Primary care providers are an important piece of the puzzle when it comes to identifying mental health challenges a child may be facing, especially earlier in the course of a condition. A primary care provider (PCP) or doctor, has often watched the child grow up, so has built a trusting relationship with the young person and the family.
Parents can bring up any concerns during a child’s annual well visit, of course, but if a problem arises outside of that timeframe, it’s best to reach out to the PCP’s office sooner rather than having a small problem become more severe.
Yesenia Marroquin, PhD, a clinical psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia, offers some ideas on how families can effectively partner with their PCP to address behavioral and mental health concerns.
Making an appointment
Primary care practices are busy places. It’s helpful for parents — or the teen, if they are making their own appointment — to be as specific as possible about what their concern is. “I’m concerned my child may be experiencing depression or anxiety. I really could use some guidance on what to do.” “My child has expressed thoughts of dying by suicide.”
Giving specifics will help the physician’s office triage children at immediate risk and otherwise appropriately schedule time for this type of visit.
If the child has shared their problems with a parent, the parent can say, “I think it would be helpful to bring in our PCP to help guide us through this.” Give the young person some control, but within certain parameters. The parent could ask: “Do you want to reach out to them, or do you want me to? If you want to reach out, I’ll give you two weeks. But if you haven’t been about to make an appointment by then, I’ll call to make the appointment.”
This way, the parent is providing the option of who is going to reach out, not an option of whether the family will reach out. It is recommended that the parents frame it as a positive step toward bringing relief to the child. “Let’s go to your doctor to figure this out so we can address it the best we can. Here’s where we can get support.”
Some children or teens may not want to go to the PCP, taking an “it’s my business” stance. It is recommended that parents communicate to their child, “Our PCP will have another perspective on what is coming up for you and can help us find the best course of action.” Parents can also explain what details about the child’s challenges they will share with the PCP, especially for an older teen.
In situations where the parent has concerns about a younger child’s behaviors and the child may not have talked about how they’re feeling, it is recommended that the parent make the appointment.
Once at the doctor’s office
While the parent may bring up the topic and tell the PCP about their concerns, depending on the child’s age, it would be helpful to have the child or teen describe their feelings and concerns in their own words.
Depending on the condition, it’s helpful to have a written record of what a parent has observed about the child that raised concerns. Parents can give the doctor an approximate timeline of when they started observing some changes in the child’s behavior, the severity and frequency. These changes could be increased irritability, withdrawal, heightened worries, and changes in eating or sleeping patterns. Do the behaviors coincide with physical illness or other stressors? Are some more persistent or intense?
Families need to be patient. It might take more than one appointment to fully understand what the diagnosis is. The PCP may ask for teacher feedback, so that may take additional time, for example, for a potential diagnosis of ADHD.
More training for physicians
Over recent years, PCPs have received increased training on both identifying a mental health condition and on treatment options. The PCP can help determine what is more age-appropriate behavior vs. what would need addressing.
There are screening questionnaires for the child and parent/caregiver. Physicians have different tools to assess what the young person is feeling, how intense it is and options for next steps. There are some situations the PCP can manage within primary care — mild depression and anxiety symptoms; ADHD; and general guidelines for managing school/family/social stressors — while others may need additional support from behavioral and mental health professionals.
For youth who need additional treatment, the primary care office can give families referrals for individual mental health providers and community groups that offer services. The shortage of behavioral and mental health providers for young people is real and persistent, so families should connect with providers quickly to get on their waiting lists.
In the meantime, families can use the tools their PCP provided to help their child manage their current distress in adaptive and skillful ways.