How chapters are addressing pediatric mental health crisis
from the AAP Department of Community and Chapter Affairs and Quality Improvement
Chapters Views & News
Approximately one in five youths ages 13-18 experiences a severe mental disorder at
some point during their life, according to the National Alliance on Mental Illness.
For children ages 8-15, the number is 13%.
The AAP Arizona, California 3, Florida, New Jersey and Virginia chapters received
Healthy People 2020 grants to develop programs to empower families, the media and/or
communities to address the mental health crisis in children and youths. Following
is an overview of each chapter’s program.
Tracking developmental milestones
The Arizona Chapter is using a two-pronged approach to address mental health.
The first goal is to use mobile technology to engage rural and underserved families
to monitor their child’s development, emphasize the importance of timely well-child
visits and increase reporting of concerns about developmental delays. Pediatricians
will encourage families to track their child’s development using a Centers for Disease
Control and Prevention (CDC) app called Learn the Signs. Act Early. Training, technical assistance, family follow-up and support will be provided. The
effectiveness of the approach from the family and practitioner perspective will be
The second goal is to increase the number of practices conducting and reporting developmental
screening. Multiple stakeholders will identify participants, design training and materials,
and customize and share CDC materials. The initiative aims to change the perception
of developmental surveillance and screening from identification of deficits and delays
to celebrating age-appropriate achievements. The program will impact about 8,000 children.
Providing trauma-informed care
San Diego County received more refugees in 2017 than any other city in the U.S., according
to the Refugee Processing Center. California Chapter 3 is creating connections with
pediatric offices in San Diego County to address mental health concerns among immigrant
and refugee groups through trauma-informed care.
The goal is to encourage parents to express concerns about their child’s learning,
development or behavior. Educational modules that have been reviewed by community
members will be used to increase pediatricians’ understanding of cultural values and
practices in immigrant and refugee populations.
Screening adolescents for anxiety, depression
The Florida Chapter will train primary care providers (PCPs) in southeast Florida
to screen adolescents for anxiety and depression. PCPs will participate in an evidence-based
workshop that uses simulated clinical encounters with adolescent actors. Each provider
will receive individualized feedback after the workshop. Surveys will evaluate participant
knowledge before each training session and changes they made as a result of the trainings.
Educating 150 PCPs will translate into screening 45,000 adolescents for anxiety and
depression each year, which will result in diagnosis and linkage to treatment for
roughly 4,500 adolescents who may not have been identified.
“We hope that trained pediatricians will be able to recognize early signs of anxiety
and depression in their patients, intervene and make sure these teens receive the
help they desperately need,” said Madeline Joseph, M.D., FAAP, immediate past president
of the Florida Chapter.
Screening for adverse childhood experiences
The New Jersey Chapter’s program focuses on increasing the number of community organizations
providing population-based primary prevention services related to violence.
The chapter is building on emerging relationships between school nurses and pediatricians
to enhance violence prevention in Camden, N.J., which has one of the highest rates
of child abuse and neglect in the state. The project is an opportunity to engage with
community partners, identify at-risk children and provide resources before victimization
occurs by introducing adverse childhood experiences (ACEs) screening tools. Pediatricians
will be educated on ACEs screening instruments and their use at all well-child and
new patient visits.
“There’s a known correlation between adverse childhood experiences and health outcomes,”
said Fran Gallagher, CEO of the New Jersey Chapter. She added that preliminary quality
improvement data showed that 29.5% of 129 teens who completed an ACE screening had
experienced four to nine ACEs, and 3.9% experienced 10 or more ACEs.
“When social determinants negatively impact our youths’ health, identifying them and
coordinating interventions can lead to improving health and educational trajectories
for life,” Gallagher said.
Implementing telepsychiatry services
Virginia ranks 47th in the country for mental health care for children under 18 years
of age, according to the 2018 State of Mental Health in America report. The Virginia
Chapter project provides telepsychiatry services accessible to primary care pediatricians.
The chapter has recruited over 60 primary care providers to participate and psychiatrists
to support the program, reaching approximately 32,000 children with mental health
issues. Pediatric providers will be trained to screen, diagnose and treat common mental
health disorders, including attention-deficit/hyperactivity disorder, depression and
The program also has led to the development of a larger statewide initiative called
the Virginia Mental Health Access Program.
“Access to mental health services has reached a crisis situation in our state due
to the shortage of child psychiatrists and pediatric mental health providers,” said
chapter President Sandy Chung, M.D., FAAP. “By default, many primary care pediatric
providers have become the mental health providers for their communities, and our program
gives them necessary resources, including access to child psychiatrists for consults,
care coordination and telepsychiatry/telepsychology.”