How Pediatric Team-Based Care Can Improve Mental Health

In October, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) issued a joint statement declaring the U.S. was facing a new national emergency: the rapid increase in the number of children and adolescents living with anxiety, depression, and suicidal thoughts.

American Academy of Pediatrics President Lee Savio Beers, MD, FAAP, referred to the proclamation as “an urgent call to policymakers at all levels of government” to “treat this mental health crisis like the emergency it is.”

While the COVID-19 pandemic wasn’t the only factor, it shed light on the gaps in child and adolescent mental health care, especially when a patient experiences a crisis.

Mental health conditions in children and adolescents have widespread impacts on the healthcare system. In a study of emergency service utilization throughout the pandemic, The Centers for Disease Control and Prevention found that “the number of mental health-related ED visits among children decreased 43 percent concurrent with the widespread implementation of COVID-19 mitigation measures; simultaneously, the proportion of mental health-related ED visits increased sharply beginning in mid-March 2020 and continued into October with increases of 24 percent among children aged 5 through 11 years and 31 percent among adolescents aged 12 through 17 years,” compared to 2019.

The areas with the highest concentration of emergency department visits were those that had taken precautions against the virus by “closing schools and restricting non-emergent care,” with people of color being the most vulnerable. The long-term effects of untreated mental illness can bleed into adulthood. Adults who experienced untreated mental health issues as a child are three times as likely to have adverse outcomes as they age.

The Reality of Pediatric Mental Health Conditions

Mental health conditions among children and teens have a new harsh reality. According to a 2019 study by the Centers for Disease Control and Prevention, the number of youth experiencing depressive symptoms and making suicide plans has increased by 40 percent over the last ten years. Suicide is now the second leading cause of death among those aged 10 to 24.

A number of factors can increase the risk of mental health conditions in young people, some of which are:

• Social media: Teens who use social media (Twitter, Facebook, YouTube, TikTok, SnapChat, Instagram, Tumblr, and Reddit) more than three hours a day are more likely to experience depressive symptoms.
• Trauma: Bullying, cyberbullying, abuse, dysfunction at home, death of family members or friends, and other traumatic events.
• Social determinants: Genetics, ethnicity, race, poverty, racism, and location are all risk factors for mental health conditions.

The COVID-19 pandemic exacerbated the stress patients faced because of their circumstances. A 2020 study estimates that, globally, 23.8 percent of children have been diagnosed with “significant clinical depression” and 19 percent are living with anxiety. Both results are a “more than two-fold increase in prevalence rates compared with those reported prior to the pandemic.” The problems are further complicated by the gaps that exist in pediatric mental health treatment. Researchers estimate that roughly 75 percent of children and adolescents with mental health disorders go untreated for several reasons that include barriers to access and social stigma.

How Team-Based Care Can Help

Team-based care has proven effective in some studies. Instead of working alone, pediatricians engage a team of pediatricians or child and adolescent mental health experts to triage and care for young patients.

Not all pediatrics offices have the resources to build an extensive collaborative care model, but there are several approaches they can take. According to the AACAP, there are three main types of collaborative care models in pediatric primary care:

• Consultation: the clinician screens the patient by phone, telepsychiatry, or appointment. These can be done in an informal way, where a child and adolescent psychiatrist receives information from the clinician and provides advice; a formal collaboration, where the clinician discusses the patient in more detail and is responsible for treatment; or in a formal way, where the psychiatrist evaluates the patient and provides recommendations to the clinician.
• Co-location: the primary care clinician works with child and adolescent psychiatrists at their practice to streamline and enhance care coordination.
• Collaborative/Integrative: the primary care clinician and a child and adolescent psychiatrist co-manage the patient’s care.

Early studies on collaborative care interventions in the pediatric setting show promising results. The Reaching Out to Adolescents in Distress Study, also known as the ROAD Study, studied intervention for youth living with depression and found they were more likely to respond to treatment (68 percent compared to 39 percent) and experience remission (50 percent compared to 27 percent) than the control group.

Team-based care can help pediatricians deliver care that is sensitive to the patient’s needs and their cultural background. Studies suggest that collaborative care models that use population health measurements, “evidence-based mental health services, treatment-to-target, psychiatric consultation, and health information technology” may be the most successful at treating patients. Collaborative care models may also utilize health care services, such as virtual health, that can integrate directly with the pediatrician’s electronic health record (EHR). Fully integrated technology can help optimize workflows and improve team dynamics.

However, pediatricians do not have to research and implement these tools on their own; they can partner with a managed services organization (MSO) or a physician-enablement company that can help pediatricians gain access to this technology. With the right tools, talent, and technology, pediatricians may be able to significantly improve patient mental health outcomes with a collaborative care model.

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