Literature Collection

OBJECTIVE: The purpose of the study was to evaluate pediatric residents' self-reported comfort in screening, assessment, and treatment of common child mental health problems before and 1 year after piloting an integrated mental health (IMH) rotation. METHODS: Residents evaluated patients with mental health problems in their continuity clinic. Residents were supervised remotely by a child psychiatrist. Residents rated their comfort in mental health skills on a scale from 1 = very uncomfortable to 5 = very comfortable before and 1 year after the rotation was implemented. Changes in mean comfort in screening, assessment, and treatment of child mental health problems were calculated. RESULTS: Baseline pediatric resident (n = 62) comfort in providing IMH care was low, with modestly higher rates for screening and assessment than treatment. Fewer than half of the residents at baseline were comfortable with any of the aspects of treatment. At 1 year follow-up, resident (n = 64) overall comfort in treatment significantly increased from baseline (3.3 ± 0.8 versus 2.8 ± 0.8, p ≤ 0.003). There was a significant increase in the proportion of residents who reported comfort screening for attention-deficit/hyperactivity disorder (ADHD) (63.9% vs. 79.7%, p ≤ 0.050), educating families about mental health problems (33.3% vs. 51.6%, p ≤ 0.041), and starting a medication for ADHD (36.2% vs. 54.0%, p < 0.05) from baseline to follow-up. CONCLUSION: This IMH rotation allowed residents to improve their comfort in treating children with mental health conditions. Remote supervision by a child psychiatrist for IMH may be practical for dissemination given the limited workforce of child psychiatrists.

OBJECTIVE: Trauma exposure and traumatic stress are common drivers of mental health morbidities. However, trauma screening has not been widely adopted. The goal of this study was to describe rates of trauma exposure and traumatic stress symptoms, as well as clinical associations of trauma with depression, anxiety, and suicidality among youth at well-child visits. METHOD: Youth aged 11 to 19 years presenting to primary care clinics for well-child visits between July 2022 and June 2024 were included for this analysis. As part of routine care, youth completed the "Triple Screen" including the Pediatric Traumatic Stress Screening Tool, the Patient Health Questionnaire - Adolescent version, and the Generalized Anxiety Disorder 7. When indicated, the Columbia Suicide Severity Rating Scale (C-SSRS) was completed. RESULTS: Of 24 675 youth, 15.5% (3832) reported trauma exposure, and 7.5% reported moderate or high symptoms of traumatic stress. Female and Hispanic (all P < .001) youth were more likely to report a traumatic experience. Only half of youth with high traumatic stress symptoms had high anxiety and/or depression symptom scores. High traumatic stress symptoms were more common among older, female, and Hispanic individuals and those with prior mental health diagnoses (all P < .001). Adolescents with trauma and high traumatic stress were 10 times more likely to be at high risk for suicide relative to those with low or moderate traumatic stress, representing 48% of all youth at high risk for suicide. CONCLUSION: Trauma exposure and traumatic stress are prevalent among youth in primary care. Trauma screening in primary care can help identify youth at risk of mental health morbidities.