Closing the Gap in Youth Mental Health

According to the Centers for Disease Control and Prevention (CDC), 13 percent to 20 percent of children living in the United States experience a mental health disorder in a given year, and the prevalence of those conditions is on the rise. Yet only one in five of those children will receive treatment.

As noted in The Journal of Nurse Practitioners, Family Nurse Practitioners are ideally positioned to conduct mental health screening and to identify and help children at risk for mental health disorders. In this post, we’ll explain why and point you to resources that can help.

FNPs: Ideally Positioned For Early Intervention

With 50 percent of adult mental health disorders emerging by the age of 14, early intervention is key to successful treatment. Practicing in primary care settings, FNPs can:

  • Observe a child over time and recognize behaviors that vary from normal development.
  • Pre-empt “early potential threats to a child’s well-being through such interventions as parental education and screening.”
  • Develop ongoing relationships that enable families to overcome the perceived stigma of seeking mental health care.
  • Refer children with more complex mental health problems to appropriate specialists, monitor the outcomes, and coordinate care from within their scope of practice.

Mental Health Tools and Resources for FNPs

In “Mental Health Surveillance Among Children — United States, 2005–2011,” the CDC identifies the nine most common childhood mental health disorders. The chart below provides links to descriptions and information on risk factors for those disorders from sources including the Substance Abuse and Mental Health Administration (SAMHSA), the National Alliance for the Mentally Ill (NAMI), and the National Institute of Mental Health (NIMH). In addition, FNPs can reach out to their advanced practice psychiatric/mental health colleagues in the International Society of Psychiatric-Mental Health Nurses (ISPN) and the American Psychiatric Nursing Association (APNA) for consultation, mentoring, and possible referral.

Resources: The Most Common Childhood Mental Health Disorders

Mental Health Disorder: Fact Sheets
Children (ages 3-17 years)
Prevalence, per CDC
ADHD: NAMI Fact Sheet 6.8%
Behavioral or conduct problems: NAMI Fact Sheet 3.5%
Anxiety: NIH Fact Sheet 3.0%
Depression: NAMI Fact Sheet 2.1%
Autism spectrum disorders (ASD): NIH Fact Sheet 1.1%
Tourette syndrome (among children aged 6–17 years): NAMI Fact Sheet 0.2%

 

In addition to these online resources, the National Association of Pediatric Nurse Practitioners (NAPNAP) offers a comprehensive guide corresponding to the latest DSM-5 criteria. "A Practical Guide to Child and Adolescent Mental Health Screening, Early Intervention, and Health Promotion" includes Web-based resources, patient handouts, and assessment tools that can be used during well-child and routine office visits. Purchasers of the guide may download and use many of those handouts and tools here

Cooperating with Families

It’s also possible to educate and collaborate with parents on substance abuse, common mental health problems, and basic behavior management skills. As their relationships develop over time, FNPs are positioned to provide parents with timely, age-appropriate advice on spotting emerging mental health and behavioral problems.

In addition to handouts in the NAPNAP guide, FNPs will find the American Academy of Child and Adolescent Psychiatry (AACAP) online Family Facts Guide useful for parent education. The AACAP guide provides concise fact sheets on dozens of child mental health issues — from Asperger’s syndrome to violent behavior. “When to Seek Help for Your Child” in particular provides an excellent starting point for helping parents recognize some of the first warning signs of mental illness. The fact sheets, available in English, Spanish, and Chinese, may be reproduced and distributed free of charge so long as they are not included in materials for sale or profit.

Know when to seek a consultation or refer a patient to specialists:

While FNPs are able to help treat many common mental health disorders, they may also need to refer patients to mental health specialists due to a lack of expertise in a specific disorder, complexity of the case, or other family, environmental, or scope of practice factors. In making the determination to refer, FNPs will find the AACAP’s specific criteria for referrals useful.

Seek out practice opportunities, advanced training, and continuing education resources:

Writing in the Journal of Pediatric Health, 2013 NAPNAP President Susan N. Van Cleve, DNP, urges FNPs to “take the plunge” to practice and learn more about providing mental health care for children. She recommends FNPs “set up a session or two per week to perform assessments on children with ADHD; provide ongoing care to children with autism; evaluate, counsel, and treat teens with depression and anxiety.” To gain the knowledge and skills you need, Van Cleve recommends online and continuing education courses offered by NAPNAP, The Resource for Advancing Children’s Health (REACH) Institute, AACAP, and the American Academy of Pediatrics.

Of course, the above resources are only a start — but, when it comes to children’s mental health, the best start is the earliest start. 

A special thank-you to Edilma Yearwood, PhD, RN, PMHCNS-BC, FAAN, interim chair of the Department of Nursing at Georgetown University School of Nursing & Health Studies, for reviewing the content of this posting. Yearwood is president-elect of the International Society of Psychiatric-Mental Health Nurses and a co-editor of the textbook Child and Adolescent Behavioral Health: A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing (Wiley-Blackwell, 2012).

Please note that this post is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided.