םידליה אפ ור לש ודיקפת הליהקב · 2020. 2. 23. · • Behavioural •...
Transcript of םידליה אפ ור לש ודיקפת הליהקב · 2020. 2. 23. · • Behavioural •...
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בריאות הנפש בילדיםתפקידו של רופא הילדים
בקהילהגדסיר חוה "ד
לקידום בריאות ורווחת הילד בקהילה -"גושן"
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Mental health ≠ 1- mental illness
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Children’s mental health
"Child and adolescent mental health is
the capacity to achieve and maintain
optimal psychological functioning and well being. "
WHO
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Children’s mental health • Behavioural
• Neurodevelopmental
• Psychiatric
• Psychological
• Emotional
• Substance abuse
AAP – Committee on Psychosocial Aspects of
Child and Family Health and Task Force on Mental Health. Pediatrics
2009
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Children’s mental health • Family context
• Community related concerns o Child abuse and neglect
o Parental/family mental health issues
o Natural disasters
o School crises
o Grief and loss
• Somatic manifestations of mental health issues
AAP – Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health. Pediatrics 2009
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disorders
problems
Developmental variations
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Mental health disorder
Serious changes in the way children typically:
• Learn
• Behave
• Handle their emotions.
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Pediatric Mental Health • 9.5%-14.2% children 0-5y
Social emotional difficulties
• 21% Mental Health disorder
• 16.1% impairment/problems
• 10%-13% of parents of children in primary care
setting have “concerns”.
PEDIATRICS (2010) :125, Supp3
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Unmet needs • Shortage of services
• Inaccessibility to parenting programs
• Shortage of school-based mental health programs
and services
• Shortage of specialty mental health
• Lack of awareness to services
PEDIATRICS (2010) :125, Supp3
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• קצה הקרחון
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By 2020 mental health care will constitute a significant
part of general pediatric practice
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CAP study 2013, Australia
Top ten diagnosis:
o ADHD (10.7%)
o ASD (7%)
o LD (4.2%)
o Anxiety (3.5%)
o Behaviour (3/2%)
o Sleep disturbances (3.2%)
o Asthma (2.9%)
o ID (2.8%)
o Language delay (2.6%)
o Constipation (2.2%)
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Mental health-
a public health issue • All members of the community are affected by an
individual’s MH status.
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Effects of early life experience
Enduring effects of early social and emotional
experiences on the brain architecture and
development of infant and children:
• Behavior
• Biological stress reactivity
• Psychological resilience
• Immunologic resistance.
PEDIATRICS (2010) :125, Supp3
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American Academy of Pediatrics
Pediatric primary care clinicians will play an
increasingly important role in promoting the social-
emotional health of children and providing
treatment— or serving as an entry point to specialty
treatment—for children and adolescents who have
mental health and substance abuse problems
PEDIATRICS (2010) :125, Supp3
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American Academy of Pediatrics
The growth in this role will involve transformational
changes in:
• Primary care practice
• New knowledge and skills
• Collaborative relationships
• Resources.
• Payment structures
PEDIATRICS (2010) :125, Supp3
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Why pediatrician?
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Why pediatrician?
• Unique access to the families of young children
• Universal access
• Non stigmatizing service
• Highly respected
• Linking to services and resources
PEDIATRICS (2010) :125, Supp3
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Why pediatrician?
Foster effective nurturing by the caregivers and
positive early experiences for the child
PEDIATRICS (2010) :125, Supp3
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Strengths of pediatrician • Therapeutic relationship
– longitudinal
– trusting
– Empowering
• Family centered care
• Preventive care – Promoting healthy living
– Reinforcing strengths in the child and family
– Offering support at times of recognized adverse childhood experiences
and stressors
– Offering anticipatory guidance
– Providing timely intervention for common problems
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Strengths of pediatrician
• Understanding problems in the context of
development and environment
• Working as coordinator and care manager
• familiarity with chronic care principles
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Barriers • Lack of knowledge and skills
• Time constraints
• Payment?
• Limited access to mental health consultation
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Role of Pediatrician
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Addressing children’s Mental Health in Primary
Care • Promotion of social-emotional health and resilience
in children and families
• Recognition of adverse childhood experiences and
environmental stressors
• Intervention to prevent mental health problems
• Address emerging mental health problems
• Care of children with mental health disorders in a no stigmatizing and supportive medical home
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Addressing children’s Mental Health in Primary
Care
• Coordinating care with o mental health specialty services
o school
o child care
o social services.
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The challenge
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Getting ready
• Normalize conversations about mental health and
substance use
• Signal openness to mental health concerns
• Destigmatize mental health/substance use topics
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Getting ready • Mapping services and making connections
• Familiarize with screening tools
• Bright futures surveillance questions
• SEEK • HEADSSS
o Home & Environment o Education (Employment) o Activities
o Drugs o Sexualitiy o Suicide/depression
• SDQ - sdqinfo.org
• CBCL
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Getting ready • Acquiring knowledge and skills
o Learning to identify symptoms of emotional
disturbances
o Basic HELP support
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HELP- Generic/Common Factor Interventions
• Hope
• Empathy
• Language
• Loyalty
• Permission
• Partnership
• Plan
Reflect confidence in the child’s and family’s capacity
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