Child Mental Health Issues Research Articles

Adverse Mental Health Impact of the COVID-19 Lockdown in Individuals With Tourette Syndrome in Italy: An Online Survey.

During the early stages of the coronavirus disease 2019 (COVID-19) pandemic in Italy, an online survey was launched via a local patient advocacy website to investigate mental health issues in children and adolescents with Tourette syndrome (TS). Respondents were parents, who were asked to report on their child's general health, tics, comorbidities/problems, pharmacological treatment/psychotherapy, symptom variations, and daily routine, as well as on their family's health and work experiences during the pandemic. Two hundred thirty-eight people participated in the survey, 203 females and 35 males. Our findings indicate that, in the time window of 4–6 weeks after the beginning of the COVID-19-related lockdown, 67% of individuals with TS developed a relevant worsening of the overall clinical condition as rated by their parents. An improvement or no variation of the clinical picture was reported in 20.5 and 6.7% of cases, respectively. Most worsened symptoms included tics, hyperactivity, rage attacks, obsessions/compulsions, and anxiety. Of the subjects experiencing a clinical worsening, the majority (51.76%) showed variations across two to five symptom domains. No association was found between symptom variation and family demographics or health and economic issues specifically related to the lockdown. The current COVID-19 pandemic is exerting a considerable impact on the mental health of young individuals with TS by worsening both tics and emotional and behavioral symptoms.

Acceptability and Feasibility of Early Identification of Mental Health Difficulties in Primary Schools: A Qualitative Exploration of UK School Staff and Parents\u2019 Perceptions

One in eight children aged 5–19 years in the UK suffer from a psychiatric disorder, while fewer than 35% are identified and only 25% of children access mental health services. Whilst government policy states that primary schools are well-placed to spot the early warning signs of mental health issues in children, the implementation of early identification methods in schools remains under-researched. This study aims to increase understanding of the acceptability and feasibility of different early identification methods in this setting. Four primary schools in the East of England in the UK participated in a qualitative exploration of views about different methods that might enhance the early identification of mental health difficulties (MHDs). Twenty-seven staff and 20 parents took part in semi-structured interviews to explore current and future strategies for identifying pupils at risk of experiencing MHDs. We presented participants with four examples of identification methods selected from a systematic review of the literature: a curriculum-based approach delivered to pupils, staff training, universal screening, and selective screening. We used NVivo to thematically code and analyse the data, examining which models were perceived as acceptable and feasible as well as participants’ explanations for their beliefs. Three main themes were identified; benefits and facilitators; barriers and harms, and the need for a tailored approach to implementation. Parents and staff perceived staff training as the most acceptable and feasible approach to systematic identification, followed by a curriculum-based approach. Universal and selective screening garnered mixed responses. Findings suggest that a systematic and tailored approach to early identification would be most acceptable and feasible, taking into consideration school context. Teacher training should be a core component in all schools.

A multi-trajectory analysis of commonly co-occurring mental health issues across childhood and adolescence

Developmental trajectories of mental health issues can often be usefully summarised in a small number of clinically meaningful subtypes. Given the high levels of heterotypic and homotypic comorbidity in child and adolescent mental health symptoms, we explored whether it was possible to identify clinically meaningful developmental subtypes of multiple commonly co-occurring mental health issues. We evaluated the combined developmental trajectories of the most common and commonly co-occurring child and adolescent mental health issues: attention-deficit/hyperactivity disorder (ADHD), internalising, and externalising symptoms in a normative sample of youth with data (n = 1620) at ages 7, 8, 9, 10, 11, 12, 13 and 15 using group-based multi-trajectory modelling. Multinomial logistic regression was used to evaluate predictors of group membership. Our optimal model included six trajectory groups, labelled ‘unaffected’, ‘normative maturing’, ‘internalising’, ‘multimorbid late onset’, ‘multimorbid remitting’, and ‘multimorbid with remitting externalising’. Examining covariates of group membership suggested that males and bully victims tend to have complex mental health profiles; academic achievement and smoking during pregnancy have general associations with mental health irrespective of symptom developmental trajectories or combination; and maternal post-natal depression is primarily related to symptoms that are already in evidence by the beginning of the school years. Results suggest that developmental trajectories of commonly co-occurring mental health issues can be usefully summarised in terms of a small number of developmental subtypes. These subtypes more often than not involve multiple co-occurring mental health issues. Their association with mental health covariates depends on the combination and developmental timing of symptoms in ways that suggest they can be clinically informative.

Children and youth in the institutional setting - mental health characteristics of children from the Center for Protection of Infants, Children and Youth in Belgrade

Background/Aim. Unfavorable life experiences of children and youth, unmet emotional needs at an early age may lead to difficulties in emotional life and mental health or externalizing problems. The aim of the study was to determine the number of children in the Center for Protection of Infants, Children, and Youth (hereinafter Center) in Belgrade with mental health issues, their life circumstances, and the way their issues are manifesting. Methods. The study included all children in residence (n = 486) at the Center during 2015. The study was conducted in the period from February to April 2016. For the needs of the research, a questionnaire examining the children's mental health issues was developed. Both health workers and social workers participated in the research. The children's health status questionnaire was filled in from their health records, while social anamnestic data were taken from the social worker's records. The research included four group homes for children without parental care, ages between 7 and 18 years, 3 children's shelters for children from birth to 18 years, and the organizational unit infirmary (children with developmental difficulties, aged between 4 and 18 years). Results. Out of the total number of children placed in institutions during 2015 (n = 486), 96 (19.8%) children were diagnosed with mental health issues. The most frequent diagnoses were F90-F93 (behavioral and emotional disorders usually occurring in childhood and adolescence); F70-F72 (mental retardation); F30-F32.3 (mood disorder ? affective disorder). The percentage of children with mental health issues diagnosed prior to their admission was 41.7% with one diagnosis, while 21.8% had two, three, or more diagnoses. After being received to the institution, 36.5% of children and youth got their diagnosis. Prior to their arrival at the Center, 74% of children had more than one life change. The average age of children was 11 years, although there were deviations in two group homes (15 years). After the paramedic emergency intervention, 21% of children were hospitalized. Inadequate parental care was the most prominent reason for institutionalization into the organizational units of children's homes, as well as the inability of parents to exercise their parental rights (76%). Inadequate parental care was neglected in 2/3 of children, while in 1/3 of children, it was abuse. Conclusion. Living in an institutional setting can lead to a number of problems in child development. The results of the research unequivocally show that children and adolescents placed in the social protection system are a vulnerable population and at a significantly higher risk of developing mental disorders, considering the negative influences and the absence of positive emotional stimuli from the earliest childhood. The type of consequence due to the stay at the institution depends on the age of the child, the length of the stay, their previous family experience, and the life changes that the child had.

Appropriate prescribing of dental prophylaxis in patients with orthopedic implants.

Total joint arthroplasty frequently is performed in the United States to treat degenerative hip and knee arthritis. Despite the routine nature of this procedure, recommendations about dental prophylaxis in patients with prosthetic joints have varied considerably over the past decade. In 2016, the American Academy of Orthopaedic Surgeons (AAOS) published appropriate use criteria for dental prophylaxis in patients with orthopedic implants. Despite these recommendations, discrepancies in prescribing practices persist, and controversy surrounding this topic remains prevalent in the medical literature. This article reviews the AAOS appropriate use criteria and discusses the ongoing controversy about the use of dental prophylaxis in patients with orthopedic implants.

Oregon audit finds its MH system is failing children, staff

The Oregon Secretary of State Audits Division revealed this month that the state's mental health system is failing children and families at a time when they need it most, Willamette Week reported Sept. 21. An audit report listed failings that ranged from a chronic workforce shortage to lack of performance measurements, which prevents the Oregon Health Authority (OHA) from catching shortcomings in its own work. Auditors discovered high turnover among mental health staff, which sometimes retraumatizes patients. The report says employees leave because of low pay and a high‐stress work environment — and the high turnover puts a strain on the staff members who stay. (Staff also reported not getting support from management who have made it clear they are replaceable.) In‐depth training is required to efficiently improve children's mental health issues, but various OHA mental health staff told auditors that new hires are not receiving the proper training to help high‐risk children. This puts staff at risk from traumatized children who can become aggressive and violent in an instant. OHA responded by agreeing to all 22 recommendations made by the auditors and set a target date for implementing each one.

Psychological Correlates of Sedentary Screen Time Behaviour Among Children and Adolescents: a Narrative Review.

