NAPNAP Position Statement on Integration of Mental Health Care in Pediatric Primary Care Settings

published online 28 July 2007.

Article Outline

The National Association of Pediatric Nurse Practitioners (NAPNAP) acknowledges the importance of providing comprehensive mental health services, including prevention, screening, early intervention, and follow-up for children in need. Mental and behavioral health disorders affect 15 million children and adolescents and are associated with disabling morbidity, significant mortality, and substantial health care costs (Centers for Disease Control and Prevention 2006, Mark and Buck 2006, National Mental Health Association 2005). Fewer than 35% of affected children and youth receive treatment for their disorders (Centers for Disease Control and Prevention 2006, Stein et al 2006) because of a lack of appropriate screening and identification by primary care providers (PCPs) (Melnyk, Brown, Jones, Kreipe, & Novak, 2003), a critical shortage of child psychiatrists and other pediatric mental health providers in the United States (Kim, 2003), and inadequate reimbursement for mental health services in primary care settings (American Academy of Pediatrics, 2000). In addition, substantial stigma about mental health problems results in denial by families and reluctance to talk with their PCPs about the problems (Melnyk et al, 2002).

Primary care practices are an optimal setting in which to promote the physical, developmental, and mental health of children and adolescents and to identify and implement early interventions for mental and behavioral health disorders. To advocate for improved mental health screening and earlier intervention in primary care settings, NAPNAP asserts the following:

1.Using a lifespan approach, mental health promotion and screening starts at the beginning of life and continues through adolescence into adulthood.

2.Optimal physical and mental health in childhood and adolescence lays the foundation for physical and mental well-being in adulthood.

3.All children and adolescents have the right to high-quality culturally competent mental and physical health care (NAPNAP, 2006).

4.Pediatric nurse practitioners (PNPs) in primary care and school-based settings should integrate prevention, screening, and early identification of mental health problems into routine pediatric health care, including screening parents for mental health disorders (Olson, Dietrich, Prazar, & Hurley, 2006) and incorporating the use of screening tools such as the KySS Guide for Child and Adolescent Mental Health Screening, Early Intervention and Health Promotion (Melnyk & Moldenhauer, 2006) and Bright Futures in Practice: Mental Health-Volume II. Tool Kit. (Jellinek, Patel, & Froehle, 2002).

5.PNPs and other PCPs should implement early evidence-based interventions for common mental and behavioral health problems.

6.PNPs and other PCPs should refer children with complex mental health problems to mental health specialists and work collaboratively with them to deliver appropriate treatment.

7.PNPs and other PCPs are responsible for continuously educating families about early signs and symptoms of mental and behavioral health problems and promoting mental health.

8.PNPs and other PCPs are strongly encouraged to work for adequate reimbursement for mental health services provided to children in primary care settings.

9.All nurse practitioners are encouraged to expand their knowledge and skills in mental health promotion, assessment, and early intervention and to develop relationships with mental health professionals in the community to ensure competent provision of care for common mental health problems in primary care settings.

10.PNP programs should include didactic and clinical practicum experiences in mental health assessment, mental health promotion, early evidence-based interventions, and mental health case management for the most common mental health disorders in children and adolescents.

11.NAPNAP supports legislative and other efforts that target children’s mental health needs at the local, state, and federal level.

In summary, NAPNAP, an organization that promotes optimal health for children, acknowledges the importance of providing comprehensive mental health services to all children. Furthermore, NAPNAP acknowledges the unique contribution that PNPs in the primary care setting can make in the prevention, screening, early intervention, and follow-up of children in need of mental health services.

The National Association of Pediatric Nurse Practitioners would like to acknowledge the following members for their contribution to this statement:

Bernadette Melnyk, PhD, RN, CPNP/NPP, FAAN, NAPNAP KySS Program National Chair

Dian Baker, MA, MSN, CPNP

Elizabeth Hawkins Walsh, PhD, CPNP

Gail Hornor, MS, CPNP

Maryellen Pachler, MSN, APRN, BC

Mary T. Sheppard, MS, RN, PNP, BC

Kathleen Wilson, DSN, CPNP, APRN,BC/FNP

Heather Keesing, MSN, RN, APRN, BC, NAPNAP Staff

Dolores C. Jones, EdD, RN, CPNP, CAE, NAPNAP Staff

References

American Academy of Pediatrics 2000. 1.American Academy of Pediatrics. Insurance coverage of mental health and substance abuse services for children and adolescents: A consensus statement. Pediatrics. 2000;106:860–862(RE0090).

Centers for Disease Control and Prevention 2006. 2.Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States, 2005. Morbidity and Mortality Weekly Report. 2006;55(SS-5):1–107.

Jellinek et al 2002. 3.Jellinek M, Patel BP, Froehle MC. Bright futures in practice: Mental health—Volume II (Tool kit). Arlington, VA: National Center for Education in Maternal and Child Health; 2002;.

Kim 2003. 4.Kim WJ. Child and adolescent psychiatry workforce: A critical shortage and national challenge. Academic Psychiatry. 2003;27:277–282. MEDLINE | CrossRef

Mark and Buck 2006. 5.Mark TL, Buck JA. Characteristics of U.S. youths with serious emotional disturbance: Data from the national health interview survey. Psychiatric Services. 2006;57:1573–1578. MEDLINE | CrossRef

Melnyk and Moldenhauer 2006. 6.Melnyk BM, Moldenhauer Z. The KySS guide to child and adolescent mental health screening, early intervention and health promotion. Cherry Hill, NJ: NAPNAP; 2006;.

Melnyk et al 2003. 7.Melnyk BM, Brown H, Jones DC, Kreipe R, Novak J. Improving the mental/psychosocial health of U.S. children and adolescents: Outcomes and implementation strategies from the national KySS summit. Journal of Pediatric Health Care. 2003;17(6 Suppl):S1–S24. Full Text | Full-Text PDF (3353 KB) | CrossRef

Melnyk et al 2002. 8.Melnyk BM, Feinstein NF, Tuttle J, Moldenhauer Z, Herendeen P, Goodwin TG, et al. Mental health worries, communication, and needs in the year of the U.S. terrorist attack: National KySS survey findings. Journal of Pediatric Health Care. 2002;16:222–234. Abstract | Full Text | Full-Text PDF (106 KB) | CrossRef

National Association of Pediatric Nurse Practitioners 2006. 9.National Association of Pediatric Nurse Practitioners. Position statement on access to health care. Cherry Hill, NJ: NAPNAP; 2006;.

National Mental Health Association 2005. 10.National Mental Health Association. Children’s mental health statistics. 2005;Retrieved February 14, 2007, from http://www.mentalhealthamerica.net/index.cfm?objectid=CA866DDE-1372-4D20-C83ED60B9B5EEA52.

Olson et al 2006. 11.Olson AL, Dietrich AJ, Prazar G, Hurley J. Brief maternal depression screening at well-child visits. Pediatrics. 2006;118:207–216.

Stein et al 2006. 12.Stein REK, Zitner BA, Jensen PS. Interventions for adolescent depression in primary care. Pediatrics. 2006;118:669–682.

Adopted by the National Association of Pediatric Nurse Practitioners’ Executive Board on May 24, 2007.

All regular position statements from the National Association of Pediatric Nurse Practitioners automatically expire 5 years after publication unless reaffirmed, revised, or retired before that time.

Correspondence: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633.

PII: S0891-5245(07)00220-9

doi:10.1016/j.pedhc.2007.06.006

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