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Adding Mental to the Annual Physical

By Kurt Kleiner

During kids’ annual physical exams, pediatricians dutifully track height and weight, update vaccinations and check overall physical health. But one important area often goes overlooked during the exam: the child’s mental health.

As many as 12 percent of children will suffer from a diagnosable mental health problem sometime in their childhoods, notes Larry Wissow, MD, MPH ’84, professor in Health, Behavior and Society (HBS).  

While most of the problems are relatively minor, says Wissow, “the bad news is that a lot of mental health issues in childhood go undetected for a long time.” 

Serious mental health problems such as major depression or schizophrenia are rare in children. More common, milder disorders, like anxiety or attention problems, often aren’t diagnosed until the patients are young adults. By then, important developmental years have been affected, says Wissow, who is heading up the Bloomberg School’s new Center for Mental Health in Pediatric Primary Care, funded by a $5 million NIH grant. 

He and his colleagues are developing techniques that primary care providers can use to flag mental health problems, refer the most serious cases to specialists and provide effective treatment to other patients. 

Primary care providers are sometimes dubious that they can effectively treat mental and emotional disorders within the time constraints of a standard office visit. But a recent study Wissow conducted, along with HBS professor Debra Roter, DrPH ’77, MPH ’75, MS, and senior research associate Susan Larson, MS, shows that relatively short training can lead to better care. 

In the study, providers who were taught seven different skills over three training sessions—including how to manage time during an office visit, ways to elicit patient concerns and ways to give advice—had patients with better outcomes than providers in a control group.

Among the strategies taught during the study: Providers can give a short questionnaire designed to start a discussion about possible problems, asking things like whether the child has seemed especially sad or angry lately. Something as simple as inquiring whether there is anything else they want to discuss can encourage a patient to bring up an issue, Wissow says. They can then offer short but effective counsel—perhaps by helping the family figure out one change that they can make to improve the situation. 

“The important thing is to be optimistic and engaged with them. You emphasize that you care, and that you think you can work out a plan to help,” Wissow says. 

Pediatricians in the study learned tips on how to manage patient interactions to keep them from going on too long. For instance, they learned to help patients focus on a single issue, offering a longer follow-up visit to discuss other problems. While it may seem counterintuitive, taking time to address mental health issues during an office visit can actually save time in the long run. Wissow pointed out that children with untreated mental health issues tend to be “sticky” patients—they require office visits more often than others. Effective mental health treatment might solve their problems and thereby take pressure off the pediatrician’s schedule.