The aims of this narrative review were to (1) synthesise the literature on the relationship between screen time and important mental health outcomes and (2) examine the underpinning factors that can influence this association. Paralleling the rise of mental health issues in children and adolescents is the ubiquitous overuse of screens, but it is unclear how screen time is related to important mental health outcomes and whether this association differs by gender, age and screen type. Medline/PubMed, PsychINFO and Google Scholar databases were searched on December 2019 for articles published mainly in the last 5years. The search focused on two main concepts: (i) screen time and (ii) mental health outcomes including anxiety, depression, psychological and psychosocial well-being and body image concerns. Sixty studies were included in the review. Higher levels of screen time were associated with more severe depressive symptoms. We found moderate evidence for an association between screen time and poor psychological well-being and body dissatisfaction especially among females. Relationships between screen time and anxiety were inconsistent and somewhat gender specific. Social media use was consistently associated with poorer mental health. Higher levels of screen time are generally associated with poorer mental health outcomes, but associations are influenced by screen type, gender and age. Practitioners, parents, policy makers and researchers should collectively identify and evaluate strategies to reduce screen time, or to use screens more adaptively, as a means of promoting better mental health among children and adolescents.

Association of Child and Adolescent Mental Health With Adolescent Health Behaviors in the UK Millennium Cohort

There is potential for mental health status to act as a determinant of an individual's ability to engage in healthful lifestyle behaviors. To investigate the associations of parent-reported mental health problems during childhood and self-reported mental health problems in adolescence with health behaviors in adolescence. This cohort study used data from wave 4 (collected in 2008) and wave 6 (collected in 2015) of the Millennium Cohort Study, a UK population-representative longitudinal study of young people born during 2000 to 2001. Wave 4 included data on parent-reported mental health issues for children at age 7 years. Wave 6 included data on self-reported mental health problems as well as health behaviors for the same children at age 14 years. Data were analyzed July 5, 2020. Mental health problems at age 7 years were parent-reported using Strengths and Difficulties Questionnaire. Mental health problems at age 14 years were self-reported using the Short Mood and Feelings Questionnaire. Health behaviors at age 14 years were the main outcome of interest. Sleep duration; fruit, vegetable, and soft drink consumption; and social media use were self-reported using recall on a typical day. Regression models were calculated for each lifestyle variable, with mental health change from ages 7 to 14 years as the exposure variable. Data were weighted to account for the potential clustering of region of sampling and adjusted for nonresponse. A total of 9369 participants were included in waves 4 and 6 of the Millennium Cohort Study, including 4665 (48.1%) girls and 6014 participants (81.9%) who were born in England. Adolescents who self-reported mental health problems at age 14 years only were less likely to have at least 9 hours of sleep (odds ratio [OR], 0.39; 95% CI, 0.34-0.45) and to consume fruit (OR, 0.55; 95% CI, 0.46-0.65) and vegetables (OR, 0.66; 95% CI, 0.52-0.83) reported greater use of social media (b = 0.62; 95% CI, 0.49-0.75) compared with individuals who did not have mental health problems at both time points. Similarly, those with mental health problems at both time points were less likely to achieve 9 hours sleep (OR, 0.68; 95% CI, 0.51-0.90), consume fruit (OR, 0.39; 95% CI, 0.26-0.58) and vegetables (OR, 0.57; 95% CI, 0.35-0.91), and reported greater social media use (b = 0.63; 95% CI, 0.34-0.91). These findings suggest that the presence of depressive symptoms at ages 7 and 14 years and at age 14 years only were associated with some health behaviors in adolescence. These findings are particularly important given that independent health behaviors can deteriorate and become habitual during adolescence, and adolescence is a known time for the first emergence of mental health problems that continue into adulthood.

Debate: COVID-19 and children in India.

The COVID‐19 pandemic impact on children is a growing concern. The United Nations and its agencies (the World Health Organization and UNICEF), Indian Association For Child and Adolescent Mental Health and National Institute of Mental Health and Neuroscience in India warn about the broader impacts on children and call for urgent action to support the world’s children amidst the pandemic which may have lasting consequences. The COVID‐19 pandemic and unprecedented control measures to prevent its spread have disrupted nearly every aspect of children’s lives – their health, development, learning, behaviour and their families’ economic security, including protection from violence and abuse. Given this background, there is an urgent need for action through screening to minimize the mental health issues of children in India who constitute a substantial proportion of the population.

