Need for Integrated Pediatric Health Care Highlighted in Two Recent Studies

Date: 

07/01/2015

Two recently published studies highlight the benefits of integrating behavioral health in primary care for children and youth.

  • Integrating behavioral health (BH) into pediatric care might lead to short- and long-term improved health outcomes for children, argues a recent Viewpoint article published in the Journal of the American Medical Association. Childhood disorders such as asthma, obesity, and diabetes are being recognized as having a large behavioral component. Research has also shown that childhood behavioral disorders can contribute to poor physical health into adulthood. Severe early life stress such as exposure to violence or abuse has been linked to both behavioral disorders in children and a variety of poor health outcomes including premature death in adults. Several evidence-based interventions have demonstrated that behavioral intervention for children and their families early in childhood can lead to improvements in outcomes. Implementing behavioral medicine interventions within medical care settings, allows for the potential of reaching children early on and in an environment in which the family may be more open to receiving treatment.

“Organized medicine has an opportunity to ensure healthy starts for children, cognitively, behaviorally, and physically by using health care in primary care settings as the intervention venue.” 

Integrating BH into primary care (PC) practice is becoming more prevalent. Small studies have demonstrated that promoting parenting, as well as screening parents and children for behavioral health concerns (e.g., depression) in the PC setting is feasible. There are several barriers to integrating in early child health care, including reimbursement issues for providing this type of care and lack of training in BH for current health professionals. Despite these barriers, efforts to integrate BH into child health care should be promoted and funded. Primary child health care provides an excellent opportunity to behaviorally intervene and improve children’s lifelong health and well-being.

  • Findings from a study recently published in The New England Journal of Medicine indicate a need for increased BH services for children and adolescents within primary care settings. The study found that rates of severe mental illness in youths have dropped substantially in the last decade and outpatient mental health treatment and psychotropic-medication use increased during the same time period, particularly among those with severe mental illness. These findings come from nationally representative survey data from the Medical Expenditure Panel Surveys from 1996-1998, 2003-2005, and 2010-2012, with more than 50,000 persons included in the analysis. While rates of treatment increased, the results also showed that only a quarter of young people with severe mental health issues received psychotherapy and 31percent reported psychotropic medication use, indicating that there may be a need for improved access to BH providers. The majority of young people in this study with severe mental illness received no mental health care. The authors concluded that schools and primary care settings could improve methods for identifying youths most in need of treatment and referring them to get the appropriate care.    

The two studies are at:

http://www.ncbi.nlm.nih.gov/pubmed/?term=JAMA.+2015%3B313%2815%29%3A1509-1510.+doi%3A10.1001%2Fjama.2015.2977.

http://www.nejm.org/doi/pdf/10.1056/NEJMsa1413512