Checkup e-news: January 2010
Physician Advisor Joins TeenScreen
From the Field
Tools and Resources
John H. Genrich, M.D., a pediatrician from Colorado Springs, Colo., joins TeenScreen this month as its new Physician Advisor.
In this role, Dr. Genrich will liaise with primary care providers across the U.S. to offer guidance on offering mental health checkups to adolescents in a primary care setting.
Dr. Genrich treats adolescents in his practice. He has found that offering a mental health checkup as part of a teen’s regular health assessment is easy to do and effective in identifying youth at risk for depression and other mental illnesses. He will share best practices on how to incorporate mental health checkups into practice as part of his new TeenScreen post.
Dr. Genrich also will speak publicly about mental health checkups at policy briefings, webinars, and through media interviews.
Webinar: “Offering Mental Health Checkups in Primary Care
”Mon. Feb. 8, 12 p.m. (EST): TeenScreen Physician Advisor, John Genrich, M.D., will present a webinar for medical professionals on the process of administering a mental health checkup in an adolescent health care setting. Dr. Genrich will share practical tips on offering and scoring screening questionnaires, follow-up evaluation and setting up a referral system.
The event will take place from 12 p.m. to 1 p.m. Primary care providers including physicians, nurse practitioners and nurses, practice office staff, and other adolescent health professionals may register at: https://www323.livemeeting.com/lrs/8002049490/Registration.aspx?pageName=52ktd4n4v4khcnbv.
23rd Annual Children’s Mental Health Research & Policy Conference
Mar. 7-10: The University of South Florida Department of Child and Family Studies will host its yearly conference for professionals in the field of youth mental health. This year’s event will recognize the 25th anniversary of federal support for systems of care for children with serious emotional disturbances. Early registration with reduced fee closes Sunday, Jan. 31, 2010.
From the Field
Investigators at Children’s Hospital of Philadelphia (CHOP) have developed and validated a web-based behavioral health screening tool (the BHS) for adolescent ambulatory medical settings. With grant funding, they have implemented the tool in the Emergency Department (ED) at CHOP and in several primary care practices in northern Pennsylvania.
Medical settings such as these provide key opportunities for the early identification of psychiatric illness in youth. Research at Cincinnati Children’s Hospital Emergency Department has shown that 40 percent of teens who come in exhibit symptoms of mental illness severe enough to impact daily activities. In primary care settings, approximately two in three depressed adolescents are not identified and do not receive any type of care, according to a 2006 review published in Behavior Modification.
The BHS initiatives are run by Joel Fein, M.D., M.P.H., a pediatric emergency medicine physician at CHOP and director of the Philadelphia Collaborative Violence Prevention Center, and Guy Diamond, Ph.D., a clinical psychologist and director of CHOP’s Center for Family Intervention Science.
The BHS was developed for adolescents and young adults, ages 12 to 24. It covers a range of risk behaviors and psychiatric problems. The full BHS assesses 12 domains: medical, school, family, safety, substance use, sexuality, nutrition and eating, anxiety, depression, suicide, psychosis and trauma/ abuse. The ED version has fewer scales so that it can be delivered in a more expedient manner. Patients complete the screening on their own in the waiting or exam room. The web-based program then scores the data and generates a report for providers to review before meeting with the patient. The data can be integrated with electronic medical records and aggregate reports are available at the office or hospital level.
In a feasibility study in the CHOP ED, nurses and medical technicians were trained to administer the BHS-ED. After research staff support was removed, one-third of eligible ED patients were approached by clinical staff for the BHS-ED. The project in primary care focuses on similar transportability and feasibility challenges with additional attention to linkages with local mental health services. These are among the first projects to test screening as a standard of care that is delivered by clinical staff instead of research staff following a protocol. Drs. Fein and Diamond said that both their projects have shown great promise, but that further progress is needed.
“To reach full potential,” said Dr. Fein. “There has to be system-wide change. Mental health screening needs to become a billable, standard of care. Widespread implementation can help reduce stigma and increase quality of care.”
