Literature Collection

Pediatricians are typically the first people families trust to discuss their child's mental health concerns and are uniquely positioned to help address the problem of limited access to mental health services. This article covers brief behavioral interventions pediatricians can use to help treat mild depressive symptoms in the primary care context. Interventions include strategies for talking about depression (eg, validating experiences, normalizing difficulties, and emphasizing whole-body health), educating patients and their families (eg, psychoeducation about signs, symptoms, and treatment options), using brief behavioral and cognitive interventions (eg, behavioral activation and cognitive coping), and including a family and culturally sensitive approach to symptom management. [Pediatr Ann. 2023; 52(11):e413-e417.].

Up to 33% of American adults will experience a diagnosable anxiety disorder in their lifetime. Approximately one-third of anxiety diagnoses assigned by mental health providers in outpatient settings are unspecified. The tendency of many providers to use an unspecified anxiety diagnosis may negatively impact the provision of evidence-based treatments for specific anxiety disorders. This study examines the perspectives of mental health providers working in an integrated and stepped health care system, asking how their roles and responsibilities shape their practices related to diagnosing specific anxiety disorders. The authors conducted semi-structured interviews with 32 Veteran Health Administration (VHA) mental health providers to understand their perspectives on diagnosing anxiety disorders. Matrix analysis was used to identify different roles and responsibilities articulated. Thematic analysis was used to highlight themes across providers' discussion of their roles in diagnosing and treating patients. The results show that, for most providers, assigning a specific diagnosis is a component of duties but rarely their focus. Second, it is unclear in which clinic setting a specific anxiety diagnosis should be made. Finally, among different types of mental health professionals, there is no clear designation on who should be providing a specific anxiety diagnosis. Altogether, results indicate that many providers feel making a specific diagnosis for anxiety is the responsibility of others-either those in other clinic settings or with other credentials. Findings call for clearer guidelines that specify individual clinician accountability for obtaining a specific anxiety diagnosis in a team-based environment.

Combination buprenorphine-naloxone is a cornerstone of outpatient treatment for substance use disorder, and is more widely accessible in primary care. Because oral buprenorphine has been diverted and abused for its euphoric properties, a combination formulation was developed and will trigger withdrawal symptoms if injected IV.