An Integrated Approach to Deal with Mental Health Issues of Children and Adolescent during COVID-19 Pandemic

The pandemic caused by COVID-19 has left few countries untouched. It is a far-reaching implication on humankind, with children and adolescents, being no exception. Although the prevalence and fatality are negligible among children, a possible impact on their psychological and mental health cannot be disregarded. The unprecedented change in the way of living is bound to be having some psychological consequences on children and adolescents. The experiences gathered in childhood and adolescence are known to contribute to shaping the physical, emotional, and social well-being in adult life. Children are highly susceptible to environmental stressors. The present situation has the potential of adversely affecting the physical and mental well-being of children. To save the children from the long term consequences of this pandemic, a holistic approach integrating biological, psychological, social and spiritual methods of enhancing mental health have become essential. A concerted effort of government, Non Government Organisations (NGOs), parents, teachers, schools, psychologists, counselors and physicians are required to deal with the mental health issues of children and adolescents. This paper discusses the possible role of these agencies in the holistic intervention of this crisis.

Children on the brink: Risks for child protection, sexual abuse, and related mental health problems in the COVID-19 pandemic.

In developing contexts such as India, children in adversity form a high-risk group, one that cannot be subsumed under the general category of children, who are generally considered as a vulnerable group in disaster and crisis situations. Child mental health issues in contexts of protection risks and childhood adversity tend to be over-looked in such crises. This article focuses on examining the impact of the COVID-19 pandemic and its socio-economic consequences on children in adversity, describing the increased child protection and psychosocial risks they are placed at, during and in the immediate aftermath of the COVID-19 crisis and its lockdown situation. It specifically links the lockdown and the ensuing economic issues to sexuality and abuse-related risks, as occur in contexts of child labour, child sex work and trafficking, child marriage and child sexual abuse, and that result in immediate and long-term mental health problems in children. It proposes a disaster risk reduction lens to offer recommendations to address the emerging child protection, psychosocial and mental health concerns.

The present crisis in male reproductive health: an urgent need for a political, social, and research roadmap.

There is a global crisis in male reproductive health. Evidence comes from globally declining sperm counts and increasing male reproductive system abnormalities, such as cryptorchidism, germ cell tumors, and onset of puberty. Male factor infertility occurs in ~40% of couples experiencing infertility. Data demonstrate an association between male infertility and overall health. Associated significant health conditions include diabetes mellitus, metabolic disorders, and cardiovascular disease. Adding to the complexity is that men typically do not seek health care unless there is acute medical need or, as in the case of the infertile couple, the male goes for a reproductive examination and semen analysis. However, 25% of the time a reproductive health examination does not occur. Couples are increasingly utilizing IVF at more advanced ages, and advanced paternal age is associated with increased risk for (i) adverse perinatal outcomes for both offspring and mother; (ii) early child mortality, cancer, and mental health issues. In addition to age, paternal lifestyle factors, such as obesity and smoking, impact not only the male fertility but also the offspring wellness. The purpose of this paper was (i) to spotlight emerging and concerning data on male reproductive health, the relationship(s) between male reproductive and somatic health, and the heritable conditions father can pass to offspring, and (ii) to present a strategic roadmap with the goals of increasing (a) the awareness of men and society on the aforementioned, (b) the participation of men in healthcare seeking, and (c) advocacy to invigorate policy and funding agencies to support increased research into male reproductive biology. The Male Reproductive Health Initiative (MRHI) is a newly established and rapidly growing global consortium of key opinion leaders in research, medicine, funding and policy agencies, and patient support groups that are moving forward the significant task of accomplishing the goals of the strategic roadmap.

Mental Health of Refugee Children: A Discursive Look at Causes, Considerations and Interventions

There is a growing need both locally and internationally to manage the effects of traumatic and loss experiences on the development and recovery of refugee children and young people. Trauma, whether active or through deprivation, is degenerative, with crucial impact on developing bodies, brains and minds. This discursive article considers the nature and scope of the problem and draws on literature and current frameworks to suggest the importance of interventions and proactive protection of mental health for this sub-group of refugees. School is discussed as a place of primary intervention but also a player in creative and sophisticated multimodal integrative services. A range of approaches can be, and, indeed are used in response to mental health issues for children in detention or upon resettlement. Schooling represents one such solution, providing a multi-pronged approach to facilitate mental health improvement for these children. For children needing to recover from loss and trauma secondary to experiences as a refugee, school offers a developmentally appropriate space to mobilise and enhance recovery, both at a simple level and as part of more specialised secondary and tertiary level care. The implications for future practice among health care professionals is to understand the mental health plight of refugee children, through both their pre-arrival exposure to trauma and their post-arrival, detention setting, the key role that schooling can play in facilitating mental health, and the capacity to advocate for programmes and services to work collaboratively with schools to achieve greater access for refugee children.

