Enhancing Pediatric Mental Health Care: Algorithms for Primary Care

In 2004, the American Academy of Pediatrics (AAP) Board of Directors appointed the Task Force on Mental Health and charged it to assist pediatricians and other primary care clinicians* in enhancing the mental† health care they provide. The task force determined that 3 goals were important to accomplishing its purpose: The task force recommended addressing the goals sequentially; that is, before implementing the clinical process proposed in this report, clinicians need to (1) accomplish system changes such as payment for mental health services provided by primary care clinicians1,2 and development of clinical relationships with mental health specialists,3 (2) achieve mental health competencies,4 and (3) enhance their office systems by applying chronic care methods to the care of children with mental health problems.5 Strategies the task force used to address these goals are summarized in the introduction to this supplement.6 In this report, the task force proposes a clinical process for delivering mental health services in pediatric primary care settings. The report summarizes key features of this clinical process, then provides algorithms developed in collaboration with informaticians from the AAP Council on Clinical Information Technology; these algorithms are intended to ensure clarity of the proposed process and facilitate its translation to electronic systems. Appendix S5 lists procedural codes that can be used in billing for each step of the process. An accompanying toolkit to assist with implementation is scheduled for distribution in spring 2010. The concepts and process proposed in this report were developed by consensus of 4 groups, the members of which are listed in Appendix S6. These members recognized that the “primary care advantage”7 is the opportunity for longitudinal relationships with children and families—relationships … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu