ABSTRACT
OBJECTIVE: The authors examined utilization of the Massachusetts Child Psychiatry Access Project, a mental health telephone consultation service for primary care, hypothesizing that greater use would be related to severe psychiatric diagnoses and polypharmacy. METHODS: The authors examined the association between utilization, defined as the mean number of contacts per patient during the 180 days following the initial contact (July 2008-June 2009), and characteristics of the initial contact, including consultation question, the child's primary mental health problem, psychotropic medication regimen, insurance status, and time of year. RESULTS: Utilization (N=4,436 initial contacts, mean=3.83 contacts) was associated with initial contacts about medication management, polypharmacy, public and private health insurance, and time of year. The child's primary mental health problem did not predict utilization. CONCLUSIONS: Telephone consultation services address treatment with psychotropic medications, particularly polypharmacy. Joint public-private funding should be considered for such public programs that serve privately insured children.
Subject(s)
Child Health Services/methods , Hotlines/statistics & numerical data , Mental Health Services/statistics & numerical data , Primary Health Care/methods , Adolescent , Adult , Child , Child Psychiatry/methods , Child, Preschool , Female , Humans , Insurance, Health , Male , Massachusetts , Pediatrics/methods , Polypharmacy , Psychotropic Drugs/therapeutic use , Referral and Consultation/statistics & numerical data , Retrospective Studies , Time Factors , Young AdultABSTRACT
Schools are evolving to support all students, including those with mental health issues. Clinicians can help patients and schools by providing diagnostic clarity about a child's condition, how that condition interferes with school progress, and what interventions are needed in the school setting. State and Federal legislation supports timely response by schools to mental health issues emerging in students through special education laws and general education accommodations, such as Response To Intervention (RTI), which encourages schools to implement evidence-based interventions for students exhibiting mental health conditions. Case examples illuminate important legal considerations when clinicians are faced with issues such as therapeutic placements, home hospital forms, and substance abuse, and student misconduct.
Subject(s)
Adolescent Psychiatry/legislation & jurisprudence , Child Psychiatry/legislation & jurisprudence , Education, Special/legislation & jurisprudence , Schools/legislation & jurisprudence , Students/legislation & jurisprudence , Students/psychology , Adolescent , Adolescent Psychiatry/standards , Child , Child Psychiatry/standards , Education, Special/organization & administration , Evidence-Based Medicine/legislation & jurisprudence , Female , Humans , Male , Schools/organization & administration , United StatesABSTRACT
School is a rich environment for cultivating academic skills, but also for developing metacognitive skills such as executive functioning and emotional regulation. However, the hours students spend in school are often guided by familiar practices rather than contemporary findings about how the brain best learns and grows. This article describes biological conditions favorable to brain development, psychological skills associated with effective school functioning, and school practices associated with academic and interpersonal success. The aim is that schooling might be shaped with regard to children's and adolescents' brain development needs rather than social custom.
