|
Sign In to gain access to subscriptions and/or personal tools.
|
Targeted Child Psychiatric Services: A New Model of Pediatric Primary ClinicianChild Psychiatry Collaborative Care
Daniel F. Connor, MD
Department of Psychiatry, Division of Child and Adolescent Psychiatry and Pediatrics, University of Massachusetts Medical School, Worcester, MA.
Thomas J. McLaughlin, ScD
Department of Psychiatry, Division of Child and Adolescent Psychiatry and Pediatrics, University of Massachusetts Medical School, Worcester, MA.
Mary Jeffers-Terry, RN CS
Department of Psychiatry, Division of Child and Adolescent Psychiatry and Pediatrics, University of Massachusetts Medical School, Worcester, MA.
William H. OBrien, MSW
Department of Psychiatry, Division of Child and Adolescent Psychiatry and Pediatrics, University of Massachusetts Medical School, Worcester, MA.
Christopher J. Stille, MD, MPH
Department of Psychiatry, Division of Child and Adolescent Psychiatry and Pediatrics, University of Massachusetts Medical School, Worcester, MA.
Lynda M. Young, MD
Department of Psychiatry, Division of Child and Adolescent Psychiatry and Pediatrics, University of Massachusetts Medical School, Worcester, MA.
Richard C. Antonelli, MD, MS
Department of Psychiatry, Division of Child and Adolescent Psychiatry and Pediatrics, University of Massachusetts Medical School, Worcester, MA.
Between 15% and 25% of children and adolescents seen in pediatric primary care have a behavioral health disorder with significant psychopathology, high functional impairment, and frequent psychiatric diagnostic comorbidity. Because child psychiatry services are frequently unavailable, primary care clinicians are frequently left managing these children without access to child psychiatry consultation. We describe Targeted Child Psychiatric Services (TCPS), a new model of pediatric primary clinician-child psychiatry collaborative care, and describe program utilization and characteristics of children referred over the first 18 months of the program using a retrospective chart review. The TCPS model can serve a large number of pediatric primary care practices and provide collaborative help with the evaluation and treatment of complex attention deficit hyperactivity disorder, depression, anxiety disorders, and pediatric psychopharmacology.
References
- Costello EJ, Mustillo S, Erkanli A, et al. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;60(8):837-844.[Abstract/Free Full Text]
- Costello EJ, Angold A, Burns BJ, et al. The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. Arch Gen Psychiatry. 1996;53 (12):1129-1136.[Abstract/Free Full Text]
- Costello EJ. Child psychiatric disorders and their correlates: a primary care pediatric sample. J Am Acad Child Adolesc Psychiatry. 1989;28(6):851-855.[Web of Science][Medline]
[Order article via Infotrieve]
- Rushton J, Bruckman D, Kelleher K. Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med. 2002;156(6):592-598.[Abstract/Free Full Text]
- Williams J, Klinepeter K, Palmes G, et al. Diagnosis and treatment of behavioral health disorders in pediatric practice. Pediatrics. 2004;114(3):601-606.[Abstract/Free Full Text]
- Kelleher KJ, McInerny TK, Gardner WP, et al. Increasing identification of psychosocial problems: 1979-1996. Pediatrics. 2000;105(6):1313-1321.[Abstract/Free Full Text]
- Cartwright-Hatton S, Roberts C, Chitsabesan P, et al. Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. Br J Clin Psychol. 2004;43 (Pt 4):421-436.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Reinecke MA, Ryan NE, DuBois DL. Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 1998;37(1):26-34.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Fonagy P. Evaluating the effectiveness of interventions in child psychiatry. Can J Psychiatry. 1997;42(6):584-594.[Web of Science][Medline]
[Order article via Infotrieve]
- Pappadopulos EA, Tate Guelzow B, Wong C, et al. A review of the growing evidence base for pediatric psychopharmacology.Child Adolesc Psychiatr Clin N Am. 2004;13(4):817-855.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Riddle MA, Kastelic EA, Frosch E. Pediatric psychopharmacology. J Child Psychol Psychiatry. 2001;42(1):73-90.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Bernal P. Hidden morbidity in pediatric primary care. Pediatr Ann. 2003;32(6):413-418; quiz 421-422.[Web of Science][Medline]
[Order article via Infotrieve]
- Cassidy LJ, Jellinek MS. Approaches to recognition and management of childhood psychiatric disorders in pediatric primary care. Pediatr Clin North Am. 1998;45(5):1037-1052.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Rushton JL, Whitmire JT. Pediatric stimulant and selective serotonin reuptake inhibitor prescription trends: 1992 to 1998. Arch Pediatr Adolesc Med. 2001;155(5):560-565.[Abstract/Free Full Text]
- Rushton JL, Clark SJ, Freed GL. Pediatrician and family physician prescription of selective serotonin reuptake inhibitors. Pediatrics. 2000;105(6): E82-E82.
- American Academy of Pediatrics. The new morbidity revisited: a renewed commitment to the psychosocial aspects of pediatric care. Committee on Psychosocial Aspects of Child and Family Health. Pediatrics. 2001;108 (5):1227-1230.[Abstract/Free Full Text]
- Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Measur. 1960;20:37-46.[CrossRef]
- APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.
