Category Archives: Pediatric care
With the passage of the Mental Health Parity Act and the implementation of the Affordable Care Act (ACA), behavioral health experts are pushing to improve the quality of that care so that people seeking help—some for the first time—receive evidence-based care that best suits their individual needs. As part of that conversation, the U.S. Senate Health, Education, Labor and Pension committee held a hearing this week on mental health treatment trends in the United States.
Sen. Tom Harkin (D-Iowa) the committee chair opened the hearing by “pointing to disturbing new trends [including]...significant increases in the prescribing of psychotropic medications, while the use of behavioral and psychological treatments among children and youth has increased only slightly, and has actually decreased among adults.”
According to committee research on recent use of psychotropic drugs, use of antipsychotic medications has increased eight-fold among children and five-fold among adolescents, and has doubled among adults between 1993 and 2009.
The key witness at the hearing was William Cooper, MD, MPH, a professor of pediatrics and health policy at the Vanderbilt University School of Medicine who conducts population-based studies of medication use in children. Cooper told the committee about a nine-year-old boy he treated for weight gain—which turned out to be a side effect of a psychotropic drug the child had been prescribed by a primary care provider given for disturbing the classroom. No mental illness diagnosis had been made for the child, and no mental illness was detected after evaluation at Vanderbilt.
Cooper said that in recent years the United States has seen a tremendous increase in the numbers of children diagnosed with mental health disorders.
“Whether this is a result of increased awareness, improved diagnosis, or other factors is not clearly understood,” said Cooper, who added that “while we must acknowledge that a part of the increase could be due to over-diagnosis, there is no disputing the fact that a large number of children and their families suffer significantly because of mental illness.”
Furthermore, added Cooper, given the fact that suicide is the second leading cause of death for children ages 12-17, “tragic consequences of childhood mental health disorders highlight our sense of urgency in addressing this important problem.”
Cooper added that treating mental health disorders can be challenging and that 50-75 percent of the care for children with mental health disorders occurs in primary care settings “making it critical that consultation and communication between primary care professionals and experts in mental health be enhanced.”
Significantly, Cooper told the panel that despite guidelines, much of the mental health care for children occurs in a manner “inconsistent with optimal practice,” including:
- Use of medications for diagnoses for which there is little evidence of benefit.
- Use of multiple medications at the same time, especially among particularly vulnerable children such as children in foster care, where a recent study found multiple psychiatric medications in up to 75 percent of children being treated.
- Use of medications alone without proven psychotherapies.
Cooper attributed the problems to several factors, among them:
- Many general practice doctors are unaware of current mental health treatment guidelines.
- Inadequate mental health resources to provide best treatments.
- Too few professionals with training in providing mental health care to children.
- Barriers to treatment, including cost or the need to travel long distances.
- Stigma associated with mental illness, which may reduce families’ willingness to acknowledge a mental health disorder and seek treatment.
The HELP committee plans to hold additional hearings to address mental health issues. Other attention to the issues addressed at the hearing include a recent meeting in Washington, D.C. among professionals who conduct psychiatric clinical trials. They stressed the need to involve patients and families more in trial design and access, as well as to work with trial designers on mental health needs not currently being met.
The Substance Abuse and Mental Health Services Administration, a federal agency, recently announced several new funding grants to help individual groups facing mental health concerns including:
- A grant program for residential treatment of pregnant and postpartum women.
- A grant program to expand and sustain comprehensive community mental health services for children and their families, in order to improve behavioral health outcomes for children and youth with serious emotional disturbances, as well as improve the health and well-being of their families.
- A grant program to provide tribal and urban American Indian and Alaskan Native communities with tools and resources to plan and design a holistic, community-based coordinated system of care approach to support mental health and wellness for children, youth and families.
Read more about mental health on NewPublicHealth.
In reaching teens, crisis hotlines have had to adapt not only to what they say, but how they say it. While counseling teens by phone is still the dominant method of communication, texting has become a popular way for teens to contact crisis centers in their times of need. A recent story in The New York Times takes a look at what Crisis Text Line and other centers have accomplished in the field of helping teens using their preferred medium of communication.
For troubled teens, texting offers a critical element of privacy if they feel threatened by someone nearby and allows them to look and feel more natural if they are in a public space. Benefits for crisis counselors include the ability to deal with more than one person at a time and to introduce experts into the conversation without a lapse in contact. Organizations such as Crisis Text Line that offer text counseling report receiving messages from teens who might not have otherwise contacted the hotline by phone. People who text hotlines for help receive the same services as callers—risk assessment, emotional validation and problem solving—but the interactions are often longer and more direct than phone calls.
