Algorithm: A Process for Integrating Mental Health Care Into Pediatric Practice APPENDIX 1 Initial psychosocial assessment (Expedite using previsit data collection and review) Perform S-E/MH screening and surveillance, including ACEs, social determinants, routines, relationships, functioning (school, home, peers), parenting, parental MH, trauma exposure, family disruptions, environmental risks Explore positive findings Observe child and parent perform examination as indicated Elicit and reinforce strengths throughout Incorporate brief MH update Acute care visit Yes Yes No 1 4 3 5 6 7 8 9 10 11 2 No Yes, findings suggest an emergency No Brief primary care intervention(s) All visits: Engage using “common factors” add patient to registry Acute care visit: Complete acute care 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 Routine health supervision Provide reassurance Promote healthy S-E development and resilience per Bright Futures Facilitate referral for emergency services Request results Return to algorithm at step 17 when resolved Complete acute care visit Concerns other than normal variations? Concerns other than normal variations? Emergency? Schedule RHS visit or visit for MH concern 33-MHCC_appendix-01.indd 815 4/5/18 1:33 PM
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