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One of the long-standing difficulties faced by primary care providers is the need to master the seemingly huge range of child mental health problems and their specific, evidence-based treatments. Applying a specific treatment to a specific diagnosis is a core tenet of medical care, but the over-application of this rule can stand in the way of helping families when a child has an emotional or behavioral problem. In this article, we outline some “universal†approaches to these problems.
Are there "universal" treatments for child mental health problems?
First, most mental health problems come to light because of how they interfere with an important function or day-to-day activity. Joining with families to identify those issues is a first step toward making problems seem solvable. A second step is recognizing the context in which the child’s problems are occurring. Nearly always there will be stressors experienced by other family members. At a minimum, the child’s problems will be causing tension within the family or posing challenges to parents’ work or personal lives. Often the child’s symptoms are happening in parallel with major issues the family is experiencing, including financial instability or a major illness in a sibling, parent, or grandparent. Sometimes there will be issues of exposure to trauma vicariously, in the community, or at home. Simply acknowledging this context and empathizing with it is therapeutic – parents realize that you can weave your help into their existing efforts. Often there will specific help you can offer.
Fortunately, many child emotional and behavioral issues will improve if the emotional and behavior demands on children can be temporarily lessened, or if parents can help children to adopt stronger coping styles. Similarly, parents’ abilities to help children can be strengthened if their own resources are not overly stretched. So another universal approach involves asking about current demands and what might be temporarily scaled back or postponed. Closely related is the evidence-based practice of prescribing pleasurable activities. What sorts of things have brought pleasure to either the parent or child in the past, or been settings in which the parent and child were happy together? Can the family deliberately do some of these things? Can the parent and child take even 10 minutes of time together – perhaps just after school or on a weekend, in some mutually-enjoyable activity?
Once more is on the table about the context of the child’s problems, and the family has the assurance of the provider’s understanding and some tools for self-care, providers can then propose some more specific solutions from their existing toolbox of advice about parent-child interactions and child behavior. Families will often have thought already about things that might help, so the provider’s job is often more of validating those approaches and helping to refine them rather than having to come up with new ideas. Once some specific steps are identified, the most important aspect of concluding a visit is with a concrete plan for follow-up. How will the family decide if things are getting better or not, and how will they get back in touch to convey that information and decide what to do next.
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Dr. Larry Wissow is board certified in pediatrics, child and adult psychiatry, and has faculty appointments in the Johns Hopkins University Schools of Public Health and Medicine. His main clinical work is as part of the mental health teams in the pediatric and transitional age HIV programs at Johns Hopkins. Dr. Wissow has been working with BHIPP since it's inception and he most enjoys the chance to meet so many people who care and work so hard for mental health in Maryland - in community organizations, offices, and universities, as well as local, county, and state governments.
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Tuesday, April 26, 2016
BHIPP Informational Session,
"Meet, Greet, and Link" Event
6:00pm-8:00 pm
Union Hospital
Elkton, MD
Free. Dinner included.
Click here for registration & additional information.
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Saturday, May 14, 2016
BHIPP CME Conference,
Mental Health Skills for Primary Care
8:30 am-2:00 pm
Harford County, Location TBA
Free. Light breakfast, lunch, and CME available.
Click here for registration & additional information.
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Saturday, June 11, 2016
BHIPP CME Conference,
Mental Health Skills for Primary Care
8:30 am-2:00 pm
St. Mary's County Health Department
Leonardtown, MD
Free. Light breakfast, lunch, and CME available.
Click here for registration & additional information.
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Resources and Information
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The Maryland SBIRT Project is co-sponsoring two FREE SBIRT-related trainings for medical and and behavioral health care professional. Physician CMEs are available for both trainings and CEUs are also available for the training on 4/18/16.
April 9, 2016, 8:30 am to 12:00 pm
Chesapeake College, Wye Mills, MD
"Reducing unhealth drug use among patients in office-based physician practices"
Presenters Christopher Welsh, MD and Carlo DiClemente, Ph.D.
Registration needed ASAP - Contact Erica Horney, ehorney@msmhs.org or 410-770-4801.
April 18, 2016, 6:00 pm to 9:00 pm
Calvert Memorial Hospital, Prince Frederick, MD
"Substance use during reproductive health years and pregnancy"
Presenter Mishka Terplan, MD.
Online registration: http://goo.gl/forms/Cboc2W6b6U
For more information about the Maryland SBIRT project, visit their website. |
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Mark your calendars! Children's Mental Health Awareness Week 2016 is May 1-7.
Join the campaign and become a 2016 Partner!
Only through partnership with organizations like yours can the campaign reach a diverse audience of families, caregivers, educators, and providers through many different channels.
Visit the campaign's Partners page for more information and ideas to share the importance of children's mental health in your community.
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The Early Childhood Mental Health Partnership in Massachusetts aims to strengthen, expand and integrate statewide services for children with emotional and behavioral needs by creating a comprehensive system of community-based, culturally responsive, behavioral health services.
With the support of two Substance Abuse Mental Health Service Administration (SAMHSA) grants (MYCHILD and PROJECT LAUNCH), the Partnership has developed an early childhood mental health toolkit titled "Integrating Mental Health Services into the Pediatric Medical Home."
Access more information about the Early Childhood Mental Health Partnership and the toolkit on their website.
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