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Pediatric Mental Health Power point - AMERICAN ACADEMY OF by sofiaie


									         AAP Section on Residents
        Annual Advocacy Campaign:
        Pediatric Mental Health
October 27, 2007
•   Demographic of pediatric mental health
•   AAP Stance on Mental Health
•   Barriers to Mental Health
•   Residents as Advocates
•   Forums for Advocacy
    •   Patient Advocacy
    •   Community Advocacy
    •   State Legislative Advocacy
    •   Federal Legislative Advocacy
Pediatric Mental Health
• Mental health is an integral part of a child’s
  overall health & wellbeing.
• More than 1 out of 10 children (0-17 years
  old) suffer from a mental health disorder.
• Less than 20% of those with mental health
  disorders receive treatment.
Pediatric Mental Health
• “The prevalence of mental disorders among
  children is predicted to rise in the next 15
  years by 50%, becoming a major cause of
  morbidity, mortality and disability.”
  (Surgeon General’s Conference on Children’s Mental Health, 2000)

• Suicide is already:
        4th leading cause of death between ages 10-14 yo
        3rd leading cause of death between ages 15-24 yo
Pediatric Mental Health
• Most common pediatric mental health
  disorders include:
   •   Anxiety disorders (most common)
   •   Mood disorders
   •   Attention Deficit Hyperactivity Disorders
   •   Autism Spectrum Disorders
   •   Conduct Disorders
   •   Eating Disorders
   •   Substance abuse
Pediatric Mental Health
• Undiagnosed, untreated, or under-treated
  pediatric mental illnesses have been linked
      •   School failure
      •   Suicide
      •   Substance abuse
      •   Violence
      •   Homelessness
      •   Incarceration
AAP Stance on Mental Health
• The AAP has a long standing interest in
  mental health access for youth.
• The AAP developed a consensus statement
  in 2000 entitled “Insurance Coverage of
  Mental Health & Substance Abuse Services
  for Children & Adolescents.”
• The AAP was joined by other groups
  including the American Academy of Child &
  Adolescent Psychiatry, American
  Psychological Association, & the American
  Psychiatry Association.
AAP Stance on Mental Health
• The AAP consensus statement addresses 3
  issues: access, coordination, & monitoring.
• It states that "these issues should be
  considered from the standpoint of needs for
  preventative interventions, direct mental
  health and substance abuse services, and
  coordinated multi-service care."
  (Pediatrics 2000; 106; 860-862)
AAP Stance on Mental Health
• Recognizing the need for increased mental health
  care in the context of primary care, the AAP
  chartered the Task Force on Mental Health at the
  end of 2004.
• The Mental Health Chapter Action Kit was
  developed through this task force & is available at:
  Within it, you can find valuable resources such as
  “the clinician feedback form” & “how to develop a
  community resource guide.”
Barriers to Mental Health Services
• Stigma among families to bring up mental
  health concerns with doctors.
• Inadequate identification of youth with
  mental health issues.
• Mental health provider shortages.
• Inadequate coverage of mental health
  services by both public & private health
  insurance programs.
• Complex & fragmented service delivery
Barriers for Pediatricians
• Lack of time during an appointment to
  address mental health.
• Lack of training, expertise, & comfort with
  mental health identification or treatment.
• Lack of payment or compensation for
  providing mental health services.
• Lack of knowledge regarding community
  mental health referral services.
• Lack of mental health referral services in the
Advocacy Among Pediatric Residents
• Can advocate for our patients on many
  different levels.
• Can personally choose the level we feel most
  comfortable & effective at.
• Can advocate for our patients within our
  time limitations.
• Can help create the changes we believe are
  needed in the field of pediatrics.
• If we do not advocate for our patients, who
Advocacy at the Individual Patient Level
 • # 1 barrier to pediatric mental health is lack
   of diagnosis or identification.
 • Work on understanding signs of mental
 • Screen patients within your own continuity
 • Talk about mental health concerns or
   questions with the family as part of your
   well child visit.
