Early Childhood Referrals by HealthySteps and Community Health Workers.

This study explored how a community health worker (CHW) within a primary care team with a HealthySteps (HS) Specialist impacted referrals to social determinant of health resources for families with children aged birth to 5 years. Medical charts with documentation of HS comprehensive services between January and June 2018 were reviewed at 3 primary care clinics: 2 with an HS Specialist (HSS Only) and 1 with an HS Specialist and CHW (HSS + CHW). Eighty-six referrals were identified, 78 of which had documented outcomes. Outcomes were categorized as successful, unsuccessful, and not documented. The HSS + CHW group had a higher rate of successful referrals (96%) than the HSS Only group (74%). Statistical analysis (χ2 = 8.37, P = .004) revealed a significant association between the referral outcome and having a CHW on a primary care team with an HS Specialist. Therefore, primary care practices should consider adapting their HS model to include CHWs.

Treating postpartum mood and anxiety disorders in primary care pediatrics.

Postpartum psychiatric disorders represent a significant public health problem that has not been readily addressed, particularly in the primary care setting. As maternal mood and anxiety difficulties are associated with a number of adverse outcomes for the mother, her offspring and the family system, addressing these concerns during the perinatal period is of critical importance. Although researchers and clinicians have become increasingly aware of the problem, postpartum mood and anxiety disorders (PMADs) remain widely unrecognized and poorly understood by both patients and providers. As pediatric primary care providers encounter mothers repeatedly throughout the postpartum period, the pediatric clinician has the unique opportunity to intervene with mothers suffering from mental illness. Given the potentially devastating impact of PMADs across multiple domains, the purpose of this article is to provide guidelines for pediatric clinicians to better manage maternal mental illness within the primary care pediatric setting. As such, we review the categories and prevalence of PMADs and provide strategies for responding to a positive PMADs screen or concerns raised during surveillance of the mother-infant-dyad. In addition, we offer a summary of the literature on evidence-based treatments for PMADs to allow pediatricians to guide the parents of their patients towards the most effective interventions. Finally, we provide an overview of alternative treatment models that can facilitate the screening and treatment of behavioral health concerns within the primary care setting.

Toddler anxiety disorders: a pilot study.

OBJECTIVE: This research examined the validity of criteria for diagnosing social phobia (SOC) and generalized anxiety disorder (GAD), where the DSM-IV criteria were modified to better identify toddlers who could have these disorders. METHOD: Diagnoses were made with a semistructured clinical interview that included child observations. Parents and caregivers completed child behavior, temperament, and socioemotional functioning questionnaires to test convergent and discriminant validity. RESULTS: Of 72 children, 18 months to 5 years old, 19 met modified SOC criteria (8 met DSM-IV criteria SOC also), 29 met modified GAD criteria (5 met DSM-IV criteria GAD also), and 35 met no anxiety disorder criteria. Children with modified SOC were more likely than nonanxious children to display higher levels of anxiety symptoms and shyness/inhibition and to have anxious parents. Modified SOC did not relate to the nonanxiety constructs (cuddling, imaginary play, fine motor). Children with modified GAD did not consistently demonstrate higher levels of anxiety symptoms, did not have more anxious parents than nonanxious children, and did not have higher mean scores on the nonanxiety constructs. CONCLUSIONS: This research provides initial evidence supporting convergent and discriminant validity for the modified SOC criteria but not the modified GAD criteria.