Mental Health Screening in the Medical Home

Mental+Health+Screening+in+the+Medical+Home%3a+Introduction%0d%0aJane+Meschan+Foy%2c+MD+Department+of+Pediatrics+Wake+Forest+University+School+of+Medicine%0d%0a%0d%0a%0cPrevalence+of+mental+health+problems+in+childhood*%0d%0a%e2%80%a2+11%25+of+children+have+a+MH+diagnosis+%2b+evidence+of+functional+impairment+(%e2%80%95SED%e2%80%96)+%e2%80%a2+16%25+of+children+have+symptoms+that+do+not+rise+to+level+of+a+diagnosis%2c+but+have+functional+impairment+%e2%80%a2+9%25+have+a+diagnosis+without+current+impairment+%e2%80%a2+27-36%25+total+may+have+need+for+MH+services%0d%0a*+Great+Smoky+Mountain+Study+of+Youth.+Health+Affairs%2c+Fall%2c+1995%0d%0a%0d%0a%0cRisk+factors+for+mental+illness%3a+children+with+serious+emotional+disturbance+are%e2%80%a6%0d%0a%e2%80%a2+Twice+as+likely+to+be+living+in+poverty+(40%25+vs.+20%25)+%e2%80%a2+40%25+more+likely+to+have+a+parent+who+has+been+arrested+(17%25+vs.+12%25)+%e2%80%a2+50%25+more+likely+to+have+a+parent+with+a+drug+or+alcohol+problem+(11%25+vs.+7%25)+%e2%80%a2+3+times+as+likely+to+have+a+mother+who+is+depressed+(18%25+vs.+6%25)+%e2%80%a2+25%25+more+likely+to+have+a+parent+who+did+not+finish+high+school+(42%25+vs.+32%25)%0d%0a%0d%0a%0cRisk+factors+for+mental+illness+(cont.)+%3a%0d%0achildren+with+serious+emotional+disturbance+are%e2%80%a6+%e2%80%a2+Nearly+3+times+as+likely+to+have+a+poor+relationship+with+his%2fher+parents+(49%25+vs.+17%25)+%e2%80%a2+Nearly+2+times+as+likely+to+have+witnessed+physical+violence+between+parents+(13%25+vs.+8%25)+%e2%80%a2+Nearly+2+times+as+likely+to+have+one+or+both+parents+unemployed+(17%25+vs.+9%25)+%e2%80%a2+50%25+more+likely+to+come+from+a+family+other+than+one+with+two+biological+or+adoptive+parents+(77%25+vs.+50%25)%0d%0a%0d%0a%0cRisk+factors+for+mental+illness+(cont.)%0d%0a%e2%80%a2+Children+with+6+or+more+stress+factors+are+40+times+more+likely+to+have+SED+than+children+without+stress+factors.+%e2%80%a2+Children+with+chronic+medical+illnesses+are+at+higher+risk+for+mental+health+disorders+(including+mild+and+moderate+disorders).+%e2%80%a2+Adolescents+tend+to+have+the+most+significant+health+problems+and+the+lowest+utilization+of+healthcare+services+of+any+age+group%2c+esp.+ethnic+minorities%2c+and+are+least+likely+to+be+insured.%0d%0a%0d%0a%0cConsequences+of+mental+illness%0d%0a%e2%80%a2+Children+with+SED+are+more+likely+to%e2%80%a6%0d%0a%ef%83%98+%ef%83%98+%ef%83%98+%ef%83%98+be+expelled+from+or+drop+out+of+school+become+pregnant+be+convicted+of+a+crime+use+alcohol+or+other+illicit+drugs%0d%0a%0d%0a%e2%80%a2+Children+with+mental+illness+are+more+likely+to+use+medical+services+%2f+emergency+rooms+(%e2%80%9cdisplaced+utilization%e2%80%9d)%3b+their+parents+are+also+higher+users+of+health+services.*%0d%0a%0d%0a*Bernal%2c+Hidden+Morbidity+in+Pediatric+Primary+Care%2c+Pediatric+Annals+32%3a6%2c+June%2c2003.%0d%0a%0d%0a%0c70%25+of+children+in+need+of+MH+services+are+untreated.*%0d%0a%0d%0a*Surgeon+General%e2%80%99s+report%3a%0d%0awww.surgeongeneral.gov%0d%0a%0d%0a%0cMental+illness+treatment+sources%0d%0a%e2%80%a2+%e2%80%a2+Specialty+MH+system+Child+welfare+and+juvenile+justice+system+Education+(70%25%3b+sole+provider+for+50%25)%0d%0a%0d%0a%e2%80%a2%0d%0a%0d%0a%e2%80%a2%0d%0a%0d%0aHealth%0d%0a%0d%0a%0cBarriers+to+treatment+of+mental+illness+in+MH+specialty+system%0d%0a%0d%0a%ef%82%a7+%ef%82%a7+%ef%82%a7+%ef%82%a7+%ef%82%a7+%ef%82%a7+%ef%82%a7%0d%0a%0d%0aStigma+Fragmentation+%2f+schism+Cost+Cultural+biases+%2f+trust+issues+Absence+of+care+coordination+mechanisms+Funding+%2f+reimbursement+issues+Shortage+of+mental+health+professionals+generally%0d%0a%0d%0a%0cBarriers+to+treatment+of+mental+illness+in+MH+specialty+system+(cont.)%0d%0a%ef%82%a7+MH+system+reform%3a+targeting+of+public+services+to+the+severely+ill+%ef%82%a7+Procedural+requirements+of+public+and+private+mental+health+programs+%ef%82%a7+Poor+communication+with+primary+care+%ef%82%a7+Non-parity+of+mental+health+benefits+in+insurance+plans+%ef%82%a7+Adolescent-specific+issues%3a+denial%2c+confidentiality%e2%80%a6..%0d%0a%0d%0a%0cBarriers+to+treatment+of+mental+illness+in+child+welfare+and+juvenile+justice+system%0d%0a%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+Adversarial+relationship+with+family+Under-funding+Family+disorganization+Agency+focus+on+non-MH+aspects+of+care+Discontinuity+in+custody+Incomplete+medical+and+mental+health+history+Poor+communication+among+agency%2c+family%2c+and+healthcare+providers%0d%0a%0d%0a%0cBarriers+to+treatment+of+mental+illness+in+schools%0d%0a%ef%82%a7+Focus+on+educational+mission+(e.g.+testing%2c+attendance)+%ef%82%a7+Confidentiality+issues+inhibiting+exchange+of+information+with+healthcare+providers+%ef%82%a7+Inadequacy+of+school+funding+%ef%82%a7+Shortage+of+school-based+mental+health+professionals+and+school+nurses+%ef%82%a7+Reimbursement+issues+for+schoolemployed+personnel%0d%0a%0d%0a%0cBarriers+to+treating+mental+illness+in+primary+care+settings%0d%0a%0d%0a%e2%80%a2+Comfort+of+primary+care+providers+(other+than+uncomplica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