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Early Identification of Mental Health Problems Saves Lives


By: Dr. Jeff Bostic and Dr. Lisa Cullins

Scope of the Problem: At any given moment, about 1 in 5 children meet criteria for a mental health (MH) disorder, with anxiety disorders most common (13%), followed by ADHD (7%), and depression (3%). In DC, many youth contend with adverse childhood experiences, increasing their risk for mental illness. Locally, 26% of teens report feeling sad or hopeless and 13% of teens report having made a suicide attempt. Early identification and intervention of MH problems in children and adolescents can change life trajectories and save lives. Yet, a child waits an average of 8-10 years between onset of MH symptoms and receiving treatment, primarily due to a lack of access to services.  

Primary Care: Of those children who seek treatment only 20% use MH specialty services with the vast majority receiving treatment from their primary care providers (PCPs). Approximately 25-33% of primary care visits for children include significant MH concerns. PCPs remain the first-line providers, familiar and trusted by families, and likely to hear of emerging MH concerns in young people.  Often these concerns occur amidst an office medical visit for a sore throat or stomachache, positioning the PCP to address several concerns simultaneously.  The PCP is often in the difficult role of trying to prioritize various concerns while discerning the nature and severity of the problem described by a family. 

Routine Mental Health Screening: One way to improve the early identification and treatment of MH problems is to conduct routine MH screenings during annual well child visits. Research suggests that formal screening using a norm-referenced screening tool, which is encouraged by the American Academy of Pediatrics and the DC Department of Health Care Finance, is more effective than subjective assessments in identifying MH problems. However, PCPs face numerous barriers to implementing routine MH screening, including lack of time, insufficient referral resources, inadequate reimbursement, and limited partnerships with MH providers who can provide training or consultation.

DC MAP (District of Columbia Mental Health Access in Pediatrics) provides PCP’s a new (past 2 years) option for obtaining assistance with mental health services for your patients.  While acute problems (e.g., suicide attempts, development of mania/psychosis, etc.) may require emergency room/hospital interventions, often the problems described in the office warrant quick (within 1-2 weeks) intervention, which DC MAP can help the PCP to provide:

  • If the patient needs referral to a local clinician (who takes their insurance), if the resource directory or social worker at the clinic, are not of assistance, then the PCP may contact the DC MAP Care Coordinator, Erica Smith-Grasse, at 1-844-303-2627.
  • For patients who may have imminent clinical needs (such as impairing ADHD or depression such that the youth is withdrawing from peers and school activities), the PCP may get guidance on medication management.
  • For patients and families who have behavior issues, the PCP may contact DC MAP and speak with a child psychologist/social worker, within an hour, to discuss interventions the PCP might implement with the patient or parent.

Please remember these three things:

  1. Early identification and intervention in children and adolescents can change life trajectories and save lives.
  2. Routine MH screenings in pediatric primary care practices are essential.
  3. DC MAP is here for you!