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1.
N C Med J ; 74(1): 28-33, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23530376

RESUMO

The Bright Futures guidelines published by the American Academy of Pediatrics offer a comprehensive agenda for improving the health of people from birth to age 21 years. The guidelines are the culmination of a century of multidisciplinary, multiorganizational efforts in the United States to prevent illness and promote health in children and adolescents, and, in turn, the adults they become. Regulations interpreting the Patient Protection and Affordable Care Act (ACA) specifically state that group health plans must, at a minimum, provide coverage for the preventive services recommended in the Bright Futures guidelines. Thus the ACA will be an impetus for implementation of the guidelines. This issue brief describes the genesis, history, and development of the guidelines. In addition, it briefly touches on each of the commentaries and other articles contained in this issue of the NCMJ dedicated to the implementation of Bright Futures guidelines.


Assuntos
Serviços de Saúde da Criança/organização & administração , Pediatria/organização & administração , Guias de Prática Clínica como Assunto , Adolescente , Criança , Serviços de Saúde da Criança/normas , Pré-Escolar , Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Humanos , Lactente , Recém-Nascido , North Carolina , Patient Protection and Affordable Care Act , Pediatria/normas , Prevenção Primária/organização & administração , Estados Unidos
2.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31636143

RESUMO

Pediatricians have unique opportunities and an increasing sense of responsibility to promote healthy social-emotional development of children and to prevent and address their mental health and substance use conditions. In this report, the American Academy of Pediatrics updates its 2009 policy statement, which proposed competencies for providing mental health care to children in primary care settings and recommended steps toward achieving them. This 2019 policy statement affirms the 2009 statement and expands competencies in response to science and policy that have emerged since: the impact of adverse childhood experiences and social determinants on mental health, trauma-informed practice, and team-based care. Importantly, it also recognizes ways in which the competencies are pertinent to pediatric subspecialty practice. Proposed mental health competencies include foundational communication skills, capacity to incorporate mental health content and tools into health promotion and primary and secondary preventive care, skills in the psychosocial assessment and care of children with mental health conditions, knowledge and skills of evidence-based psychosocial therapy and psychopharmacologic therapy, skills to function as a team member and comanager with mental health specialists, and commitment to embrace mental health practice as integral to pediatric care. Achievement of these competencies will necessarily be incremental, requiring partnership with fellow advocates, system changes, new payment mechanisms, practice enhancements, and decision support for pediatricians in their expanded scope of practice.


Assuntos
Competência Clínica/normas , Transtornos Mentais/terapia , Saúde Mental , Pediatria/normas , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Política Organizacional , Relações Profissional-Família , Psicologia do Adolescente , Psicologia da Criança
3.
Clin Pediatr (Phila) ; 45(6): 537-43, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16893859

RESUMO

The pressing need for identification and treatment of behavioral health disorders in primary care has renewed interest in the concept of co-located models of care. The purpose of this article is to describe three North Carolina practice models in which mental health professionals are co-located with pediatric primary care providers. Each of the models was sustainable, partly due to systemic changes brought about by advocacy efforts. In addition to providing practical guidance for possible replication in primary care, this article reflects on how advocacy efforts can impact the success of co-location models.


Assuntos
Serviços de Saúde Mental/organização & administração , Pediatria/organização & administração , Administração da Prática Médica , Atenção Primária à Saúde/organização & administração , Humanos , Lactente , Medicaid , Transtornos Mentais/diagnóstico , North Carolina , Equipe de Assistência ao Paciente , Área de Atuação Profissional , Recursos Humanos
7.
Pediatrics ; 115(1): e97-104, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15629972

