1. Resolving Ethical Issues 1.01 Misuse of Psychologists’ Work 1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority 1.03 Conflicts Between Ethics and Organizational Demands 1.04 Informal Resolution of Ethical Violations 1.05 Reporting Ethical Violations 1.06 Cooperating With Ethics Committees 1.07 Improper Complaints 1.08 Unfair Discrimination Against Complainants and Respondents

Ethical Principles of Psychologists and Code of Conduct

Mental health disorders affect 1 in 5 children; however, the majority of affected children do not receive appropriate services, leading to adverse adult outcomes. To meet the needs of children, pediatricians need to take on a larger role in addressing mental health problems. The accompanying policy statement, "Mental Health Competencies for Pediatric Practice," articulates mental health competencies pediatricians could achieve to improve the mental health care of children; yet, the majority of pediatricians do not feel prepared to do so. In this technical report, we summarize current initiatives and resources that exist for trainees and practicing pediatricians across the training continuum. We also identify gaps in mental health clinical experience and training and suggest areas in which education can be strengthened. With this report, we aim to stimulate efforts to address gaps by summarizing educational strategies that have been applied and could be applied to undergraduate medical education, residency and fellowship training, continuing medical education, maintenance of certification, and practice quality improvement activities to achieve the pediatric mental health competencies. In this report, we also articulate the research questions important to the future of pediatric mental health training and practice.

https://pediatrics.aappublications.org/content/pediatrics/144/5/e20192758.full.pdf

Achieving the Pediatric Mental Health Competencies.

Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model. The current study evaluates the field test of the practitioner-informed model to facilitate interdisciplinary collaboration (PIM-FIC), a systematic approach to improving inter-professional collaboration by building relationships and enhancing communication between pediatric mental health and primary care practices. Thirty-nine providers at two mental health and two pediatric primary care practices participated in a pilot project and completed surveys prior to and following their participation. Key informant interviews were also conducted prior to the project. Participating practitioners’ survey and interview responses indicate that the quantity and quality of communication between pediatric mental and medical health care providers increased post-project, as did satisfaction with overall collaboration. Improving relationships and communication are first steps in building the infrastructure to support effective coordinated care. Project results highlight practical and easily implemented strategies that pediatric mental health and primary care practices can take to strengthen their collaboration. Findings also suggest a need for collaborative care policies and competencies for child mental health providers working in freestanding practices within the PCMH-N.

Strengthening the Coordination of Pediatric Mental Health and Medical Care: Piloting a Collaborative Model for Freestanding Practices

Background As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care. Methods We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability). Results We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models. Conclusions Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.

Implementation of Off-Site Integrated Care for Children: A Scoping Review.

As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental health providers would differ in their care of patients with mental health concerns when compared to PPCPs not in such relationships. To explore differences between PPCPs who have relationships with mental health care providers and those who do not with regard to their care of children with mental health concerns. Seventy-two PPCPs completed a mailed survey addressing topics such as comfort levels diagnosing and managing patients with behavioral health disorders, perceived barriers to care, activity related to prescribing psychotropic medications, and availability of consultation with mental health specialists. More than one-third (19 providers) of providers reported no specialized training in behavioral pediatrics and nearly 45 % (32 providers) indicated having a relationship or partnership with a mental health specialist. Those providers who reported relationships indicated greater availability of consultation and communication with psychiatric providers as well as telephone consultation with non-psychiatric mental health providers. All providers were more comfortable assessing as opposed to treating children with disorders, with the exception of attention disorders, which providers were comfortable with both treating and assessing. For all conditions, there was no main effect for partnership. While partnerships may be associated with greater availability of consultation and communication, for this sample of PPCPs there was no evidence of advantage with respect to diagnosis and management. The paper concludes with a discussion of study limitations, the need for further research, and suggestions for practice.

Pediatric Primary Care Providers’ Relationships with Mental Health Care Providers: Survey Results

As many as 15 million children and adolescents in the United States are in need of behavioral health services, and it is often the pediatric primary care system that is their first contact with formal assessment and intervention services. However, pediatric primary care providers (PPCPs) face challenges to assessing and managing children with behavioral health concerns, including lack of time, lack of training, and lack of behavioral health specialists to whom they can refer. The Connecticut Behavioral Health Partnership has forged relationships between primary care and behavioral health providers through its enhanced care clinic (ECC) initiative, which focuses on improved access to behavioral health services and coordination of care for children insured by Medicaid. We report on interviews with 24 PPCPs and 8 staff/administrators from 12 pediatric practices throughout the state about their experiences with the ECCs. The majority of participants expressed satisfaction with the behavioral health partnerships and, based on their experience, would join the partnership again.

Kristen H Marcaly

Papers

Connecticut's enhanced care clinic initiative: early returns from pediatric-behavioral health partnerships.