“The integration of mental health services into medical settings is a national imperative,” added Dr. Diamond. “Ambulatory settings are already inundated with patients displaying behavioral health problems, but providers often lack the skills, tools, and support to care for these patients.”
Next steps for BHS include developing engagement strategies that will increase successful referrals and expanding the technology to assist with cross system communication between medical and behavioral health providers. Several papers under review describe the validity and usage of the BHS.
The Public Broadcasting Service (PBS) is airing a national three-part series this month on emotional health called This Emotional Life. Daniel Gilbert, Ph.D., Harvard University psychology professor and author of Stumbling on Happiness, narrates an exploration of the struggles and triumphs of individuals who grapple with the complexities of their mental health every day. A Part 2 profile highlights the intractable depression of Caitlin, a high school student who has suffered from the mood disorder since the eighth grade.
“Human beings change a great deal during adolescence, so while somebody is struggling with depression, they’re unable to make the social gains, the intimacy gains, the academic gains that are so necessary when somebody is developing from adolescence to a young adult. It essentially robs people of their lives,” said Caitlin’s doctor, Child and Adolescent Psychiatrist Sheila Marcus, M.D., from the University of Michigan. “The problem with letting depression linger is we know that there are subtle changes in the brain such that it’s an illness that becomes harder to treat as you let it take its course.”
Caitlin’s story underscores the need for early identification of depression and other mental health disorders so that treatment can promptly begin and young people can be given the best chance for a healthy future.
Today’s youth are five times as likely to suffer from anxiety, depression, and other mental health issues than their Great Depression era counterparts, according to a recent San Diego State University Department of Psychology study.
Researchers analyzed responses to the Minnesota Multiphasic Personality Inventory (MMPI) from 77, 576 high school and college students between 1938- 2007. There was an overall increase in the number of participants who indicated symptoms of a mental health disorder, including depression, which rose from one to six percent. The study will be published in a future issue of the Clinical Psychology Review.
Jean Twenge, Ph.D., the study’s first author cites the increasing influence of popular culture, growing expectations for financial success and pressure to succeed, as possible reasons for this increase. Researchers also hypothesize that growing divorce rates and instability in families might also be an underlying factor.
“It’s another piece of the puzzle — that yes, this does seem to be a problem, that there are more young people who report anxiety and depression,” said Twenge in an interview with the Associated Press. “The next question is: What do we do about it?”
Further studies will seek to determine contributors to this increase and elucidate potential implications for improving mental health counseling and treatment.
Senate Health Care Reform Bill Includes Access to Mental Health Checkups With passage of the Senate health reform bill on Dec. 24, 2009, broader access to early identification of mental illness for adolescents is one step closer to becoming a reality. While differences between the House and Senate bills are expected to be resolved in the coming weeks, both proposals contain similar language requiring that health plans participating in the health exchange provide access to annual mental health checkups for teens. “This is a sign of real progress in the effort to promote timely detection of mental health disorders among our nation’s youth,” said TeenScreen Executive Director Laurie Flynn.
NIMH Survey: Higher Rates of Mood Disorders in Adolescents; Half Go Untreated
Results from the National Health and Nutrition Examination Survey (NHANES) show that adolescents ages 12 to 15 are more than twice as likely to suffer from mood disorders, such as major depression, than 8 to 11-year-olds. Only half of these adolescents have been seen or been treated by a mental health professional. This data from the National Institutes of Mental Health was reported in the December 2009 issue of Pediatrics.
Higher rates of mental illness in teens is not surprising considering previous research in the Archives of General Psychiatry which noted that 50 percent of all lifetime mental disorders begin by age 14.
The study provides the first estimates of the prevalence of child and adolescent psychiatric illnesses in the U.S. population. “Data from the NHANES survey can serve as an important baseline as we follow trends of mental disorders in children,” said National Institute of Mental Health (NIMH) Director Dr. Thomas R. Insel to HealthDay News.
According to NHANES, 3.9 percent of 12 to 15-year-olds surveyed reported that they suffer from mood disorders and 3.2 percent suffer from major depression. Overall, 11.5 percent of adolescents suffer from a psychiatric disorder. Girls who responded to the survey reported double the rate of mood disorders than boys reported. Researchers also found that, of those diagnosed with a mental disorder, only 55 percent had received mental health care or treatment, with numbers even lower for minority youth.
“Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth,” said the Pediatrics paper’s lead author Kathleen Ries Merikangas, Ph.D., senior investigator and chief of the epidemiology research branch of NIMH. “When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth.”
The Baltimore school system has made great strides in providing mental health screening and services to adolescent students in its district, according to a review of the city’s school-based mental health initiatives by the University of Maryland’s Center for School Mental Health.
One hundred and five schools (55 percent) now offer school mental health programs, according to the review report published in the January 2010 issue of Psychology in Schools.
Baltimore’s success in widely implementing interventions in a large urban school district shows potential for school administrators and parents to work together in bringing similar measures to communities across the U.S.
The reviewers held up one Baltimore program as exemplary – the Excellence in School Mental Health Initiative (ESMHI). ESMHI has shown particular success in enhancing support and services in two schools that serve youth.
ESMHI uses a four-tiered approach for improving mental health services. The initiative emphasizes:
- Engagement among students, parents, community members and school personnel;
- Universal prevention methods like school wide problem solving workshops;
- Selective prevention with cognitive behavioral lessons for at-risk adolescents transitioning into middle school; and
- Indicated or individual prevention with targeted interventions for those exhibiting behavioral need.
These are many of the same techniques recommend by the Institute of Medicine/National Research Council 2009 Report, Preventing Mental, Emotional and Behavioral Disorders Among Young People. The report highlights the “considerable potential of school-based intervention” and encourages support for programs that have the ability to improve long-term outcomes for at-risk youth.
ESMHI and the Baltimore City School systems continue to make improvements in providing early identification and risk prevention for their students. In recognizing the competing demands of school staff and frequent changes in district leadership, the programs seek to expand training for teachers and other school personnel. This will also help to spur advocacy among invested players such as parents and community members and strengthen the infrastructure and processes that support these efforts.
Tools and Resources
AAP’s Bright Futures Offers Guidelines, Tools for Pediatric Primary Care
The American Academy of Pediatrics (AAP) has made available its Bright Futures Tool and Resource Kit to assist providers in making the most efficient use of child and adolescent health care visits and streamlining key aspects of the visit, such as mental health screening.
By making such assessments a more regular piece of adolescent health, health care professionals have the ability to detect symptoms of mental disorders in teens early—helping to curtail the long-term consequences of mental illness.
| The Tool Kit includes:
The Tool and Resource Kit serves as a companion to best practice techniques found in the Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, 3rd Edition.
The AAP recommends routine mental health screening for all ages including 11 to 21-year-olds. They recommend use of screening assessment tools specifically designed for adolescents. Through its Bright Futures program, the AAP outlines guidelines for addressing mental health with teens and their families and incorporating screening and referral as a regular part of health care.
The AAP’s Bright Futures program is a set of principles, strategies and tools that are theory based and systems oriented and can be used to improve the health and well-being of all children through age and culturally appropriate interventions.
Adolescent Screening Tools, USPSTF Recommendations Go Mobile
The Agency for Healthcare Research and Quality (AHRQ) has made key resources on mental health screening available to health providers on their iPhones, BlackBerries, Palms and other personal digital assistant (PDA) devices. The Electronic Preventive Services Selector (ePSS) is an application developed to assist primary care providers in easily identifying age-appropriate recommendations and screening tools for their patients through handheld, mobile electronics.
AHRQ designed this initiative in response to low rates of preventive screening, as well as the recognition that primary care providers and their busy schedules necessitate quick, practical ways to access expert guidelines and tools.
The program is also available online and is based on recommendations from AHRQ’s U.S. Preventive Services Task Force, including those on adolescent depression screening. Suggested available resources include links to validated screening tools including the Beck Depression Inventory, CRAFFT, CES-D, PHQ-A, and PHQ-9.
For more information on downloading the ePSS applications, visit: http://epss.ahrq.gov/PDA/index.jsp.
The Bright Futures guidelines and tool kit can be ordered through the AAP Bookstore for $325 ($275 for AAP members).