Mental health policies tackling violation of children's human rights in Chile

In August, 2018, the UN Committee on the Rights of the Child reported on the plight of thousands of at-risk children who are subject to extreme neglect, leading to endangerment and human deterioration in Chile. 1 UN Committee on the Rights of the ChildInforme de la investigación relacionada en Chile en virtud del artículo 13 del Protocolo facultativo de la Convención sobre los Derechos del Niño relativo a un procedimiento de comunicaciones. https://www.ohchr.org/Documents/HRBodies/CRC/CRC_C_CHL_INQ_1.pdfDate accessed: February 25, 2019 Google Scholar This alarming report noted that the human rights of children living under court protection and deprived of liberty (ie, those living in the National Children's Service, Sename) are being systematically violated. It also highlighted that nearly 70% of these at-risk children have at least one untreated mental disorder. In the report, the Chilean Health Ministry acknowledged that, despite this high prevalence of mental disorders among children living in institutions, these children have little or no access to mental health services. Additionally, it revealed a systematic lack of access to most diagnostic and health services: 68·6% of adolescents aged 14–18 years show symptoms associated with depression, but, of those, 45·3% have not been evaluated by a psychologist or psychiatrist. The Committee concluded that Chile lacks a plan to treat mental health issues in children and adolescents. 1 UN Committee on the Rights of the ChildInforme de la investigación relacionada en Chile en virtud del artículo 13 del Protocolo facultativo de la Convención sobre los Derechos del Niño relativo a un procedimiento de comunicaciones. https://www.ohchr.org/Documents/HRBodies/CRC/CRC_C_CHL_INQ_1.pdfDate accessed: February 25, 2019 Google Scholar

The Change Clinic Counselling Service: Blending Client-Centred and Strength-Based Practices to Improve Mental Health Services to Families

Operating in a small urban Canadian location, Change Clinic is a brief counselling service intended for child and adolescent mental health issues. It blends principles from different strength-based and client-centred approaches to counselling (e.g., solution-focused, narrative, and single session therapies). Using the parent-report version of the Strengths and Difficulties Questionnaire, changes in child and adolescent mental health difficulties were assessed. Compared to pre-test scores, significant improvements in behavioural, emotional, and hyperactivity problems were observed six months after delivery of the service. Effect size was estimated to be moderate (.62) based on the Added Value Score calculation. Almost three quarters of clients were served in one to two sessions.

Moderating Effects of Physical Activity and Global Self-Worth on Internalizing Problems in School-Aged Children With Developmental Coordination Disorder.

School-aged children with developmental coordination disorder (DCD) are at greater risk for physical inactivity, lower global self-worth, and internalizing problems, such as depression and anxiety. Based on the environmental stress hypothesis (ESH), recent research has shown that physical inactivity and lower global self-worth sequentially mediate the relationship between DCD and internalizing problems, suggesting that DCD leads to lower levels of physical activity, which in turn leads to lower levels of global self-worth, and ultimately, a greater amount of internalizing problems. However, physical activity and global self-worth may also buffer (i.e., moderate) the adverse effect of DCD on internalizing problems. To date, this has yet to be tested. Participants were 1206 children aged 12–14 years [611 boys, 79 with probable DCD (pDCD)]. All children received assessments of motor coordination, physical activity, global self-worth, and internalizing problems. Children with pDCD were less physically active, had lower self-worth, and experienced more internalizing problems compared to typically developing (TD) children (p’s < 0.05). Furthermore, the moderated moderating effect (three-way interaction) of physical activity and global self-worth was also evident (p < 0.05), indicating that internalizing problems in both TD and pDCD groups decreased with concurrent increases in physical activity and global self-worth. Importantly, when compared to TD children, increases in physical activity and global self-worth were associated with a greater reduction in internalizing problems among children with pDCD. The findings support several pathways in the ESH and highlight that, in addition to improving motor skills, interventions should also target both physical activity and global self-worth to mitigate potential mental health issues for children with motor difficulties.

