Encouraging Parental Reflective Functioning in Caring for the Adolescent Patient: Opportunities to Foster Connection.

Parental reflective functioning is the capacity for parents to understand how their actions and those of their children are affected by both their thoughts and emotions. Strong reflective functioning skills can be especially helpful for families of adolescents, to build understanding and connection during a time of great developmental change. This article offers pediatricians ways that they can encourage and strengthen parental reflective functioning while providing anticipatory guidance and supporting families through times of conflict or stress. [Pediatr Ann. 2023;52(11):e409-e412.].

International perspective on integrated care models in child and adult mental health.

The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.

Impact on Child Psychiatry.

The American pediatric mental health system is in crisis; the COVID-19 pandemic highlighted and exacerbated existing gaps. All youth were affected by the pandemic, an impact medicated by mental illness, the closing of schools, reduced access to mental health services, loss and bereavement, and financial and emotional stress on families. The pandemic's fallout is likely to be felt for years to come as today's youth move through successive developmental stages. Improvements in health care systems for youth, innovations in how care is delivered, and ongoing community support for recovery and resilience are needed moving forward.

Nonsuicidal Self-Injury in Youth: A Primer for Pediatricians.

Nonsuicidal self-injury (NSSI) is a relatively common occurrence in youth, and pediatricians must be prepared to address this behavior in their patients in an open and nonjudgmental way. Although NSSI is done without suicidal intent, its occurrence does increase the risk for suicide and is often found with other diagnosable psychiatric conditions. Screening for NSSI should be accompanied by screening for suicidal ideation and comorbid psychiatric disorders to ensure that the patient's current risk is properly assessed and that they have access to the right resources and treatments. This article is a primer for primary care pediatricians for how to talk about and address NSSI in their patients. [Pediatr Ann. 2021;50(2):e72-e76.].

Impact of Child Psychiatry Access Programs on Mental Health Care in Pediatric Primary Care: Measuring the Parent Experience.

OBJECTIVE: This study aimed to assess parents' satisfaction with the primary care provider (PCP) in the treatment of their child's mental health problems after the PCP consulted with the Massachusetts Child Psychiatry Access Program (MCPAP). It studied how parental satisfaction may vary across factors, including service utilization, parental perception of the child's illness, and parental perception of certain PCP attributes. METHODS: The study analyzed 374 telephone consultations made from PCPs to MCPAP between March 2010 and June 2012. Questions in a structured telephone survey administered to parents identified the types of services participants were referred to and assessed satisfaction rates on the basis of measures reflective of the patient-doctor relationship and of illness factors. RESULTS: Eighty-six percent of participants expressed satisfaction with their PCP's handling of their child's mental health problems after MCPAP consultation. Participants who agreed with statements reflective of a positive patient-doctor relationship (in terms of the PCP's empathy and knowledge) exhibited higher rates of satisfaction with the PCP's role in the treatment of their child's mental health problems than those who did not agree. The most common recommendations made to families after consultation were to follow up with the child's PCP (94%) and to obtain further MCPAP consultation (78%). CONCLUSIONS: The survey results indicated high rates of parents' satisfaction with the PCP's handling of their child's mental health issues. Recommendations made to PCPs by MCPAP consultants aimed to strengthen the PCP's role as a mental health provider.

Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities.

The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. Providers were less likely to have available appointments for children on Medicaid, which is public insurance for low-income people. The most common reason for being unable to make an appointment was that the listed phone number was incorrect. Pediatricians were twice as likely to see new patients and to see them sooner than child psychiatrists. Increasing the number of both types of providers may be necessary to increase access to mental health care for children.

Liver transplant and quality of life in the pediatric population: a review update (2013-2014).

PURPOSE OF REVIEW: Liver transplantation is emerging as the treatment of choice for children with end-stage liver disease and some cases of acute liver failure. Owing to improvements in the surgical and medical management of liver transplantation, most patients survive surgery and do well physically in the posttransplant period. However, quality of life (QOL) for these children remains below expectation and is associated with poor psychological and social functioning. In this article, we review the recent literature and provide an opinion regarding QOL in pediatric liver transplant (PLT) patients and possible interventions to optimize it. RECENT FINDINGS: We reviewed articles published in 2013 and 2014 reporting QOL in PLT survivors. Our review of the literature suggests that children undergoing liver transplantation have varying degrees of QOL in the post transplantation period despite improvements in medical and surgical managements. SUMMARY: It is important to proactively identify and address psychological difficulties in patients and their families prior to transplant. Following transplantation, a multidisciplinary approach to targeting rehabilitation and decreasing negative effects of the transplant may assist with improving the QOL for patients and their families.