Archives: Resources

Learning and School Health

ABC’s of Learning and School Health

CME Conference from 2018, CA Chapter 1

[LINK here… if we still have it]

AAP Policies

  • School-aged Children Who Are Not Progressing Academically: Considerations for Pediatricians, 2019. Link Celiane Rey-Casserly, Laura McGuinn, Arthur Lavin, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH,SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
    • Pediatrics, Oct 2019, 144 (4) e20192520

ACEs, Trauma Informed Care, and Child Abuse and Maltreatment

 

State and National Level Adverse Childhood Experiences (ACEs) Resources

ACEs Aware

California Surgeon General’s website for ACEs resources and ACEs screening initiative

AAP’s Resilience Project

AAP’s Resilience Project includes a tool kit for health car providers to better understand the effects of exposure to violence and sections of how to improve practice, policy and education, policy and eduction, and creating a medical home children and adolescents exposed to violence.  Peds 21 presentations from 2015 are also included.

 

Trauma Informed Care

The National Child Traumatic Stress Network provides information about trauma, trauma response, and treatments that work.  Also has training opportunities.

Resources for Child Trauma-informed Care

Trauma Informed Pediatric Care: Iowa ACES Data and 21st Century Practice covers the health impact of ACES and provider roles in screening. Trauma Informed Care Scenario.

 

Trainings and Courses

AAP ECHO Trauma and Resilience Course

Telementoring program for health care professionals to learn about and improve the identification, care, management and outcomes of traumatized children and their families in pediatric settings. There are 2 levels to this program.  [Several chapter members have participated in these courses and found them valuable. <– ok to include names/contact/etc?]

– Level 1: Trauma Aware – 6 one-hours weekly sessions

– Level 2: Trauma-Responsive – 12 one-hour weekly sessions

Mind-Body Skills Training for Resilience, Effectiveness, and Mindfulness (STREAM) ​

An innovative on-line education program for health professionals developed by the Ohio State University Center for Integrative Health and Wellness designed to help you learn and practice skills that will help you personally and professionally to become more resilient in the face of stress, more clinically effective in helping patients, and more mindful in your daily life as you learn the latest scientific research about mind-body skills, engage in reflective practices, and use our free online recordings of evidence-based mind-body practices.  Cost approx $25 per module with $15 for registration, bulk discount available at time of this posting.  

Additional educational opportunities related to child abuse and neglect can be found on the Section on Child Abuse and Neglect Website.  Other AAP educational opportunities can be found on Pedialink​. 

AAP Policies on ACEs and Child Maltreatment

 

Resources for Families

Sesame Street in Communities

Sesame Street has videos on traumatic experiences for families (parents or caregivers) and resources for providers for different age levels. They have characters who have experienced homelessness and foster care and have segments helping others better understand and support them. Also available in Spanish.

The Center on the Developing Child

This center from Harvard was created to connect science, programs, and policy. It offers videos and games to explain toxic stress and ways to address it.

 

Explore other Resources:

Anxiety, Depression, and Suicide Risk

Behavioral & Emotional Concerns (Attention, Emotional Dysregulation and Aggression)

Surveillance, Screening and Psychosocial Assessment for Behavioral Health Concerns

or go back to Mental Health Issue Page

Behavioral & Emotional Concerns (Attention, Emotional Dysregulation and Aggression)

 

American Academy of Pediatrics (AAP) Mental Health Initiatives

This site provides videos and tools for behavioral and emotional concerns.

 

Parenting Tools & Training

We know that parental training can help with issues with behavior and emotional regulation (link to article).  Here are some helpful websites and some classic books to get you started.

  • Books:  
    • 1.2,3 Magic by Thomas Phelan book and video (ages 2-12 yrs)
    • The Explosive Child by Ross Greene
    • The Out-of-Sync Child by Carol Kranowitz

 

Explore other Resources:

ACEs, Trauma Informed Care, and Child Abuse and Maltreatment

Anxiety, Depression, and Suicide Risk

Surveillance, Screening and Psychosocial Assessment for Behavioral Health Concerns

or go back to Mental Health Issue Page

 

 

Anxiety, Depression, and Suicide Risk

Medical Education Training in Adolescent Depression and Suicide Screening

 

Anxiety

Websites for Anxiety

Educational materials for patients and families

 

Depression

 

Maternal/Perinatal Depression

 

  • Emotional Wellness Self-Help Tool from Maternal Mental Health NOW guides women who are thinking of having a baby, pregnant, or post-partum in creating a personalized care plan online for themselves in English and in Spanish.  This is also downloadable.

 

  • Medi-Cal extended coverage for new mothers with maternal medical conditions to 90 days to up to 1 year following the last day of pregnancy through the Provisional Postpartum Care Extension (PPCE) Program. This applies to Medi-Cal and the Medi-Cal Access Program, as of August 1, 2020.  (Pregnant individuals in general will continue to be eligible for a 60-day period beginning on the last day of pregnancy. Eligibility ends on the last day of the month in which the 60th day occurs.