269 Prevalence of Depressive Symptoms Over Time in Pediatric Burn Survivors

Prior research shows that adult pediatric burn survivors have a higher incidence of mental health issues when compared to the general population. The aim of this study is to examine the prevalence of depressive symptoms over time in children being treated in outpatient burn clinics. The Multi-Center Benchmarking Study includes four burn centers that administered the Burn Outcomes Questionnaire (BOQ) to parents of children aged 5–18 to assess physical and psychosocial recovery from burn injuries. Children were eligible for the study if they were English or Spanish speaking, and had experienced a total body surface area (TBSA) burn ≥20% or a burn to a critical area (face, hands, feet, genitalia). Surveys were administered at the first return to the clinic after discharge from inpatient care (baseline), 3, 6, 12, 18, 24, and 36 months after discharge. This study focuses on the question, “This child feels depressed and talks about death” with possible answers: “None of the time”, “Some of the time”, “About half of the time”, “Most of the time”, and “All of the time”. Responses other than “None of the time” were considered a “positive” depressive or suicidal response. Surveys were collected from the parents of 836 total patients over the course of 7 time points. The rate of “positive” responses decreases over time among the full sample of cases at each time point as well as for subjects that had complete data at all 7 time points (Table 1). Around 50% of patients maintained a “positive” response from each successive time point. From baseline to 36 months, 45% of children had a “positive” response for at least one time point, while only 2% had a “positive” response at all time points. Over all 7 time points, the majority (72%) of children with a “positive” response were rated as being depressed “Some of the time” and only a small percentage (4%) of patients with a “positive” response were rated as being depressed “All of the time”. This study shows almost half of children recovering from burn injuries experience depressive symptoms at least once in the first 3 years of recovery. The prevalence of these symptoms is greatest at baseline and decreases until it tapers off around 12% at 2 to 3 years. Many children’s symptoms persist over successive time points, suggesting a lack of mental health evaluation. This study indicates a need to prioritize screening and treatment of mental health issues in children recovering from burn injuries, not only early in recovery, but 2 to 3 years post-injury.

Caregiver depression and trajectories of behavioral health among child welfare involved youth

Child welfare involvement has been linked to child behavioral health issues, including increased likelihood of internalizing mental health problems such as depression and anxiety, and externalizing behavioral problems such as oppositional behaviors and substance use problems. One predictor of child behavioral health is caregiver mental health. Although, there remains a specific gap associated with identification of factors among caregivers that are associated with longitudinal child behavioral health trajectories. Using LONGSCAN, we explore the effects of caregiver depression on the behavioral health of children over time. Multilevel mixed-effects linear regression models showed that children with a caregiver who reported depression showed significantly higher internalizing behavioral problems over time, and significantly larger decreases in externalizing behavioral problems over time, compared to children with a caregiver who reported no depression. These findings emphasize that early interventions geared towards jointly assessing and treating parent and child mental health issues in the child welfare system may be successful at improving future behavioral health outcomes.

Promoting mental health first aid literacy in secondary schools.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a new initiative designed to help teachers in secondary schools better understand and identify mental health issues in children.

Mental health issues in children and adolescents with chronic illness

PurposeThe purpose of this paper is to consider mental health issues in children and adolescents with chronic illness or health conditions, including their treatment, and issues related to delivery of services.Design/methodology/approachA selective review of the literature was conducted to highlight significant mental health issues and their treatment in youth with various types of chronic illness.FindingsA significant portion of youth experience mental health problems related to their chronic health conditions. While evidence-based treatments are available to address these problems, significant barriers exist that impede the delivery of psychological and behavioral interventions for many youth.Research limitations/implicationsMore controlled studies are needed to demonstrate the effectiveness and cost offset of delivering psychological and behavioral interventions for the population of youth with various types of chronic health conditions, particularly in clinical and community settings.Social implicationsPolicy reform can ensure that mental health issues are effectively addressed for children with chronic illness. Policy is needed that promotes integrated health care, whereby psychological and behavioral interventions are delivered in health care settings along with medical interventions to reduce barriers to care.Originality/valueSignificant numbers of children and adolescents have chronic health conditions and many experience mental health problems related to their conditions. While evidence-based treatments are available to address these problems, significant barriers impede the delivery of psychological and behavioral interventions for many youth. Health care policy promoting integrated health care to deliver psychological and behavioral interventions in health care settings along with medical interventions should reduce barriers to care and improve both physical and mental health outcomes for youth.