TABLE 4

Core Pediatric Mental Health Competencies: Clinical Skills

Pediatricians providing care to children and adolescents can maximize the patient’s and family’s health, agency, sense of safety, respect, and partnership by developing competence in performing the following activities:
 Promotion and primary prevention
  Promote healthy emotional development by providing anticipatory guidance on healthy lifestyles and stress management
  Routinely gather an age-appropriate psychosocial history, applying appropriate tools to assist with data gathering
 Secondary prevention
  Identify and evaluate risk factors to healthy emotional development and emerging symptoms that could cause impairment or suggest future mental health problems, applying appropriate tools to assist with screening and refer to community resources when appropriate (ie, parenting programs)
 Assessment
  Recognize mental health emergencies such as suicide risk, severe functional impairment, and complex mental health symptoms that require urgent mental health specialty care
  Analyze and interpret results from mental health screening, history, physical examination, and observations to determine what brief interventions may be useful and whether a full diagnostic assessment is needed
  Diagnose school-aged children and adolescents with the following disorders: ADHD, common anxiety disorders (separation anxiety disorder, social phobia, generalized anxiety disorder), depression, and substance use
 Treatment
  Apply fundamental (common factors, motivational interviewing) communications skills to engage youth and families and overcome barriers to their help seeking for identified social and mental health problems
  Apply common-factors skills and common elements of evidence-based psychosocial treatments to initiate the care of the following:
   Children and youth with medical and developmental conditions who manifest comorbid mental health symptoms
   Depressed mothers and their children
   Infants and young children manifesting difficulties with communication and/or attachment or other signs and symptoms of emotional distress (eg, problematic sleep, eating behaviors)
   Children and adolescents presenting with the following:
    Anxious or avoidant behaviors
    Exposure to trauma or loss
    Impulsivity and inattention, with or without hyperactivity
    Low mood or withdrawn behaviors
    Disruptive or aggressive behaviors
    Substance use
    Learning difficulties
  When a higher level of care is needed for symptoms listed above, integrate patient and/or family strengths, needs, and preferences, the clinician’s own skills, and available resources into development of a care plan for children and adolescents with mental health problem(s), alone, with the practice care team, or in collaboration with mental health specialists
  Demonstrate proficiency in selecting, prescribing, and monitoring (for response and adverse effects) ADHD medications and selective serotonin reuptake inhibitors that have a safety and efficacy profile appropriate to use in pediatric care
  Develop a contingency or crisis plan for a child or adolescent
  Develop a safety plan with patients and parents for children and adolescents who are suicidal and/or depressed
  Apply strategies to actively monitor adverse and positive effects of nonpharmacologic and pharmacologic therapy
  Facilitate a family’s and patient’s engagement with and transfer of trust (ie, “warm handoff”) to a mental health professional
  Demonstrate an accurate understanding of privacy regulations
  Refer, collaborate, comanage, and participate as a team member in coordinating mental health care with specialists and in transitioning adolescents with mental health needs to adult primary care and mental health specialty providers