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Efforts to meet the mental health needs of children and adolescents.

As child and adolescent psychiatric-mental health nurses, we are quite aware of the shortage of treatment beds, treatment facilities, and appropriately trained mental health professionals to provide mental health services to children and adolescents. As a consequence, many of our most vulnerable individuals are not receiving early screening, a correct diagnosis, referral, or treatment. By the time most children and adolescents come to the attention of mental healthcare providers, their behavioral or psychiatric needs have been woefully neglected. In essence, our current system of treatment responds well to the “squeaky wheel” phenomenon. If a youngster repeatedly gets into trouble at school or in the community, or escalates to the point that he/she is dangerous to self or others, the system reflexively goes into crisis mode and responds by attempting to address the immediate presenting needs. Unfortunately, at this point the level of psychiatric or behavioral need may be so complex and extensive that a successful treatment outcome is jeopardized. Prevention and early intervention must become the gold standard rather than the selective, inconsistent, and haphazard approach to child mental health that currently exists. Advocates for the health and mental health of children are looking at new models that will reach more children earlier and in multiple nontraditional settings. Pediatricians, child and adolescent psychiatrists, and advanced practice nurses in child and adolescent mental health and pediatrics are all responding to the significant mental health needs of our specialty population. For example, the American Academy of Pediatrics (AAP) developed a policy statement on competency guidelines that strongly recommended that healthcare providers in primary care screen all children and adolescents for behavioral and psychiatric difficulties (AAP, 2009). In describing the need to intervene in primary care, they cited the discrepancy between the large number of children with mental health needs and the relatively low number who access and receive services; the disproportionate impact of unmet mental health needs on minority populations; the shortage of treatment specialty providers; the fact that most psychiatric disorders have their origin in childhood or adolescence; and that anxiety and depression are frequent comorbid presentations with medical illnesses in youth. In their position paper, AAP stipulated that in order for pediatricians to be competent in providing mental health and substance abuse services in their practice, changes must be made to their residency training. They also identified that their continuing education offerings should include content on knowledge and skills in caring for children who present with anxiety, depression, and substance use; skills in recognizing and managing psychiatric emergencies; skills in recognizing behavioral and mental health risk factors; and skills in promoting healthy lifestyles. Lastly, they identified that pediatric healthcare providers should commit to lifelong learning about mental health concepts and engage in collaborative relationships with mental health specialists in order to better meet the needs of children and adolescents in their own practice. Child and adolescent psychiatrists have endorsed the view of pediatricians that primary care is a natural place to screen all children and adolescents for risk of mental health or behavioral concerns (early case finding). More recently, their specialty organization, the American Academy of Child and Adolescent Psychiatry (AACAP), endorsed a position paper on Building Collaborative Mental Health Care Partnerships in Pediatric Primary Care. That document was written in response to the shortage of trained mental healthcare providers and the acknowledgment that other pediatric medical professionals are already assessing and treating youth with mental and behavioral health disorders. The AACAP “supports policies that promote mental health recovery as integral to overall health” (AACAP, 2010, p. 3). The AACAP Council further stated that “safe and effective mental and physical health care requires collaboration and communication between child and adolescent psychiatrists and other medical professionals” (p. 3). Early in 2012, a new textbook will be available titled Child and Adolescent Behavioral Health: A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing. Editors and contributing authors for the text are I, Edilma Yearwood, Geraldine Pearson, and Jamesetta Newland (Yearwood, Pearson, & Newland, 2012). The book, which is published by Wiley-Blackwell, is written collaboratively by advanced practice pediatric or family nurses and child and adolescent psychiatric-mental health practitioners. The editors wanted to produce a document that would strongly advocate for mental health screening of all children and adolescents in primary care. Secondly, we hope the text supports collaboration in nursing between two specialties, both of whom provide treatment to children. Thirdly, we wanted to begin the conversation as to which child and adolescent clinical presentations could be managed in doi: 10.1111/j.1744-6171.2011.00314.x Journal of Child and Adolescent Psychiatric Nursing ISSN 1073-6077