Screening/ Early Intervention

What’s needed:

  • Increase physicians and other care providers awareness of the importance of this for healthy family functioning

  • Change funding mechanisms to make this viable

  • Increase availability of referral resources

  • Integrate credentialing to insure the provision of quality services 

 

Abstract- from the Promoting Optimal Development article (below):

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems.

 

from the Child Trends articles (cited below):

 

Many negative mental health issues, if addressed early, could be averted. For example, every year more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most under-diagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship

It's a positive sign that there's increasing public awareness and concern about the harmful consequences of depression and other early adverse experiences (detailed in the parent section),  and policymakers in a number of states are calling for routine screening of individual children—in pediatric care, home visiting programs, early care and education, schools, and other child and family service settings. Many of these efforts cite and use the adversities included in the original Adverse Childhood Experiences (ACEs) study However, it is essential for policymakers to understand the limitations of this approach, as well as its potential for unintended consequences. These include the potential for re-traumatizing children and families, contributing to stigma and a deficits focus, the lack of age- and culture-sensitive screening tools, and finally a conception of adversity that does not take into account the individual's unique response to neglectful or traumatizing events.

 

                                                 Screening Resources

 

Good policy recommendations for screening in these articles from Child Trends:

 

Childhood adversity screenings are just one part of an effective policy response to childhood trauma

 

Adverse childhood experiences are different than child trauma, and it’s critical to understand why


The following sites are from the Center for the Study of Social Policy:

 

Pediatrics Supporting Parents:

Enhancing standards of care in pediatric well-child visits 


Advancing Early Relational Health

Transforming child health care and early childhood system building


Fostering Social and Emotional Health through Pediatric Primary Care: Common Threads to Transform Everyday Practice and Systems

 

The following are from the National Institute for Children’s Health Quality: 

 

Five ways Pediatrics can support social-emotional development 

 

Pediatricians partnering with parents to promote social and emotional development.

 

From the American Academy of Pediatrics:

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

 

Strategies for system change in children’s mental health


Clinical Report—Incorporating Recognition and

Management of Perinatal and Postpartum Depression

Into Pediatric Practice

American College of Obstetricians and Gynecologists 

Screening for Perinatal Depression


 

From the Medical Home Portal- 

University of Utah Department of Pediatrics 

 

Infant & Early Childhood Social-Emotional Screening

 

 

                                         Early Intervention Resources:

An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: study protocol of a randomized controlled trial

Prenatal representations predicting parent-child relationship in transition to parenthood: Risk and family dynamic considerations


Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder

Howard Steele

Foundations for Infant/Toddler Social Emotional Health and Development: Online Course for Parents and Families


The effects of parental rearing styles and early maladaptive schemas in the development of personality: a systematic review


Early maladaptive schemas as predictors of maternal bonding to the unborn child


Parental Reflective Functioning: An approach to enhancing parent-child relationships in pediatric primary care


The Multiple Determinants of Maternal Parenting Stress 12 Months After Birth: The Contribution of Antenatal Attachment Style, Adverse Childhood Experiences, and Infant Temperament


The child as held in the mind of the mother: The influence of prenatal maternal representations on parenting behaviors


Maternal parenting predicts infant biobehavioral regulation among women with a history of childhood maltreatment 

 

Development of a prenatal program for adults with personal histories of childhood abuse or neglect: a Delphi consensus consultation study.


An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: study protocol of a randomized controlled trial

 

The prenatal parental reflective functioning questionnaire: Exploring factor structure and construct validity of a new measure in the finn brain birth cohort pilot study

 

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