Mental Health Care in Pediatric Practice ii Action/ Process Start Stop Decision Chart color code: Causes for Concern, Tab 1 First Response, Tab 2 Next Steps, Tab 3 Symptomatic Care, Tab 4 Abbreviations: ACE, adverse childhood experience DBP, developmental-behavioral pediatrician MH, mental health PCC, primary care clinician RHS, routine health supervision S-E, social-emotional SUD, substance use disorder. Legend Family-centered care plan Summarize strengths & needs (patient & family) Articulate patient’s & family’s goals Reach agreement with family, school, agencies (+ MH specialists & pediatric subspecialists, if involved) on care components, including psychoeducation & plan for emergency care Define roles of family and others 17 18 15 Full diagnostic assessment Provide full diagnostic assessment in primary care Interpret findings to youth and family Full diagnostic assessment Refer to MH, DBP, or SUD specialist for diagnostic (re)assessment Request results 16 Yes 14 12 Full diagnostic assessment needed? Who will provide further assessment? PCC MH specialist No 13 Monitor for symptoms and functioning Reenter at step 9 if concerns recur 20 19 Return to step 14 Yes No 21 Monitor for symptoms and functioning Reenter at step 9 if concerns recur Concerns resolved? Care plan implementation, comanagement, and monitoring (May require collateral data, information exchange, visits, and/or outreach) Apply and schedule monitoring mechanisms Coordinate with family and other clinicians Schedule RHS for age Revise plan as needed For adolescents, articulate plan for transition to adult care Yes, findings suggest an emergency No 10 Facilitate referral for emergency services Request results Return to algorithm at step 17 when resolved 9 Emergency? 11 Brief pediatric intervention(s) All visits: Engage by using “common factors” add patient to practice registry Acute, chronic, or subspecialty care visit: Complete visit address MH concern now (as in the bullets below) or plan follow-up visit RHS visit or visit for MH concern: Take one or more of the following actions: Expand assessment (eg, secondary screening behavioral diary collateral data collection from school, child care, previous MH evaluation) Offer focused problem-solving, common elements intervention, stress reduction, assistance with behavior change, and/or self-help resources Facilitate referral of family member for MH specialty or social services, if indicated Schedule return(s) or outreach as needed to assess response, complete RHS, try additional interventions, or advance to step 12 2 RHS visit or visit for MH concerns 1 3 No Yes No 7 4 RHS Provide reassurance Promote healthy S-E development & resilience per Bright Futures Concern other than normal variation? Concern other than normal variation? 8 Complete acute, chronic, or subspecialty care visit Initial psychosocial assessment (Expedite by using previsit data collection and review) Perform S-E/MH screening & surveillance, including ACEs, social determinants, routines, relationships, functioning (school, home, peers), parenting, parental MH, trauma exposure, family disruptions, and environmental risks Explore positive findings Observe child & parent perform examination as indicated Elicit and reinforce strengths throughout Incorporate brief mental health update 6 5 Acute, chronic, or subspecialty care visit MMHC - INTERIOR - FLIP CHART - PORTRAIT.indd 2 5/14/21 3:09 PM
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