The Pennsylvania Academy of Pediatrics held its biannual Medical Home Initiative Conference April 11 with a focus on adolescent mental health, particularly suicide screening and prevention. The main messages: (1) Universal screening in primary care will help kids who do not clearly present with suicidal ideation. (2) The right resources can help primary care practices properly screen and treat mental and behavioral health problems.
Keep reading for helpful tips and the latest information on resources, including a statewide youth suicide prevention initiative looking for practices to institute a new screening tool (includes free education and technical assistance).
Pediatric Approach to Mental Health Care
Marry Dobbins, MD
- The importance of experience on development is intuitive, but now there's evidence that stress impacts biological development.
- The Adverse Childhood Experiences Study (ACES) shows neglect and abuse limit "executive" thinking.
- Limited access to consults? Few kids actually need a child psychiatrist. Don't be afraid to try something. Connect with the school district if nothing else.
- A bigger barrier than access is navigating between resources. Families and providers don't know about resources, or they don't know how to access them.
The Pennsylvania Model for Youth Suicide Prevention in Primary Care
Guy Diamond, PhD (diamondg@email.chop.edu)
- Suicide prevention is a continuum. Screening for depression and ideation are part of prevention.
- Screening makes more sense in primary care than schools.
- You're already dealing with mental health; screening won't make it worse.
- Reach out to other mental health providers besides physicians.
- 27 counties have suicide prevention task forces. Click here for county-specific info.
- Participate in the initiative to receive on-site training, use of a computer-based screening tool that auto-calculates, access to developing resources. Looking for family practices in these counties:
- NORTHEAST: Lackawanna, Luzerne, Schuylkill
- SOUTHWEST: Allegheny, Westmoreland
- SOUTHEAST: Berks, Bucks, Chester, Delaware, Montgomery, Philadelphia
- Click here for a resource toolkit including a template for developing partnerships with mental health providers.
Suicide Risk Assessment: After a Positive Screen
Matthew Wintersteen, PhD
- Young people die more often from issues physicians don't learn about in med school.
- 14.7% of Pa. high school students seriously think about suicide.
- Suicidal kids don't clearly present.
- If you screen only when indicated, get good at calling in a crisis.
- If you can't say "suicide," neither will patients. Don't be afraid to use that word.
- Don't take notes while talking to patients about living and dying.
- Acting aor looking hurried appears to be disinterest.
- The stories that drive ideation may be horrible, but you must model hopefulness.
- National Institutes of Health (NIH) study: Kids who will kill themselves usually do it within a month. Have a safety plan.
- A safety plan gives kids something to do when they are suicidal. It tells them how to stay alive. Click here for a sample.
- Self-injurious behavior and suicidal behavior are different, although sometimes overlapping.
Panel Discussions with Pediatric Practices and Behavioral Health Providers
- Screening can slow you down, but it catches suicidal kids who you would never otherwise suspect.
- In these practices, teens take a screen alone in a separate room. No parents should be present.
- Do a meet-and-greet with local mental providers so you know to whom you are referring.
- (One practice referred patients for 20 years to a provider four blocks away but knew nobody who worked there.)
- Multiple contacts between physical health and mental health providers is one of things that is broken in the current system. Best practice: Have a single liaison on both sides who regularly follow-up with each other to make sure the patient is getting the help needed.
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