- Jellinek MS, Murphy JM, Robinson J, et al. Pediatric Symptom Checklist: screening school-age children for psychosocial dysfunction. J Pediatr. 1988;112(2):201-209.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Jellinek MS, Murphy JM, Little M, et al. Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: a national feasibility study. Arch Pediatr Adolesc Med. 1999;153(3):254-260.[Abstract/Free Full Text]
- Achenbach TM. Child Behavior Check-listCross-Informant Version. Burlington, VT: Department of Psychiatry, University of Vermont; 1991.
- Jellinek MS, Murphy JM, Burns BJ. Brief psychosocial screening in outpatient pediatric practice. J Pediatr. 1986;109(2):371-378.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Jellinek M, Little M, Murphy JM, et al. The Pediatric Symptom Checklist. Support for a role in a managed care environment. Arch Pediatr Adolesc Med. 1995;149(7):740-746.[Abstract/Free Full Text]
- Jellinek MS, Bishop SJ, Murphy JM, et al. Screening for dysfunction in the children of outpatients at a psychopharmacology clinic. Am J Psychiatry. 1991;148(8):1031-1036.[Abstract/Free Full Text]
- Conners CK. Manual For Conners' Rating Scales. North Tonawanda, NY: Multi-Health Systems, Inc.; 1990.
- Guy W. Assessment Manual for Psychopharmacology. Washington, DC: U.S. Department of Health, Education, and Welfare; 1976.
- Shaffer D, Gould MS, Brasic J, et al. A children's global assessment scale (CGAS). Arch Gen Psychiatry. 1983; 40(11):1228-1231.[Abstract/Free Full Text]
- Rey JM, Starling J, Wever C, et al. Inter-rater reliability of global assessment of functioning in a clinical setting. J Child Psychol Psychiatry. 1995;36(5):787-792.[Web of Science][Medline]
[Order article via Infotrieve]
- Lavigne JV, Gibbons RD, Christoffel KK, et al. Prevalence rates and correlates of psychiatric disorders among preschool children. J Am Acad Child Adolesc Psychiatry. 1996;35(2):204-214.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Hosmer D, Lemeshow S. Applied Logistic Regression. New York: John Wiley; 1989.
- Costello EJ, Edelbrock C, Costello AJ, et al. Psychopathology in pediatric primary care: the new hidden morbidity. Pediatrics. 1988;82(3 Pt 2):415-424.[Abstract/Free Full Text]
- Briggs-Gowan MJ, Owens PL, Schwab-Stone ME, et al. Persistence of psychiatric disorders in pediatric settings. J Am Acad Child Adolesc Psychiatry. 2003;42(11):1360-1369.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Briggs-Gowan MJ, Horwitz SM, Schwab-Stone ME, et al. Mental health in pediatric settings: distribution of disorders and factors related to service use. J Am Acad Child Adolesc Psychiatry. 2000;39(7):841-849.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Skaer TL, Sclar DA, Robison LM. Antidepressant trends among children and adolescents diagnosed with depression: 1990-2001. In: National Institute of Mental Health New Clinical Drug Evaluation Unit Annual Meeting; 2004; Phoenix, Arizona; 2004.
- Olson AL, Kelleher KJ, Kemper KJ, et al. Primary care pediatricians' roles and perceived responsibilities in the identification and management of depression in children and adolescents. Ambul Pediatr. 2001;1(2):91-98.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Rushton JL, Clark SJ, Freed GL. Primary care role in the management of childhood depression: a comparison of pediatricians and family physicians. Pediatrics. 2000;105(4 Pt 2):957-962.[Abstract/Free Full Text]
- American Academy of Pediatrics. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics. 2001;108(4):1033-1044.[Abstract/Free Full Text]
- American Academy of Pediatrics. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. American Academy of Pediatrics. Pediatrics. 2000;105(5):1158-1170.[Abstract/Free Full Text]
- Biederman J, Newcorn J, Sprich S. Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry. 1991;148(5):564-577.[Abstract/Free Full Text]
- Barkley RA. Attention-deficit hyperactivity disorder. Sci Am. 1998; 279 (3):66-71.[Web of Science][Medline]
[Order article via Infotrieve]
- Pliszka SR. Psychiatric comorbidities in children with attention deficit hyperactivity disorder: implications for management. Paediatr Drugs. 2003; 5(11):741-750.[CrossRef][Medline]
[Order article via Infotrieve]
- Pliszka SR. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview. J Clin Psychiatry. 1998;59(Suppl 7): 50-58.
- Connor DF. Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: Guilford Publications; 2002.
- Steiner H. Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry. 1997;36(10 Suppl): 122S-139S.[CrossRef][Medline]
[Order article via Infotrieve]
- Bird HR, Gould MS, Staghezza BM. Patterns of diagnostic comorbidity in a community sample of children aged 9 through 16 years. J Am Acad Child Adolesc Psychiatry. 1993;32(2):361-368.[Web of Science][Medline]
[Order article via Infotrieve]
- Biederman J, Faraone SV, Monuteaux MC. Differential effect of environmental adversity by gender: Rutter's index of adversity in a group of boys and girls with and without ADHD.Am J Psychiatry. 2002;159(9):1556-1562.[Abstract/Free Full Text]
Clinical Pediatrics, Vol. 45, No. 5,
423-434 (2006)
DOI: 10.1177/0009922806289617

CiteULike Complore Connotea Del.icio.us Digg Reddit Technorati Twitter What's this?
This article has been cited by other articles:

|
 |

|
 |
 
Committee on Psychosocial Aspects of Child and Fam
The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care
Pediatrics,
July 1, 2009;
124(1):
410 - 421.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. B. Forrest
A Typology of Specialists' Clinical Roles
Arch Intern Med,
June 8, 2009;
169(11):
1062 - 1068.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|
|