions, use my knowledge of that child and their family, and make a quick assessment. However, once we started regularly using the TeenScreen screening tools in practice. I realized that the “hunch technique” missed some who may have been suffering with depression or another mental illness.

For example, I had a 12-year-old patient that I had been seeing since infancy and know that she comes from a well-functioning family. Her mother brought her in because she noticed that she had been sleeping a lot. One of her hobbies was writing music, and lately, she hadn’t been able to finish a song. My staff gave her a screen (the PSC-Y) to fill out in the waiting room and much to my surprise, she checked ‘yes’ to the suicide ideation question. During the examination, I learned that her older sister – with whom she was very close – was about to leave for college. She felt all alone and was losing hope. In addition, she was having trouble in school. We treated her for depression and further assessment revealed that she was dyslexic, which she was treated for as well. So in addition to revealing her depression and suicide ideation, the screen helped us determine that she also had a learning disability.

Check our new Fact Sheet on the impact of adolescent mental health screening in primary care.

Another patient, a 14-year-old boy, came to see me with a minor sports injury. As is our standard practice, my staff gave him a screen (the PSC-Y) in the waiting room – and he checked ‘yes’ to thinking about suicide. I spoke to him about this and learned that he was drinking alcohol and smoking marijuana every day. And most disturbing, he had a precise suicide plan – he was very serious about it. I immediately referred him to a nearby therapist and he has been in therapy for more than a year now. As of our last appointment, he had stopped drinking and smoking marijuana. For me, this case again reinforced the value of screening: to find a very serious problem that is unrelated to the reason for the office visit.

As pediatricians, we see our adolescent patients just once a year – if we’re lucky – in our practices. And in this brief visit, we get only a quick flash into their life. Without the TeenScreen screening questionnaires, we’re missing opportunities. The screens save time and make communication more efficient. Having the answers to a screen helps direct conversations to the important points at hand. The questionnaires are easy to give – and teenagers seem to feel comfortable answering the questions because they’re given in a non-threatening manner (a self-report questionnaire filled out in the waiting room). There’s no one sitting across the table from them. And the fact that they’re confidential is something that my patients and their parents really appreciate.

Posted in Adolescent health, Depression Screening, Guest Blogger, Mental Health, Pediatricians, TeenScreen | Tagged , , , , | Leave a comment

The Unexpected Benefits of Mental Health Screening

Posted on March 16, 2012 by Laurie Flynn

More than half of all mental disorders begin by age 14, but the majority of teens struggle for years before their illness is diagnosed. During that time, symptoms can often worsen. Suffering continues, as does the risk of suicide. That’s why our focus at TeenScreen is the early identification of mental disorders. An annual screening can alert parents and providers of a possible mental health problem early, before symptoms are full blown.

But, parents and providers have told us that screening can offer other benefits, even when the results are negative and a teenager shows no indication of a mental disorder. By completing the screening questionnaire, teens have an opportunity to think about how they’re feeling — about themselves, their relationships with peers and family, and the responsibilities of school. They can respond to questions that they most likely have never been asked. The screening process can open up a conversation on topics that are often difficult to broach and hard to discuss.

In our latest video, TeenScreen Primary Care Program Director Christina Newport discusses how routine mental health screening can help teens, their parents, and providers in unexpected ways.

Posted in Depression Screening, Mental Health, TeenScreen | Tagged , , | Leave a comment

New Report: How we can improve teen mental health

Posted on March 15, 2012 by Laurie Flynn

When the Affordable Care Act (ACA) was signed into law in 2010, it was a policy advance with major implications for teens. Among its benefits was a renewed focus on prevention and early identification of serious mental illnesses. As we discuss in our new Trendell Health Forum Policy Report, the teen years are usually the healthiest time of life with regard to physical ailments. However, depression, anxiety, bipolar disorders and other mental health problems are common, with half of all cases emerging by age 14. Mental illness is the leading cause of disability for Americans 15 to 44 years of age. Fully 20 percent of adolescents have a diagnosable mental disorder.

One-quarter to one half of all visits to pediatric primary care providers now include behavioral, emotional, or developmental concerns. However, most primary care providers do not feel comfortable diagnosing and treating these disorders without additional training or support. A scarcity of mental health specialists makes referral difficult. The result? Most young people suffering with mental illness do not receive timely care.

Despite these challenges, health care innovations are making a difference, both for teens and the primary care providers that care for them. This report from our Trendell Forum, Bridging the Gap through Innovation: Expanding Access to Adolescent Mental Health Services, highlights these successful solutions.

A. Seiji Hayashi, MD, MPH, Chief Medical Officer of the Bureau of Primary Health Care, Health Resources Services Administration calls the integration of behavioral health and primary care a “game changer”. His colleague Barbara Edwards, Director of the Disabled & Elderly Health Programs Group Center for Medicaid, CHIP and Survey and Certification at the Centers for Medicare and Medicaid Services agrees. And so do we.

“People understand that if we’re going to have a sustainable health care delivery system, we have to do better care,” said Ms Edwards, “and one of the areas we have to pay particular attention to is the intersection of physical and behavioral health care.” Read more.

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Bipolar Disorder in Adolescents: Improving Diagnosis in Primary Care

Posted on March 14, 2012 by Laurie Flynn

It’s a scenario unfolding in primary care offices every day: An adolescent is brought in by his parents, who voice concern about mood swings. He’s either irritable and apathetic or impulsive and ‘high energy’. They wonder if he is using drugs and alcohol. They worry about his insomnia. They don’t know his friends or where he is much of the time. As for the teen, he says he “feels great, really great.” And so begins the provider’s challenge of determining exactly what could be going on, and whether the problem is bipolar disorder. It’s a particularly complex challenge, and one that has met with recent controversy.

