One in five children has an identified mental health problem as early as age 3. Early detection is key to earlier intervention, and it also could prevent more severe conditions down the line, such as ADHD, depression and anxiety. Pediatric primary care is an ideal setting to conduct screening for mental health risk, given that pediatricians tend to have close, ongoing relationships with young patients and their families, and broad reach to historically marginalized communities. Since mental health screening of toddlers in primary care is uncommon, it is important to train pediatricians to do so without implicit bias and in a way that prevents unintended consequences, such as increased stigma.
Clinicians from Ann & Robert H. Lurie Children's Hospital of Chicago will address these concerns in partnership with Northwestern University's new Mental Health, Earlier Center funded by an $11.7 million award from the National Institute of Mental Health (NIMH) of the National Institutes of Health. They aim to reach approximately 1,200 toddlers by implementing screening for mental health risk across 30 clinics, and training pediatricians to communicate results to families and make decisions about next steps.
"We will work with pediatricians and parents to develop interactive training that is anti-racist, culturally responsive and specific to early childhood practice," said Andrea Spencer, MD, Principal Investigator on the subproject of the NIMH grant that is focused on equity in screening toddlers for mental health risk. Dr. Spencer is Vice Chair for Research at the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children's and Associate Professor of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine.
Since pediatricians might feel uncomfortable talking to families about the child's mental health, especially when time is limited, they could be susceptible to unconscious bias in how they approach families from diverse backgrounds. We want to help pediatricians conduct evidence-based screening that is effective and equitable."
Andrea Spencer, MD, Principal Investigator
This training will involve weekly sessions over a few months via video conferencing. Each session will include a didactic portion and case consultations, allowing pediatricians to dissect actual screening situations that were challenging. This will be a supplement to the basic training on screening toddlers for mental health risk that pediatricians will receive as part of the overall Mental Health, Earlier Center implementation.
In addition to equity considerations, training content will be evaluated for potential ethical issues, in order to proactively address unintended consequences. This will be done prior to training implementation and as the training sessions progress.
"We have an ethical responsibility to consider how kids and families might be affected by mental health screenings in primary care, especially when it comes to children from minoritized groups," said Seema Shah, JD, HEC-C, Ethicist at the Mental Health, Earlier Center and Co-Principal Investigator on the ethics subproject of the overall grant. She is the Director of Research Ethics and Founders' Board Chair of Medical Ethics at Lurie Children's, as well as Professor of Pediatrics at Northwestern University Feinberg School of Medicine.
"We are thinking about how kids who are identified as having mental health risk at an early age might be treated when they start school, or if that identification of risk might become a self-fulfilling prophecy," said Professor Shah. "On the other hand, pediatricians might worry about stigma and miss identifying a child who truly needs help. We want to make sure we address these types of concerns before and during the training rollout. Our project is novel because it integrates ethics, equity and implementation science."
The core team at the Mental Health, Earlier Center also includes Michelle Macy, MD, MS, from Lurie Children's, who leads the overall evaluation of the project. "It will be important to evaluate the effectiveness of these trainings so we can learn how to continue improving the training content and implementation, and so our efforts can be replicated and expanded," said Dr. Macy, Director of Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center at Stanley Manne Children's Research Institute at Lurie Children's, and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "We want to make sure that we proceed with equity and ethics in mind. Ultimately, we hope that toddlers who are showing signs of mental health concerns receive earlier intervention that prevents more challenging psychiatric conditions."
The team from Lurie Children's involved in projects through the Mental Health, Earlier Center also include Audrey Brewer, MD, MPH, Susan Friedland, MD, John Parkhurst, PhD, Alize Jaffe Sass, PhD, and John Walkup, MD.
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