Advocacy at the Individual Patient Level
 • Increase awareness at your clinics regarding
   suicide prevention & crisis hotlines.
 • Find out the numbers of your community’s
   help lines.
 • Create posters & wallet sized cards with
   these or local numbers:
 • 1-800-SUICIDE (suicide prevention/crisis)
 • 1-800-273-TALK
   (counseling, suicide prevention, mental health referrals)
Advocacy at the Community Level
• Although we may not have the time to
  extensively treat a mental health disorder, we
  can make effective community referrals.
• Learn about the resources available in your
• Spread the word about what is available to your
  fellow residents.
• Contact the community resources to build a
  better relationship with your clinic.
• Find out which community resource is the most
  comprehensive & effective by speaking with
  other community members & psychiatrists.
Advocacy at the Community Level
• If there are few community resources
  available, take action.
• Write op-ed pieces to your city/town
  newspapers about the need for more
• Contact your mayor, city council, or school
  board about the need for more mental health
  resources from your stance as a pediatrician.
Advocacy at the State Level
• 33 states currently mandate that certain
  insurers provide varying levels of “parity” or
  equality in coverage between mental health
  benefits and medical benefits.
• 16 states mandate that certain insurers
  provide specific mental health coverage.
• Only Wyoming currently has no mental
  health insurance mandates.
Advocacy at the State Level
• In 2007, 10 states introduced legislation
  targeted at expanding mental health
• 4 states (Colorado, New Mexico,
  Washington, West Virginia) passed
  legislation strengthening existing mental
  health parity laws.
• No state has enacted legislation targeting
  increasing access to mental health for
  children & adolescents.
Advocacy at the State Level
• Contact your local AAP chapter to find out
  about mental health legislation that is being
  discussed within your state.
• Find your AAP chapter legislative contacts
  by going to:
• Find out how you can become more
  involved with your AAP chapter’s legislative
Advocacy at the State Level
• Be a leader for pediatric mental health in
  your state!
• Find out who are your state representatives
  by going to
• Learn more about pediatric mental health at
  the state level by reading the AAP Child &
  Mental Health Issue Brief.
• The AAP Division of State Government
  Affairs is available to act as a resource to you
  as you work with your chapters on state
  advocacy issues.
Advocacy at the Federal Level
• There are currently 2 bills at the federal level
  that would increase insurance coverage for
  pediatric mental health:
   • SCHIP: Children’s Mental Health
     Parity Act
   • Mental Health Parity Act of 2007
The SCHIP Children’s Mental Health Parity Act
    • S. 1337 is a bill to ensure the parity of mental
      & medical care in programs operated under
      the State Children's Health Insurance
      Program (SCHIP).
    • The bill would require that states offering
      both medical & mental health coverage to
      children offer mental health coverage that is
      not more restrictive than medical coverage in
      terms of "financial requirements and
      treatment limitations."
Mental Health Parity Act of 2007
• S. 558/H.R. 1424 will improve the mental health
  of all Americans, especially children &
• Would require businesses that offer mental health
  insurance to provide equal coverage for both
  physical & mental health services.
• Would require parity in co-payments, deductibles,
  out-of-pocket expenses, covered hospital days,
  outpatient visits, and substance abuse treatments.
Mental Health Parity Act of 2007
• Businesses with less than 50 employees
  would be exempt from the requirement.
• Employers can opt-out if the requirement
  would increase their health care costs by over
  2% the first year or over 1% for subsequent
Advocacy at the Federal Level
• Find out who your Senators & House
  representatives are by going to:
• Sign & send copies of the AAP Mental Health
  Parity letter of support found at:
• Start a letter writing campaign within your
  residency program.
Advocacy at the Federal Level:
Be a Key Contact
• Key Contacts are AAP members who have
  agreed to take their advocacy to the next
  level by developing an ongoing relationship
  with their respective federal legislators.
• The Key Contacts program serves as a
  critical supplement to the work accomplished
  by the Federal Advocacy Action Network
  (FAAN) and the AAP Department of
  Federal Affairs.