 

Apps that Patients Can Use to Help with Anxiety and Depression

  • Breath2Relax   A app that teaches diaphragmatic breathing to help with anxiety
  • Headspace and Calm   Two apps that help teach meditation and relaxation techniques
  • Mood Tools: There are good reviews from the Anxiety and Depression Association of America for this app.  It has a thought diary, psychotherapy and cognitive behavior components.
  • My3:  Developed by the Mental Health Association of New York.  Allows one to develop a crisis intervention plan and provide crisis hotline numbers.

 

Suicide risk

 

Explore other Resources:

ACEs, Trauma Informed Care, and Child Abuse and Maltreatment

Behavioral & Emotional Concerns (Attention, Emotional Dysregulation and Aggression)

Surveillance, Screening and Psychosocial Assessment for Behavioral Health Concerns

or go back to Mental Health Issue Page

Surveillance, Screening and Psychosocial Assessment for Behavioral Health Concerns

A wealth of information regarding mental health concerns can be obtained by establishing trusted primary care relationships and utilizing AAP-recommended components of each well child visit as well as targeted screening of many issues relevant to mental health. Many mental health concerns in the pediatric office setting are elicited through attentive listening, as well as surveillance and screening for potential mental health issues. Surveillance is the routine elicitation of family concerns often performed in the context of a well child exam. Screening is the practice of using a validated instrument to evaluate a possible condition of concern. The Bright Futures/AAP Preventive Pediatric Health Care periodicity schedule contains the most recent recommendations regarding the elements of well child exams and can be found on the AAP website; detailed information, evidence and implementation ideas on each component of the exam are found on the Bright Futures website 7,8.

The Screening Technical Assistance & Resource Center (STAR Center) is an excellent resource for reviewing early childhood screening, counseling, referral and follow-up for developmental milestones, maternal depression and social determinants of health.9 Many tools useful in screening and follow-up of behavioral and emotional problems are available on this website. Most of these tools are free and can be implemented as routine screens during well child exams, or with presenting concerns. Effective screening occurs when routinely integrated into the electronic health record and completed and scored by team members before the primary care provider sees the child. It’s essential to a validated screen in a primary care office, especially with respect to how it the validity correlates with the population seen in your practice.  Screening tools should have a sensitivity and specificity of > 0.70 in order to adequate identify, but not over-identify children with suspected disorders in your practice.

 

Psychosocial/Behavioral Assessments. Persistent or significant adverse childhood experiences, including persistent unbuffered stress and family dysfunction can lead to the development of behavioral and emotional problems in children.  Clinical judgement has not been shown to reliably identify these problems.  These issues are often correlated with familial stresses such as poverty, substance abuse, domestic violence, food and housing instability and mental illness among family members. The AAP Preventive guidelines recommend that pediatric primary care providers assess for the presence of these stresses at every well child visit. An excellent list of Mental Health Tools for Pediatrics provides information on general psychosocial screens that can be used for various age groups, as well as specific screens for substance abuse, adolescent depression, trauma, domestic violence and food insecurity10.

 

Developmental Delay Screening. Developmental delay and autism spectrum disorder may predict future need for family counseling and support as well as referral to programs to optimize the child’s condition.  Developmental delay has been shown to be correlated with mental health concerns as well as toxic stress disorder and when identified, should be followed by further inquiries or screening regarding stress in the family or past experiences of parental stress. Developmental surveillance is recommended at all pediatric well child visits.  Screening for developmental delay is recommended with any concerns raised by the parents, and routinely at 9 months, 18 months, and 30 months. Autism Spectrum Disorder screening is recommended at 18 months and 24 months. Recent AAP policy statements provide up-to-date information on the use of screens for developmental delay and autism11,12.

 

Resources:

  1. Recommendations for Preventive Pediatric Health Care. Bright Futures/American Academy of Pediatrics. https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf. Accessed May 18, 2020.
  2. Bright Futures. AAP. https://brightfutures.aap.org/Pages/default.aspx. Accessed May 18, 2020.
  3. Screening Technical Assistance & Resource (STAR) Center. Bright Futures/AAP. https://brightfutures.aap.org/clinical-practice/pediatric-residency-and-training-programs/Documents/Screening Technical Assistance & Resource Center (STAR Center).aspx. Accessed May 18, 2020. The Screening in Practices Initiative offers information and resources, including screening recommendations, practice tools, and so much more.
  4. Mental Health Tools for Pediatrics. https://downloads.aap.org/AAP/PDF/Mental_Health_Tools_for_Pediatrics.pdf. Accessed May 18, 2020.
  5. Lipkin PH, Macias MM, and The Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics. 2020;145(1), e20193449; DOI: https://doi.org/10.1542/peds.2019-3449
  6. Hyman SL, Levy SE, Myers SM and the AAP Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. 2020; 143(1) e20193447; DOI: https://doi.org/10.1542/peds.2019-3447
  7. Earls MF, Yogman MW, Mattson G et al and The AAP Committee on Psychosocial Aspects of Child and Family Health. Pediatrics. 2019; 143(1), e20183259; DOI: https://doi.org/10.1542/peds.2018-3259.

