Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth A National Agenda (2019) / Chapter Skim
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5 Strategies for Health Care Settings
5 Strategies for Health Care Settings
Pages 165-186
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From page 165... ...
Indeed, health care settings provide opportunities to support families at every stage that have the potential to influence a child's MEB development -- from before conception and throughout development, including preconception and prenatal health care involving both mother and father; child health care starting at birth and extending into young adulthood, including well-child care as well as care for acute and chronic conditions; health care for adolescents and young adults in the childbearing years; and parental health maintenance. This array of opportunities could have a significant impact, but there is a notable gap between these possibilities and the reality of many health care settings.
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From page 166... ...
Efforts to integrate primary child health care clinics and home visitation programs can enhance previsit planning of well-child visits in order to ensure that those visits address family needs and concerns, and also provide a way to monitor and enhance family attention to health care plans. Another example is embedding child, parent, and family community services into health care settings to provide "one-stop shopping" to address family MEB health needs.
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From page 167... ...
Young women seek care in a number of health care settings, including gynecology, pediatric adolescent medicine, internal medicine, and family medicine. However, those who most need health surveillance and advice during the preconception period are the least likely to connect with the health care system (Bish et al., 2012)
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From page 168... ...
; fetal exposures to toxic substances and maternal adverse health conditions also pose significant risks. Despite evidence that promotion of healthy pregnancy and prevention of in utero risks support healthy MEB outcomes in children, relatively modest progress has been made toward these goals.
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From page 169... ...
. Some positive results have been shown for efforts to provide universal and anticipatory health care and support reproductive choice starting before or early in pregnancy, and for community-level efforts to address health risks associated with preterm birth.
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From page 170... ...
. Pregnant women who use such substances also frequently have MEB disorders, environmental stressors, and inconsistent prenatal care (Forray, 2016)
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From page 171... ...
For example, preconception health care that includes selfcare strategies for limiting alcohol consumption in sexually active women may contribute to reduced fetal exposure to alcohol. And early identification and introduction of targeted interventions for affected children show promise for improving functional outcomes and mitigating secondary behavioral disabilities
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From page 172... ...
Preventing the initiation of use is likely to have greater impact than treating pregnant women already affected. The Youth Risk Index is a validated instrument for us in primary health care settings to target early teens; it detects initiation or risk for initiation of substance use and has considerable potential for prevention if linked to an effective intervention program (Ridenour et al., 2015)
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From page 173... ...
MEB development at a population level. Nearly all children and their caregivers are seen in primary care settings for well-child visits, with multiple visits in the first 3 years of a child's life: the AAP recommends up to 13 such visits.
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From page 174... ...
. The objective of collocation of behavioral practitioners has been the provision of "one-stop shopping" for families of children with behavioral health disorders, and this development should facilitate activities targeting integrated MEB health promotion.
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From page 175... ...
. INTEGRATING BEHAVIORAL CARE AND PRIMARY HEALTH CARE The importance of addressing both the MEB and physical health needs of children is increasingly recognized (Foy and American Academy of Pediatrics Task Force on Mental Health, 2010)
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From page 176... ...
Although many efforts to promote MEB health through primary health care exist, particularly for children in the first 2 to 3 years of life, the health care system is not systematically taking full advantage of such opportunities, particularly opportunities to work with other community partners. One reason is the organization and structure of child health care practices, and another is a reimbursement system that has compensated poorly, if at all, for promotion and risk prevention directed at healthy MEB development (Counts et al., 2018)
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From page 177... ...
Furthermore, both pediatric and psychology residents have the opportunity to observe and practice this mode of care. Universal, comprehensive behavioral care in child primary health care practices may be one of the best opportunities to address the agenda of fostering MEB health in the first years of life at a population level.
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From page 178... ...
. Such cases add considerably to the MEB health burden in the United States, and the MEB needs of these families have only recently been recognized as an important target for pediatric subspecialty and chronic disease care (Boat, Filigno, and Amin, 2017)
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From page 179... ...
Specifically: Preconception and prenatal care for women provide critical opportunities to mitigate the risks of premature birth, tobacco and alcohol exposure, and other risks to children's MEB development. Primary care for young people from infancy to young adulthood, particularly in the early years of life, offers critical opportunities to provide parenting education and screening for risks to MEB development.
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From page 180... ...
. Workforce development to enhance the cognitive, affective, and behavioral health of children and youth: Opportunities and barriers in child health care training.
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From page 181... ...
. Preventive behavioral health programs in primary care: A systematic review.
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From page 182... ...
. A national action plan for promoting preconception health and health care in the United States (2012–2014)
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From page 183... ...
. A stress coping app for hospitalized pregnant women at risk for preterm birth.
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From page 184... ...
. Training pediatric residents to provide parent education: A randomized controlled trial.
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From page 185... ...
. Preconception healthcare delivery at a population level: Construction of public health models of preconception care.
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From page 186... ...
. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review.
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