Psychological and Behavioral Health

PSYCHOLOGICAL AND BEHAVIORAL HEALTH - (click  to jump to specific module section)
Updated March 2020

• Screening
• Referral/Treatment
• Management of Suicidality

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Screening

Learning Objectives:

1. Describe the importance of screening all adolescents about mental health issues including depression, anxiety, non-suicidal self-harm, and suicidal ideation
2. Describe the importance of asking suicidal patients if there is a plan
3. Compare the presentation and diagnosis of ADHD between early, middle, and late adolescence and young adults

1. Pew Research Center, February 2019, “Most U.S. Teens See Anxiety and Depression as a Major Problem Among Their Peers” 
2. Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 2001;40(7 Suppl):24S-51S.    
3. Maslow GR, Dunlap K, Chung RJ. Depression and Suicide in Children and Adolescents. Pediatr Rev 2015;36(7):299-308; quiz 309-10.
4. Kelly P. Posttraumatic stress disorder. Pediatr Rev 2012;33(8):382-3

1. MCPAP (Massachusetts Child Psychiatry Access Project). Available at http://mcpap.org - section For Providers contains
   • Diagnostic Resources
   • Screening and Toolkits
2. The REACH Institute: Specific sections on Screening, Assessment & Referral; Issue Briefs

• Depression - Too Tired to Sleep

1. Office of Adolescent Health - Adolescent Health Topics - Mental Health. 

1. Pitts S, Borus J, Harris S, Siegel J, Gooding H, Goncalves A, Levy S, Weitzman E, Burke P. Benefitting Brad: An Interprofessional Case of Adolescent Substance Use and ADHD. MedEdPORTAL Publications; 2015. 

• Outpatient (adolescent clinic, primary care clinic, child and adolescent psychiatry)
• Inpatient (wards, PICU)
• Emergency department

Referral/Treatment

1. Assess patient readiness for change/intervention
2. Discuss outpatient treatment of depression/anxiety in adolescents including pharmacologic treatment and mental health utilization.
3. Know behavioral and pharmacologic treatments for ADHD

1. Zuckerbrot RA, Cheung AH, Jensen PS, Stein RE, Laraque D, Group G-PS. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics 2007;120(5):e1299-312.
2. Cheung AH, Zuckerbrot RA, Jensen PS, Ghalib K, Laraque D, Stein RE, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management. Pediatrics 2007;120(5):e1313-26.
3. Wolraich M, Brown L, Brown RT, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011;128(5):1007-22.

1. Guidelines for Adolescent Depression in Primary Care (GLAD-PC) Toolkit

1. ​Office of Adolescent Health - Adolescent Health Topics - Mental Health 

• Outpatient (adolescent clinic, primary care clinic, child and adolescent psychiatry; work with outpatient social work)
• Inpatient (wards, PICU, psychiatry)
• Partial hospitalization - child and adolescent psychiatry
• Emergency department

Management of Suicidality

1. Describe the importance of asking all adolescents about suicidal ideation and, if present, if there is a plan
2. Know the resources in your area for referral of an actively suicidal adolescent (crisis team, psychiatric or medical ED, psychiatric hospital)
3. Examine the basis of safety planning and how to counsel parents/guardians of safety plan 

1. It Gets Better Project 
2. To Write Love on Her Arms
3. MCPAP (Massachusetts Child Psychiatry Access Project) 
   • Suicide Prevention in the Primary Care Setting in section “For Providers” 
4. The Cornell Research Project on Self-Injury and Recovery 
5. The Trevor Project

1. ​Office of Adolescent Health - Adolescent Health Topics - Mental Health 

• Outpatient (adolescent clinic, primary care clinic, child and adolescent psychiatry; work with outpatient social work)
• Inpatient (wards, PICU, psychiatry)
• Partial hospitalization - child and adolescent psychiatry