 

Tips for accessing these materials:  Many of the AAP websites are accessible only for AAP members.  If you want to access one of these sites, go to the member log-in on the AAP website and identify yourself as a member before trying to access the site.  Articles are also available to non-AAP members through your local medical library or on-line reference library.

 

Explore other Resources:

ACEs, Trauma Informed Care, and Child Abuse and Maltreatment

Anxiety, Depression, and Suicide Risk

Behavioral & Emotional Concerns (Attention, Emotional Dysregulation and Aggression)

or go back to Mental Health Issue Page

Identifying Common Mental Health Concerns

Follow along with this case presentation to provide an overview of common mental health concerns.

Case discussion: Julio is a 7-year old Hispanic male brought in to see the pediatrician by his father because of Julio’s recent anxiety. The father says that Julio has always been a shy child. He seems to have increased difficulty with this since starting second grade a few weeks ago; the father notes that he complains that he doesn’t want to go to school, cries the night before school days and refuses to dress for school in the morning.

 

Pediatricians and primary care providers have long recognized that most mental health issues begin in childhood. Half of all lifetime problems with depression and anxiety occur by age 14.  Many of the disorders begin with early symptoms, such as an anxious temperament which may proceed onto social phobia and major depression. Many families have a co-existing mental health or substance use disorder present. A longer duration of symptoms for the child and for the family correlates with risks of future ongoing depression, suicide and lifetime co-morbidities, such as substance use disorder, unemployment and chronic cardiovascular and metabolic diseases1.

The most common mental-health related diagnoses seen in the primary care office are anxiety, depression, ADHD and eating disorders.  We also frequently see oppositional and conduct disorders and occasional bipolar disorders and early psychosis.  The incidence of mental health concerns is increasing in our patient population. A recent article in June 2020 Pediatrics reported that the percentage of children seen in hospital emergency rooms with mental health disorders increased by 60% between 2007 and 2016; the increase in visits for self-harm increased by 329%2. The recognition, management and prevention of mental health disorders has become an increasingly important part of pediatric practice over the past 15 years.

Pediatricians have a unique role in identifying children and assisting families early in the evolution of a mental health concerns.  The symptoms presenting in the office setting are often within the context of a new “problem” or ongoing behavioral concern.  The pediatrician’s role is to work with the family to identify whether or not the targeted behavior is a normal variant for age and whether it seems to be impacting the child’s or family’s daily life and/or developmental progress.

Most of the concerns brought to our attention do not meet the threshold of a mental health diagnosis.  In 2019, the AAP Committee on Psychosocial Aspects of Child and Family Health recommended using the skills and relationships established in primary care to identify the symptoms and precipitating triggers of the disorder, evaluate for diagnostic differentials and co-morbidities, and consider brief interventions and/or referrals3. Targeted interventions for mild presenting symptoms, such as re-establishing family routines, avoiding triggers, or promoting breathing exercises may improve the functioning of the patient and family and prevent further disorders. More significant or persistent disorders may indicate a need for mental health specialty involvement, with pediatric hand-off or provision of integrated care in the pediatric office. These interventions are outlined more thoroughly in two excellent AAP books on this subject and the AAP Mental Health website4,5,6.

 

Resources:

  1. Mental Health By the Numbers. NAMI.org. https://www.nami.org/mhstats. Accessed May 18, 2020.
  2. Lo CB, Bridge JA, SHI J, et al. Children’s Mental Health Emergency Department Visits: 2007-2016. Pediatrics. 2020; 145(5), e20191536; DOI: https://doi.org/10.1542/peds.2019-1536.
  3. Foy JM, Green CM, Earls M and Committee on Psychosocial Aspects of Child and Family Health. Mental Health Competencies for Pediatric Practice. 2020; 144(5) e20192727; https://doi.org/10.1542/peds.2019-2757.
  4. Foy, Jane M ed. Mental Health Care of Children and Adolescents. A Guide for Primary Care Clinicians. American Academy of Pediatrics. 2018. This book was produced through the efforts of many contributors, many of whom served on the AAP Mental Health Leadership Workgroup.  It outlines topics such as “The Pediatric Advantage”, “Enhancing Pediatric Mental Health Care” and gives a lot of algorithms and practical ideas on how to address pediatric mental health and behavioral health issues in the primary care office.
  1. Foy, Jane M ed. Promoting Mental health in Children and Adolescents. Primary Care Practice and Advocacy. American Academy of Pediatrics. 2019. This book aims to help pediatric primary care clinicians to integrate anticipatory guidance on healthy social-emotional development into their practice, identify emerging symptoms of mental health disorders and apply brief evidence-based interventions to the care of children with mental health risks and problems.
  1. AAP Mental Health Initiatives. AAP.org. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Pages/default.aspx7. Accessed May 18, 2020. Available materials include: Sound advice and Tips for Pediatricians, Collaborative Projects, Chapter Action Kit and tools for teaching motivational interviewing and resident curriculum.

Immigration as a Social Determinant of Health

ABSTRACT: Although immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this area. Global patterns of morbidity and mortality follow inequities rooted in societal, political, and economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena-social determinants of health and immigration-has resulted in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.

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