RESUMO

There remain large discrepancies between pediatricians' practice patterns and the American Academy of Pediatrics (AAP) guidelines for the assessment and treatment of children with attention-deficit/hyperactivity disorder (ADHD). Several studies raise additional concerns about access to ADHD treatment for girls, blacks, and poorer individuals. Barriers may occur at multiple levels, including identification and referral by school personnel, parents' help-seeking behavior, diagnosis by the medical provider, treatment decisions, and acceptance of treatment. Such findings confirm the importance of establishing appropriate mechanisms to ensure that children of both genders and all socioeconomic, racial, and ethnic groups receive appropriate assessment and treatment. Publication of the AAP ADHD toolkit provides resources to assist with implementing the ADHD guidelines in clinical practice. These resources address a number of the barriers to office implementation, including unfamiliarity with Diagnostic and Statistical Manual of Mental Disorders criteria, difficulty identifying comorbidities, and inadequate knowledge of effective coding practices. Also crucial to the success of improved processes within clinical practice is community collaboration in care, particularly collaboration with the educational system. Such collaboration addresses other barriers to good care, such as pressures from parents and schools to prescribe stimulants, cultural biases that may prevent schools from assessing children for ADHD or may prevent families from seeking health care, and inconsistencies in recognition and referral among schools in the same system. Collaboration may also create efficiencies in collection of data and school-physician communications, thereby decreasing physicians' non-face-to-face (and thus nonreimbursable) elements of care. This article describes a process used in Guilford County, North Carolina, to develop a consensus among health care providers, educators, and child advocates regarding the assessment and treatment of children with symptoms of ADHD. The outcome, ie, a community protocol followed by school personnel and community physicians for >10 years, ensures communication and collaboration between educators and physicians in the assessment and treatment of children with symptoms of ADHD. This protocol has the potential to increase practice efficiency, improve practice standards for children with ADHD, and enhance identification of children in schools. Perhaps most importantly, the community process through which the protocol was developed and implemented has an educational component that increases the knowledge of school personnel about ADHD and its treatment, increasing the likelihood that referrals will be appropriate and increasing the likelihood that children will benefit from coordination of interventions among school personnel, physicians, and parents. The protocol reflects a consensus of school personnel and community health care providers regarding the following: (1) ideal ADHD assessment and management principles; (2) a common entry point (a team) at schools for children needing assessment because of inattention and classroom behavior problems, whether the problems present first to a medical provider, the behavioral health system, or the school; (3) a protocol followed by the school system, recognizing the schools' resource limitations but meeting the needs of community health care providers for classroom observations, psychoeducational testing, parent and teacher behavior rating scales, and functional assessment; (4) a packet of information about each child who is determined to need medical assessment; (5) a contact person or team at each physician's office to receive the packet from the school and direct it to the appropriate clinician; (6) an assessment process that investigates comorbidities and applies appropriate diagnostic criteria; (7) evidence-based interventions; (8) processes for follow-up monitoring of children after establishment of a treatment plan; (9) roles for central participants (school personnel, physicians, school nurses, and mental health professionals) in assessment, management, and follow-up monitoring of children with attention problems; (10) forms for collecting and exchanging information at every step; (11) processes and key contacts for flow of communication at every step; and (12) a plan for educating school and health care professionals about the new processes. A replication of the community process, initiated in Forsyth County, North Carolina, in 2001, offers insights into the role of the AAP ADHD guidelines in facilitating development of a community consensus protocol. This replication also draws attention to identification and referral barriers at the school level. The following recommendations, drawn from the 2 community processes, describe a role for physicians in the collaborative community care of children with symptoms of ADHD. (1) Achieve consensus with the school system regarding the role of school personnel in collecting data for children with learning and behavior problems; components to consider include (a) vision and hearing screening, (b) school/academic histories, (c) classroom observation by a counselor, (d) parent and teacher behavior rating scales (eg, Vanderbilt, Conner, or Achenbach scales), (e) consideration of speech/language evaluation, (f) screening intelligence testing, (g) screening achievement testing, (h) full intelligence and achievement testing if discrepancies are apparent in abbreviated tests, and (i) trials of classroom interventions. (2) Use pediatric office visits to identify children with academic or behavior problems and symptoms of inattention (history or questionnaire). (3) Refer identified children to the contact person at each child's school, requesting information in accordance with community consensus. (4) Designate a contact person to receive school materials for the practice. (5) Review the packet from the school and incorporate school data into the clinical assessment. (6) Reinforce with the parents and the school the need for multimodal intervention, including academic and study strategies for the classroom and home, in-depth psychologic testing of children whose discrepancies between cognitive level and achievement suggest learning or language disabilities and the need for an individualized educational plan (special education), consideration of the "other health impaired" designation as an alternate route to an individualized educational plan or 504 plan (classroom accommodations), behavior-modification techniques for targeted behavior problems, and medication trials, as indicated. (7) Refer the patient to a mental health professional if the assessment suggests coexisting conditions. (8) Use communication forms to share diagnostic and medication information, recommended interventions, and follow-up plans with the school and the family. (9) Receive requested teacher and parent follow-up reports and make adjustments in therapy as indicated by the child's functioning in targeted areas. (10) Maintain communication with the school and the parents, especially at times of transition (eg, beginning and end of the school year, change of schools, times of family stress, times of change in management, adolescence, and entry into college or the workforce).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Relações Comunidade-Instituição , Consenso , Pediatria , Instituições Acadêmicas , Adolescente , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Barreiras de Comunicação , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Serviços de Saúde Mental , Metilfenidato/uso terapêutico , North Carolina , Pais , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta
10.
Pediatrics ; 110(6): 1232-7, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12456924

RESUMO

Poor reimbursement of pediatricians for behavioral and developmental services and the disarray of children's mental health services in the state led leaders of the North Carolina chapter of the American Academy of Pediatrics to organize an advocacy effort with the following objectives: 1) to articulate pediatricians' perspective on the current crisis in delivering and coordinating children's behavioral health services; 2) to represent the collective voice of both academic and community pediatricians in dialogue with mental health providers, Medicaid leaders, and the health and mental health segments of state government; 3) to build consensus about an achievable plan of action to address pediatricians' reimbursement and systems issues; 4) to develop a full and appropriate role for pediatricians as providers and, potentially, coordinators of behavioral health care; and 5) to facilitate implementation of Medicaid changes, as a first step in carrying out this plan. This article describes the 24-month process that achieved these objectives.


Assuntos
Serviços de Saúde Mental/organização & administração , Defesa do Paciente , Comitês Consultivos/organização & administração , Criança , Consenso , Educação em Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Medicaid , Serviços de Saúde Mental/normas , North Carolina , Mecanismo de Reembolso/organização & administração , Governo Estadual
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