Enhancing Behavioral Health Practice of Primary Care Clinicians: Report From the American Academy of Pediatrics Task Force on Mental Health

Most patients, and certainly most insurance companies, do not think of the pediatrician's office as a medical home of mental health. That has to change, said Jane M. Foy, MD, chair of AAP's Task Force on Mental Health.

Dr. Foy, a professor at Wake Forest University of Medicine, reported on the three goals her task force set for themselves. First and foremost is facilitating system change. If Medicaid and insurance carriers refuse to cover mental health consults, pediatricians won't do them, and children will be worse off.

Several states have programs that are working to correct this problem. North Carolina has a statewide deal with Medicaid, Massachusetts is running a child psychiatry project, Arizona offers over-the-phone consultations, and South Carolina now pushes for routine mental health screening of its children.

With enough work done on the community level, basic pediatric mental health will be accepted as an aspect of pediatrics. Just as a simple case of otitis media doesn't require an otolaryngologist consult, basic mental health can be handled within the practice as well.

The second step for the pediatric community is to build competence among caregivers. The task force is working on a policy statement to augment its psychological knowledge. After that comes the final step, incrementally changing the practice to incorporate this new element smoothly and confidently.

To assist in this final step, there will be an algorithm for providing mental health in primary care settings, tools to screen children and family, tools to assess functioning, and decision support for commonly prescribed medications. A special web site will provide clinical information on treatment guidelines.

But that will only happen if first payment for these new services is forthcoming, and if clinicians are comfortable with their "couch" skills. The process won't be instantaneous -- it may take years. But the talk force's goal of having a child's mind and body both cared for by the same person is within sight.