In addition to offering an effective way to communicate with teens, texting provides data and trends about people in different types of crises. “My dream is that public health officials will use this data and tailor public policy solutions around it,” says Nancy Lublin, founder of Crisis Text Line. The organization plans to compile the data and make it available to the public this spring.
The use of texting has extended beyond crisis centers. The four largest phone companies in the United States recently promised to make 911 texting possible by May for local response services that request the option.
Read more at The New York Times.
Preterm babies are born at a higher rate in the US than in 130 other countries, including many poorer nations, according to a report released today, Born Too Soon: The Global Action Report on Preterm Birth, published by the March of Dimes and almost fifty other groups, including the World Health Organization.
Preterm birth (birth before 37 weeks completed gestation) is the leading cause of newborn death in the US—nearly half a million US babies are born too early each year. Babies who survive an early birth often have breathing problems, cerebral palsy, intellectual disabilities, and other lifelong problems. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants, and the costs exceed $26 billion each year. “While our country excels in helping preemies survive, we have failed to do enough to prevent preterm births and help more mothers carry their babies full-term," says Jennifer L. Howse, president of the March of Dimes.
The report also highlights health disparities for newborns in the US. The rate of preterm births for African American mothers is 18 percent; the rate for white mothers is 11 percent.
Worldwide, the new report finds that 15 million babies are born preterm each year, and more than one million die due to preterm complications. Of these babies, the report notes, three-quarters could be saved if current cost-effective interventions were made more widely available. Those interventions, according to Dr. Howse, include:
- Giving all women of childbearing age in the U.S. access to health care, including adolescents, and including care before, between, and during pregnancy
- Behavioral changes to reduce the risk of an early birth, such as not smoking during pregnancy
- Progesterone treatments for women who have had a previous preterm birth
- Better management of fertility treatments that result in multiple births
- Hospital quality improvement initiatives to reduce early inductions and Cesarean deliveries before a full 39 weeks of pregnancy unless medically necessary
“This report underscores the need for action to reduce premature birth in the U.S., and state and territorial health officials have a critical role in championing and implementing proven solutions,” says David L. Lakey, M.D., president of the Association of State and Territorial Health Officials and Commissioner of the Texas Department of State Health Services. “Interventions that promote full term, 39-week pregnancies and improve the health of babies can significantly reduce health care costs.” Reducing preterm births is Dr. Lakey’s Presidential Challenge during his term as ASTHO president.
In February, the Department of Health and Human Services announced “Strong Start," an initiative that includes funding for enhanced prenatal care and hospital quality improvement programs. And the March of Dimes has launched its “Healthy Babies Are Worth the Wait” campaign to let women know that if their pregnancy is healthy, it’s best to wait for labor to begin on its own rather than scheduling a delivery. Elizabeth Mason, MD, director of the Department of Maternal, Newborn, Child and Adolescent Health for the WHO says model practices in other countries that have reduced preterm births include creating medical homes for expectant mothers, reducing hospital infection rates and both prenatal care and care throughout a pregnancy to monitor for concerns.
Christopher Howson, PHD, Vice President for Global Programs at the March of Dimes Birth Defects Foundation, says the current worldwide rate of preterm births could be halved by 2025 if the recommended interventions are carried out. “That is eminently, eminently feasible,” says Howson.
Bonus Reading: For a state-by-state breakdown of preterm birth rates within the U.S., see the March of Dimes 2011 Premature Birth Report Card online at marchofdimes.com/prematurity.
The National Highway Traffic Safety Administration has launched a new website, Parents Central, that will, quite frankly, help save children’s lives. The site offers frequently updated safety information for kids in cars—from the newborn firstborn to the teen homecoming queen—as well as safety guidance for travel of all kinds including bicycling, walking and riding the bus to school.
Last month’s Vital Signs report from the Centers for Disease Control and Prevention provides a critical evidence base for parents, and health care professionals, to book mark and follow Parents Central. The April report showed that child injury death rates dropped nearly 30 percent from 2000 to 2009, with a significant part of that decline coming from a 41 percent drop in motor vehicle crash deaths in children over the past decade. Safety measures that have reduced deaths in car crashes include use of child safety seats and booster seats, and more widespread adoption and the strengthening of graduated driver's licensing systems for teenagers.
While you’re on the Parents Central site, NHTSA resources well worth the look include guidance on choosing and installing car seats, the agency’s new campaign to prevent child heatstroke deaths in cars, and tips for staying safe when transporting kids in multi-passenger vans—especially as summer camps and trips start up.
Bonus Reading: Read about Operation Hang Up, an initiative in New York State this past weekend that had police officers aggressively ticketing drivers on their cell phones.