Nearly 750 primary care providers joined Moira Rynn, MD, Deputy Director of Research in the Division of Child and Adolescent Psychiatry at Columbia University and Pamela J. Murray, MD, MHP, FAAP, Chief of Adolescent Medicine and co-chair of the Division of General Pediatrics and Adolescent Medicine at West Virginia University School of Medicine for Bipolar Disorder in Adolescents: What Primary Care Providers Need to Know, a webinar co-hosted by the TeenScreen National Center and the American Academy of Pediatrics.

“There has been a lot of controversy and concern about how this disorder is being diagnosed,” said Dr Rynn, noting the increased diagnosis and prescribing trends since the mid-1990s.

Among the clinical dilemmas facing the primary care provider are the ways in which bipolar can mimic other disorders. Symptoms of ADHD, for example, can overlap with those of bipolar disorder, said Dr. Rynn, but providers should be alert to the differences. Adolescent patients with bipolar, she said, typically exhibit elevated mood, grandiosity, racing thoughts, and hypersexuality, along with cycles of depression. And while both disorders can prompt symptoms of insomnia, teens with bipolar are not fatigued when they wake up. Similarly, they may be irritable, but the irritability is episodic and not from ADHD medication side effects.

Knowing these subtle differences can assist the primary care provider, as can the use of screening tools and careful listening, said Dr. Murray.

“Bipolar is one of the most highly familial of the psychiatric disorders that we know about”, she said. In addition to heredity, risk factors include psychiatric disorders, exposure to violence and sexual abuse, prenatal exposure to drugs, early puberty in girls, and the presence of other chronic diseases, such as epilepsy, inflammatory bowel disease and type 1 diabetes.

“Even though there are some legitimate concerns about whether some of the antipsychotic medicines may be over utilized in some situations, the big picture is still that bipolar spectrum disorder is probably both underdiagnosed and undertreated,” said Dr Murray. Untreated bipolar disorder can lead to underachievement and school failure, debilitating difficulties with peers and family, and highly risky behaviors that can lead to accidental injury and even death, she said. Collaboration between primary care providers and specialists can help improve diagnosis and prevent these consequences.

Posted in Adolescent health, Depression Screening, Mental Illness, Pediatricians | Tagged , , , , | 1 Comment

Teen Depression & Anxiety Disorders: How Can Primary Care Meet the Challenge?

Posted on March 12, 2012 by Laurie Flynn

It was the largest conference for pediatricians in the U.S., and Jefferson Prince MD, — instructor in psychiatry at Harvard Medical School, director of child psychiatry for the North Shore Medical Center in Salem, MA and medical director for the Center’s regional Massachusetts Child Psychiatry Access Project (MCPAP) — was speaking to a packed house.

His topic — how to recognize and manage depression and anxiety disorders in adolescents — was among the most popular at the American Academy of Pediatrics Annual Conference. It seemed to touch a nerve. Patient need and the scarcity of child and adolescent psychiatrists are converging in the primary care office, as parents seek mental health care for their teen from primary care providers.

Evaluating and treating the mental health concerns of youth demands a new set of primary care skills. Dr. Prince – a recognized expert in primary care/mental health collaboration – was taking on this emerging priority with a standing room only crowd eager for his insights on two of the most common mental health problems in adolescence.
We are so pleased that Dr. Prince will be our featured speaker for our March 20 webcast What Can I Do With All the Depressed or Anxious Teens in My Practice?: Practical Strategies for the Primary Care Provider. He’ll discuss the issues that matter: How to recognize and diagnose depression and anxiety disorders in teens, effective treatment strategies, the role of psychotherapy and ultimately, how to help patients regain a sense of themselves.

We hope you will join us for an insightful, skill-based hour of practical strategies you can begin to implement in your practice immediately.

Posted in Adolescent health, Mental Health, Pediatricians, Screening, Teen Depression | Tagged , , , , , , | Leave a comment

Inside TeenScreen: Why TeenScreen Works in Washington

Posted on March 8, 2012 by Laurie Flynn

Sound health policy can mean the difference between early identification of teen depression or years of needless struggle.

Our health policy office works to make sure legislators and health care stakeholders understand the importance of mental health screening for young people, and how access to screening can make an enormous difference in a teen’s life. Research shows that depression and other mental health problems are under-diagnosed and teens suffer the consequences. Left untreated, depression and other mental disorders increase the risk of school failure, substance abuse, and suicide.

As our health policy director Julianna Belelieu discusses, the passage of health care reform improves access to mental health screening for all teens by ensuring coverage for screening at the adolescent’s annual health check up. As the debate around health reform continues, we remain focused on protecting this essential benefit for our youth.

 

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Inside TeenScreen: We’re Parents Too

Posted on March 1, 2012 by Laurie Flynn

We’re parents. We know what it’s like to have a child in middle and high school. It can be exhilarating, hectic and sometimes just plain exhausting! That’s why we welcome those routine health checks that our teens get for hearing, vision or other health concern. Certainly, we expect them during our teen’s annual wellness visit with their primary care provider. Preventive screenings can alert us to problems we may need to address, or assure us that all is ok for now.

We also work at TeenScreen, where we’re dedicated to reducing the impact of one of the most prevalent of adolescent health concerns — mental illness. Depression, anxiety disorders and other mental health problems are among the most common, and these disorders typically emerge by age 14. We feel passionate about the ability for a routine mental health screening — either at school or at the primary care office — to identify such problems early so that teens can get the help they need.

Hear director of digital and social media content Pat Garrison discuss why incorporating mental health screening into adolescent health care matters to her and why she’s committed to making sure providers and parents learn more about why they matter.

Posted in Parenting, Screening | Tagged , , | Leave a comment

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    (c) 2003 TeenScreen® National Center for Mental Health Checkups at Columbia University