Advocacy at the Federal Level:
Be a Key Contact
• Key Contacts will receive more sophisticated
  assignments from the AAP Department of
  Federal Affairs than FAANs and are
  expected to report back their results.
• Contacts should be ready to respond to
  requests for action and become a resource
  for their federal legislators at critical decision
• Being a Key Contact requires a very small
  time commitment but can yield big results.
Advocacy at the Federal Level:
Be a Key Contact
• Receive all the benefits of the FAAN program
  and more, including:
     * Free resources and tools to expand
  advocacy skills.
     * Techniques for relationship-building with
  your members of Congress.
     * Latest up-to-date information on legislation
  affecting pediatricians.
     * More sophisticated assignments for the
  advanced advocate.
• To sign up go to:
AAP Annual Legislative Conference
• Yearly conference in Washington D.C.
• Sponsored by the Committee on Federal
  Government Affairs (COFGA) & the
  Committee on State Government Affairs
• Designed to bring pediatricians first-hand
  legislative advocacy experience.
• Two days of interactive workshops and
  stimulating speakers.
AAP Annual Legislative Conference
• At the conclusion, attendees meet and lobby
  members of congress (or their aides) to
  support an AAP endorsed bill (this year the
  focus was on SCHIP).
• Provides an excellent introduction to the
  world of legislative advocacy for beginners as
  well continued experience for seasoned
• A wonderful event for networking.
• Pediatric mental health is an issues that is
  often overlooked as part of the general
  health of children.
• Pediatric residents can play key roles as
  advocates on many different levels.
• We can decide for ourselves what level we
  feel most comfortable & effective at.
• We can then strive for the changes we hope
  to see for the lives of our patients from the
  standpoint of a pediatrician & an AAP
    Key Internet Resources
•   Surgeon General’s Conference on Children’s Mental Health, 2000.
•   AAP Consensus Statement on Pediatric Mental Health. Pediatrics
    2000; 106:860-862.
•   AAP Committee of Pediatric Emergency Medicine. Pediatric Mental
    Health Emergencies in the Emergency Medical Services System.
    Pediatrics 2006; 118:1764-1767.
•   AAP Mental Health Chapter Action Toolkit, 2007.
•   AAP Policy Statement. Identifying Infants and Young Children With
    Developmental Disorders in the Medical Home: An Algorithm for
    Developmental Surveillance and Screening. Pediatrics 2006; 118:405-
•   AAP Policy Statement. The New Morbidity Revisited: A Renewed
    Commitment to the Psychosocial Aspects of Pediatric Care. Pediatrics
    2001; 108;1227-1230.
•   State Laws Mandating or Regulating Mental Health Benefits.
    Washington, DC: National Conference of State Legislatures. January
•   Foy EF, Earls MF, and Horowitz DA. Working to improve mental health
    services: the North Carolina advocacy effort. Pediatrics 2002; 110:1232-
•   Koyanagi C, Boudreaux R, and Lind E. Mix and Match: Using Federal
    Programs to Support Interagency Systems of Care for Children with Mental
    Health Needs. Washington, DC: Bazelon Center for Mental Health Law.
•   Seltzer T. Teaming Up: Using the IDEA and Medicaid to Secure
    Comprehensive Mental Health Services for Children and Youth.
    Washington, DC: Bazelon Center for Mental Health Law. August 2003.
•   Williams J, Shore SE, and Foy JM. Co-location of mental health
    professionals in primary care settings: three North Carolina models. Clinical
    Pediatrics 2006; 45:537-543.
•   Wishmann A, Kates D, and Kaufmann R. Funding Early Childhood Mental
    Health Services and Supports. Washington, DC: Georgetown University
    Child Development Center. March 2001.
•   Wood EP. Children and Mental Health Parity. Washington, DC: National
    Conference of State Legislatures. May 2005.
Presentation created by the AAP Section on Residents
          Leadership/Advocacy Committee
          Committee Chair: Mana Golzari, MD

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