This week is National Infant Immunization Week, an annual observance to promote vaccinations in kids two and younger.
Last September the Centers for Disease Control and Prevention announced that childhood immunization rates for vaccines routinely recommended for children are at near-record or record highs. But CDC experts say that without ongoing efforts to maintain immunization programs in the US – and to strengthen them worldwide -- vaccine-preventable diseases remain a threat to children. In 2010, for example, an outbreak of pertussis (whooping cough) killed ten infants in California.
CDC and the CDC Foundation are recognizing innovative child immunization efforts this year with the CDC Childhood Immunization Champion Awards, a new annual award to recognize individuals who make significant contributions toward improving public health through their work in childhood immunization.
Innovations recognized this year include:
- A contest to help increase the number of people vaccinated against season flu.
- A link between a hospital’s electronic medical records and the state immunization registry which lets pediatrics practices upload vaccine information directly into the registry and gives providers easy access to registry data about their patients.
- Vaccine mobiles, providing free vaccines regardless of insurance coverage, parked at public spaces and linked to a state registry system.
Weigh In: What innovative approaches have increased infant immunization rates in your community?
Next week, young farm-workers from across the country will share their stories with officials and advocates in Washington, D.C., to discuss the challenges they face working in the fields from a very young age. The youth-led and youth-organized conference will also highlight communities that are working to empower farm-worker youth to achieve healthier lives. The topics of the conference were chosen by the participating youth as the most important issues in their lives:
- Health – Pesticide exposure, the effects of working in extreme weather conditions, safety issues in work with heavy machinery, the toll the job takes on one’s body, and drugs and alcohol as coping mechanisms
- Work in the Fields – Wages, sexual assault in the fields and health issues that result from being in the fields
- Housing – The stress of migrating during the harvest, and the problems unaccompanied youth face when migrating
- Education – Barriers that migrant farm-worker youth face in finishing school, programs in place to help many farm-worker youth reach their educational goals
The event, hosted and organized by the Association of Farmworker Opportunity Programs, will take place on April 26 to April 27. Learn more about and register for the event. Registration is now free, and anyone interested in attending can email email@example.com.
The holidays are an exciting and warm time of year -- but they can also pose some unique dangers. To help ensure you have a safe holiday season, here are some tips from the American Academy of Pediatrics (AAP).
- When setting up a tree at home, place it away from fireplaces, radiators or portable heaters, and out of the way.
- Cut a few inches off the trunk of your tree to expose the fresh wood. This allows for better water absorption and will help keep your tree from drying out and becoming a fire hazard.
- Be sure to keep the stand filled with water; heated rooms can dry live trees out rapidly.
- Check all tree lights--even if you've just purchased them--before hanging them on the tree. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections. Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights, and a person touching a branch could be electrocuted. Before using lights outdoors, check labels to be sure they have been certified for outdoor use. To hold lights in place, string them through hooks or insulated staples, not nails or tacks. Never pull or tug lights to remove them. Plug all outdoor electric decorations into circuits with ground fault circuit interrupters to avoid potential shocks.
- Turn off all lights when you go to bed or leave the house. The lights could short out and start a fire.
- Use only non-combustible or flame-resistant materials to trim a tree. Choose tinsel or artificial icicles of plastic or nonleaded metals.
- Never use lighted candles on a tree or near other evergreens. Always use non-flammable holders, and place candles where they will not be knocked over.
- In homes with small children, take special care to avoid decorations that are sharp or breakable. Keep trimmings with small removable parts out of the reach of children to prevent them from swallowing or inhaling small pieces.
- Avoid trimmings that resemble candy or food that may tempt a young child to eat them.
- To prevent both burns and electrical shocks, don’t give children under age 10 a toy that must be plugged into an electrical outlet. Instead, buy toys that are battery-operated.
- Children under age three can choke on small parts contained in toys or games. Government regulations specify that toys for children under age three cannot have parts less than 1 1/4 inches in diameter and 2 1/4 inches long.
- Children can have serious stomach and intestinal problems – including death -- after swallowing button batteries and magnets. Keep them away from young children and call your health care provider immediately if your child swallows one.
- Remove strings and ribbons from toys before giving them to young children.
- Watch for pull toys with strings that are more than 12 inches in length. They could be a strangulation hazard for babies.
- Remove all wrapping papers, bags, paper, ribbons and bows from tree and fireplace areas after gifts are opened. These items can pose suffocation and choking hazards to a small child or can cause a fire if they come near a flame.
Bonus Tip: Clean up immediately after a holiday party. A toddler could wake up early and choke on leftover food or come in contact with alcohol or tobacco.
Read More Safety Tips from the American Academy of Pediatrics here.