Sidebar: Surveillance for Behavioral Health Problems and Developmental Disabilities in Pediatric Primary Care

Abstract

The Bright Futures initiative of the American Academy of Pediatrics (AAP) promotes the provision of health, developmental, and preventive services to address children’s health needs in the context of family and community [1]. Social workers trained in integrated care can contribute to pediatric and family practices and help provide surveillance for a range of issues that place children and their families at risk. Social workers with training in infant mental health can better help behavioral health teams implement Bright Futures recommendations in the early years when surveillance is more frequent. Both medical and nonmedical community agencies are involved in addressing the developmental context for children and youth with mental health problems and in providing assistance. Primary care practices and agencies providing educational instruction, early intervention, child mental health and substance abuse services, juvenile justice services, social services, and family education and support can help when caregivers and families are overwhelmed by many challenges. Therefore, a multidisciplinary approach is required because the issues and the interventions called for are often beyond the scope and expertise of a single discipline or practice or agency. At the present time, there is movement toward an interdisciplinary approach via the integration of behavioral health with primary care. Earls and Spring [2] list the following as benefits of an integrated model of pediatric primary and behavioral health care: stigma reduction; family convenience; better communication between the primary care provider and the mental health provider, with opportunities to encourage therapeutic goals; improved adherence to treatment; and opportunities for the primary care provider and the mental health provider to learn from one another. Collins and colleagues [3] foresee that administrative and service delivery structures will be streamlined in the name of cost containment and quality improvement. In their view, the coming decade will bring an opportunity to redesign primary care and mental health care so that they are delivered in a “holistic and patient-centered manner, using an integrated approach that is able to meet the full spectrum of a patient’s physical and behavioral health care needs” [3]. Social workers integrated into primary pediatric practices can partner with families of children at every age to prevent problems and provide early intervention. The 30-year-old field of infant mental health is multidisciplinary and has produced information applicable to a variety of health care settings. According to Zeanah and colleagues, unique features of infant mental health care include its “multidisciplinary nature, developmental orientation, multigenerational focus, and emphasis on prevention” [4]. Both infant mental health care and pediatric care recognize that parents and families play a pivotal role in the lives of children and have therefore adopted a 2-generational model of care. According to the AAP, “the health and wellbeing of children are inextricably linked to their parents’ physical, emotional and social health, social circumstances, and child-rearing practices” [5]. The AAP also points out that “when a family’s distress finds its voice in a child’s symptoms, pediatricians are often parents’ first source for help” [5]. This is true not just of pediatricians but of other primary care providers as well, especially when the practice serves as a medical home and provides periodic health supervision that engenders trust in the medical professionals and social workers who have established a