The Register Citizen (Torrington, CT)
‘The bottom line’
Experts: Pediatric mental health screenings are increasing, but need remains
The number of behavioral health screenings for children are increasing year-over-year, but experts said more can be done to catch mental health conditions early on, especially as they pose more of a risk to children during the COVID-19 pandemic.
According to data from the Connecticut Department of Social Services, behavioral health screenings billed to Medicaid for children aged four to 17 went up by 50,000 from 3,697 in 2013 to 53,756 in 2019. Similar screenings for children under the age of three went up from 27,992 to 73,262.
“I wish I could say it’s because of educating practices but the bottom line is those numbers are increasing as time goes on
and more resources become available,” said Dr. David Krol, a pediatrician who is also vice president for health initiatives for the Child Health and Development Institute of Connecticut. “We’re seeing more pediatricians doing these screenings.”
Valerie Lepoutre, statewide peer recovery program manager for the National Alliance on Mental Illness’ Connecticut chapter, said screenings and loved ones keeping an eye out for mental illness in children is even more crucial as many experience new levels of stress given the COVID-19 pandemic.
“We’re constantly...saying to keep an eye out to how your child is responding and acting during this time and not dismiss it,” Lepoutre said. “We don't know what the long-term effects will be and it could lead to other mental health challenges. Even if it goes away, it's better to get help now.”
While behavioral health screenings and mental illness awareness are increasing, the American Academy of Pediatrics reported in a 2017 study that up to 20 percent of children experience a mental health disorder and many remain untreated. Lepoutre said that it can take up to a year for some mental illnesses to be diagnosed.
These delays are costly, not only in setting out a treatment plan, but for a patient’s physical health. Lepoutre said delays in diagnosis can lead to many patients not getting help for their mental illness until their 20s at which point many young adults are on their own insurance and may struggle with finding the time to navigate the behavioral health care system and to find a care team. Mental health can also take a toll on physical health, particularly if a child experiences trauma at a young age.
“This could cause other challenges for our generation ahead of us to see how are they physically handling the stress,” Lepoutre said. “Children are resilient but that posttraumatic growth is huge.
We have to be mindful of negative consequences and effects this can have later in their lives.”
But there’s a number of ways experts are working to improve early detection. NAMI hosts educational programs, including one called “Ending the Silence” which is designed to teach teens the signs of mental illness.
Lepoutre said that many pediatricians only see patients once a year for wellness visits. This means it’s important to educate family, teachers and students of the signs of mental illness since they’re the ones most likely to see it in a loved one and can bring it to their attention sooner.
NAMI CT also offers support groups to teach teens how to talk to their doctors and bring up how they’ve been feeling. One struggle with yearly visits is many patients only talk about how they’re feeling in the moment and not as a whole, so the groups offer guidance on examining symptoms and advocating for yourself.
“One of NAMI’s biggest priorities is to see people get help early,” said NAMI CT Executive Director Lisa B. Winjum. “The sooner we can get people help, the better things will be for them.”
Wendy Ward, of Darien, had long been an advocate for mental health and helped co-found the Youth Mental Health project, when she realized one big help would be detecting mental health conditions sooner. She then founded futuresTHRIVE in March 2019, a startup dedicated to creating a technology-driven method for screening for mental health conditions, made with input from doctors, clinicians and medical advisers.
Ward said she found many mental health assessments only captured one moment in time and often without context. For example, some assessments may ask if a child likes to spend time alone without considering factors like personality or their personal interests.
“Without context the assessments we’re doing fall very short, if they’re getting done,” Ward said.
Ward added doing routine assessments often can educate parents as well and prevent them from being caught off guard if their child is diagnosed or has a mental health crisis.
“If we’re doing screening, doing routine assessments and doing it often, we have the option to educate parents in a preventative way,” Ward said. “By normalizing it, stigma disappears. If you think about childhood cancer, in the ‘70s, ‘80s we called it the ‘C’ word and 80 percent of kids would die. People came forward and a huge amount of money went into development and as they were doing that, they were normalizing the conversation...It’s still scary. It doesn't make the illness go away. But it means people rally around you. We want to create the same rally cry.”
CHDI offers free hourlong training sessions to the entire team at pediatrician offices to help them get up to speed on metal health screening best practices.
“A lot of the work CHDI does is continuing education — pediatrics is lifelong learning,” Kroll said. “We learn a lot in pediatric training. We need to continue our learning process. There’s a lot we need to do to help pediatricians to stay on top of things...No matter how great your education is, things keep evolving and changing the message as you, a pediatrician, do the anticipatory guidance and messaging when symptoms are starting to arise.”