Primary Care Pediatricians' Roles and Perceived Responsibilities in the Identification and Management of Depression in Children and Adolescents

Olson, Ardis L.; Kelleher, Kelly J.; Kemper, Kathi J.; Zuckerman, Barry; Hammond, Cristina S.; Dietrich, Allen J.

doi:10.1367/1539-4409(2001)001<0091:pcprap>2.0.co;2

Cited by 173 publications

(143 citation statements)

References 21 publications

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“…Although reimbursement is not the leading barrier to providing mental health care reported by pediatric practitioners, it is one of those most commonly cited (Olson et al 2001;Horwitz et al 2007;Wiley et al 2004). As with all efforts to improve the quality of mental health services in primary care, financial incentives for clinicians may facilitate the adoption of a common factors approach.…”

Section: Implications For Those Who Fund Primary and Mental Health Carementioning

confidence: 99%

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A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care

Wissow

Anthony

Brown

et al. 2008

Adm Policy Ment Health

107

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To expand the mental health service capacity of pediatric primary care, we ask whether there are evidence-based skills to allow providers to 1) immediately begin treatment for children with emotional and behavioral problems while diagnostic procedures are being pursued, and 2) offer evidence-based care to children who do not meet criteria for a specific diagnosis. We discuss why the epidemiology of child mental health problems poses difficulties for disorder-specific mental health interventions, and review evidence that "common factors" contributing to the outcome of mental health treatments define a core set of skills that primary care providers might use to complement disorder-specific interventions.

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Section: Implications For Those Who Fund Primary and Mental Health Carementioning

confidence: 99%

“…When problems are found, consultation and referral sources are limited (World Health Organization 2005). In addition, pediatric providers report that they lack the skills and knowledge to manage most mental health problems (Olson et al 2001). …”

Section: Introductionmentioning

confidence: 99%

A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care

Wissow

Anthony

Brown

et al. 2008

Adm Policy Ment Health

107

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“…11,12 A reluctance to discuss psychological problems with young people, even when GPs perceive such problems to be present, contributes to low rates of identification. 8,13 Even following identification, many young people with psychological disorders receive no specific management or follow-up, 8 perhaps because health professionals hesitate to address issues when they lack confidence in their own skills, or in the treatments available. 14 An authoritative statement that (in this age group) symptoms of depression are common and often resolve without psychological or medical intervention may have influenced practitioners.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic identification of depression in young people: lessons fromthe introduction of a new technique in general practice

Iliffe¹,

Gallant²,

Kramer³

et al. 2012

Br J Gen Pract

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BackgroundMild-to-moderate depression in young people is associated with impaired social functioning and high rates of affective disorder in adult life. Earlier recognition of depression in young people has the potential to reduce the burden of depression in adulthood. However, depression in teenagers is underdiagnosed and undertreated. AimTo assess the usability and usefulness of a cognitive-behavioural-therapy-based technique for Therapeutic Identification of Depression in Young people (TIDY). Design and settingA qualitative study of four group practices in northwest London. MethodFace-to-face semi-structured interviews were conducted with practitioners who had been trained in the use of the TIDY technique. ResultsTwenty-five GPs and six nurses were interviewed. The key themes that emerged from the interviews were: practitioners were 'making sense of teenage depression' when interpreting signs and symptoms; the training in the technique was variable in its impact on practitioners' attitudes and practice; and time factors constrained practitioners in the application of the technique. ConclusionThe TIDY technique is usable in routine practice, but only if practitioners are allowed to use it selectively. This need for selectivity arises partly from concerns about time management, and partly to avoid medicalisation of psychological distress in young people. The perceived usefulness of the TIDY technique depends on the practitioner's prior knowledge, experience, and awareness. . 16 They specifically recommend that primary care professionals should be trained in the detection of depression but there has been little systematic study of how this can be achieved.There are two problems that must be overcome if the NICE guidelines are to be implemented. First, young people with psychological morbidity are difficult to engage in psychological therapies, 17 although such therapies appear to be effective in reducing symptoms and case prevalence. 18 Second, specialist child and young people's mental health services are already struggling to meet the demand for services. It is therefore important that specialist services are focused on those with the more severe disorder.Improved skills in primary care would improve identification of those with severe depression requiring referral, and facilitate intervention for mild-to-moderate depressive disorders within the primary care setting, thus broadening access to treatment for many young people. While there is at least one suitable and valid screening instrument for detecting depression in young people in primary care, 19 there is no solution to the problem of engaging young people in therapy.An approach that supports GPs in both identifying hidden psychological morbidity and engaging young persons in therapy ('therapeutic identification') in an opportunistic way during routine consultations would fit the NICE proposals.Such an intervention has been developed in a joint project between specialists in adolescent psychiatry and GPs, 20 and consists of a workplace-based trai...

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“…[20][21][22][23] Pediatricians report high perceived responsibility for diagnosing depression, but low confidence in their ability to do so, and highlight time constraints as a key barrier to gathering adequate psychiatric history. 24 Mental health toolkits developed by the American Academy of Pediatrics (AAP) and Bright Futures are important steps to improve primary care response to mental health problems 25,26 ; although establishing clinically meaningful, evidence-based practice standards would contribute further to improving practice. The National Quality Strategy of the 2010 Patient Protection and Affordable Care Act has endorsed measuring and tracking quality indicators (QIs) as a strategy to improve health care quality, [27][28][29] but despite recognition of child mental health care as a national priority, 30 few child mental health QIs have received widespread support.…”

mentioning

confidence: 99%

Evidence for the Management of Adolescent Depression

et al. 2013

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Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested. Pediatrics 2013;132:e996-e1009

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Primary Care Pediatricians' Roles and Perceived Responsibilities in the Identification and Management of Depression in Children and Adolescents

Cited by 173 publications

References 21 publications

A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care

A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care

Therapeutic identification of depression in young people: lessons fromthe introduction of a new technique in general practice

Evidence for the Management of Adolescent Depression

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