In 2004, the American Academy of Pediatrics (AAP) Board of Directors appointed the Task Force on Mental Health, charging it to assist pediatricians and other primary care clinicians* in enhancing the mental† health care that they provide to children and adolescents.
The board's directive stemmed from its recognition that (1) 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 and (2) the growth in this role will involve transformational changes in pediatric primary care practice, requiring new knowledge and skills, payment structures, collaborative relationships, office systems, and resources.
The Growing Role of Pediatric Primary Care Clinicians in Mental Health Care
A compelling body of evidence demonstrates the enduring effects of early social and emotional experiences on the brain architecture and development of infants and young children. The evidence demonstrates the effects of these experiences, in turn, on behavior, biological stress reactivity, psychological resilience, and immunologic resistance throughout life.1,–,3 Pediatric primary care clinicians have unique access to the families of young children before and after the birth of a child and, thus, are uniquely situated to foster effective nurturing by their caregivers and positive early experiences for the child. Bright Futures provides a framework for the integration of social-emotional care within the context of routine pediatric health supervision.4 In addition to providing their own guidance, primary care clinicians play an important role in advocating for and linking families to parenting resources and to high-quality child care, preschool, and school programs, all of which may positively influence the social-emotional health of children.5,–,8
Primary care clinicians also encounter many families with concerns about their children's mental health and many children with mental …
Address correspondence to Joy Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: