Literature Collection

Rates of mental health, emotional, and behavioral (MEB) problems in the United States continue to rise, with current estimates of 13% to 20% of children having an MEB disorder and an additional 19% with problems causing impairment or distress that do not meet diagnostic criteria for a specific disorder. This clinical report incorporates and expands on recommendations from the 2019 American Academy of Pediatrics policy statement "Mental Health Competencies for Pediatric Practice" as well as "Recommendations for Preventive Pediatric Health Care." It addresses the rising MEB needs of youth since the previous clinical report, "Promoting Optimal Development: Screening for Behavioral and Emotional Problems," was published in 2015. This report outlines specific guidance for MEB screening, identification, and care of children in pediatric primary care. Screening, as part of regular health supervision visits and surveillance, begins within the first month of life to identify postpartum depression in caregivers. Child-focused screening for MEB problems begins at 6 months of age and continues at 12-, 24-, and 36-month health supervision visits, alternating with recommended developmental and autism spectrum disorder screenings at every visit in the Bright Futures Periodicity schedule and additionally when clinically indicated. After age 3, MEB screening continues annually. This report also 1) reviews updated information on prevalence of MEB problems; 2) articulates the current state of detection of these problems in pediatric primary care; 3) addresses how to manage a positive screen; 4) describes barriers to screening, including special population needs, and potential models to address those barriers; and 5) discusses potential changes at a practice and systems level that facilitate successful MEB screening.

BACKGROUND: Methadone is an evidence-based treatment for opioid use disorder (OUD) and pain management. Methadone for OUD may be difficult for some patients to access, particularly those in rural areas. OBJECTIVE: The purpose of this study was to characterize methadone distribution patterns between 2017 and 2019 across the United States. METHODS: The US Drug Enforcement Administration's Automated Reports and Consolidated Ordering System was used to acquire the number of opioid treatment programs (OTPs) per state and methadone distribution weight in grams. Methadone distributions by weight, corrected for state population and number of OTPs, were compared from 2017 to 2019 between states, within regions, and nationally. RESULTS: The national distribution of methadone increased +12.3% for OTPs but decreased -34.6% for pain. Whereas all states saw a decrease in pain distribution, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for OTPs, and most states demonstrated a relatively stable or increasing number of OTPs, with an +11.5% increase nationally. The number of OTPs per 100K state population ranged from 2.1 in Rhode Island to 0.0 in Wyoming. CONCLUSION AND RELEVANCE: Although methadone distribution for OUD was increasing in the United States, the pronounced regional disparities identified warrant further consideration to improve patient access to this evidence-based pharmacotherapy, particularly in the Midwest and West regions. Greater implementation of telehealth and involvement of primary care into opioid treatment practice offer possible solutions to eliminating geographical treatment barriers.