Navigating School Mental Health Services can be difficult for a child with mental health problems, for their family and sometimes for the pediatrician.
James Wallace, MD, Associate Professor, Department of Psychiatry and Pediatrics, University of Rochester Medical Center, Faculty Trainer in Child and Adolescent Psychiatry, The REACH Instituteexplained how to navigate the crossover landscape between pediatrician and school, in this Q&A interview with Contemporary pediatrics.
Contemporary pediatrics:
What is the role of the pediatrician in school mental health services?
James Wallace, MD:
The most important thing pediatricians can do is view the school as a natural and important ally and partner in managing pediatric behavioral health issues. Collaboration can help us make more accurate diagnoses, develop more effective multimodal treatment plans, and track progress in many areas. Without collaboration and communication, there are always pieces missing.
Contemporary pediatrics:
How can schools and pediatricians work better together, or what are the missing links?
Wallace:
Medicine and education have different ways of looking at children and adolescents. Each uses different language, follows different laws and regulations, and uses different strategies to intervene. Therefore, collaboration requires both parties to work hard to understand each other.
Simple routine communication procedures, such as sending the pediatrician a copy of each individualized education plan (IEP) and 504 accommodation plan, can be helpful. Pediatric practices could develop a liaison for schools, (such as) office workers, medical assistants, nurses, and schools could develop a liaison for medical practices, (such as) office workers, teachers in special mission, school nurses, counselors or administrators.
Complying with privacy laws (HIPPA, FERPA), having actionable information (ROI), and making routine communication an expectation are huge steps in the right direction.1
Contemporary pediatrics:
When is the right time to refer a patient to a mental health professional, perhaps moving from a therapist or school counselor to something more?
Wallace:
When children and adolescents need evidence-based care that the school cannot provide, it is essential to refer to community resources for that care. Schools and PCPs should maintain a list of providers in the community with whom they have had good experiences and share this list of resources.
Many states have child psychiatry access programs2 where primary care providers can call for a list of appropriate referrals. But it is not a choice between one or the other. Students often continue their counseling in the school setting when they enter community service. Collaboration between these 2 providers using the same language and skills building can strengthen the impact of interventions and help generalize changes to more contexts.
Contemporary pediatrics:
What are schools and pediatricians missing when it comes to providing resources to children with mental health issues?
Wallace:
A school and pediatric team can effectively assess and manage many, perhaps most, mental health problems in children and adolescents, especially if the pediatric provider has extensive training in the assessment and management of mental health problems. mental health, such as the patient-centered mental health course in pediatric primary schools. Care course (PPP4) offered by the REACH Institute.3
Primary care providers can also learn evidence-based cognitive behavioral therapy, parent training, and trauma interventions, which they themselves can offer for milder cases or when access to healthcare resources community therapy is delayed or unavailable.
Children with complex symptoms and impairments often require services and expertise beyond this core team. They often need a more specialized clinical therapist in the community. Some need consultation and treatment with a child and adolescent psychiatrist or psychiatric nurse practitioner.
Others need care management services, home services, crisis services, and acute care beyond the resources of schools and primary care providers. These services are in addition to the pediatrician-school team and not instead.
As complexity and impairment increase, the “village” of collaborating providers needed to support the family and child should expand to meet the needs. Call-in access programs can be an excellent resource for primary care providers to learn how to use the complex and often unique network of local services available.2
Contemporary pediatrics:
Who are the students most vulnerable to mental health problems?
Wallace:
Children and adolescents who have experienced significant trauma are a very vulnerable group who often need mental health services. Behavioral health problems have genetic and environmental components (natural and acquired), so they tend to be hereditary, especially when the whole family is struggling.
Those who have experienced adverse childhood events (ACES) are at risk, as are children who have been bullied, use substances, or are part of the LBGQT+ community. Non-English speakers, recent immigrants, people of color, and other minority groups are at risk due to chronic stressors. They also face complex barriers to accessing adequate health and mental health services, so they suffer doubly with greater needs and more difficult access.
Contemporary pediatrics:
What signs should pediatricians and educators/counsellors look for in these patient populations?
Wallace:
Sudden changes in mood, behavior, academic performance and/or relationships are worrying signs. School refusal, self-harm or suicidal comments or behavior, verbal or physical threats or attacks are red flags.
Subtle changes can be an early warning of a possible behavioral health problem when problems and impairments are milder and more amenable to change. School staff and primary care providers have the advantage of knowing their students/patients over time so they can know when a child’s behavior is changing. Familiar faces make it easier for students/patients and their families to disclose concerns and seek help.
In medical settings, the United States Preventive Services Task Force (USPSTF) recommends universal screening for highly common mental health conditions such as anxiety, depression, and suicidality, available on the website ProjectTeachNY.org , because some patients and families do not disclose their concerns. unless requested.1.4
Some school districts have testing protocols for the same reason. We all need to be alert for significant changes in mood, anxiety, aggression, relationships, and academic performance so that we can help these students/patients and all children and adolescents get the help they need. need.
The references:
1. Families thrive with good mental health. Teaching Project. Accessed February 9, 2024. https://projectteachny.org/
2. Integrate physical and behavioral health care for every child. National Network of Child Psychiatry Access Programs. Accessed February 9, 2024. https://www.nncpap.org/
3. REACH mental health training. The REACH Institute. Accessed February 28, 2024. https://thereachinstitute.org/training/#patient-centered-mental-health-in-pediatric-primary-care-ppp
4. Mental health problems and substance abuse. US Preventive Services Task Force. Accessed February 9, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?category%5B%5D=20&searchterm=
