By Calla R. Brown, MD, Tom Scott, MD, and Iris W. Borowsky, MD, PhD
Mental health conditions are prevalent in the pediatric population, and identification and treatment at an early age can lead to improved long-term outcomes. Primary care clinics have long been promoted by the Bright Futures Guidelines for Health Supervision as the optimal site of screening for mental health conditions in the pediatric population given pediatricians’ sustained contact with children and families.
Diagnosis of mental health conditions in children through improved screening rates has been identified by the Minnesota Department of Health as a core measure in pediatrics, and there are several tools available to the general pediatrician for screening. This Minnesota goal is in line with national objectives to increase screening and treatment for mental health conditions, and Healthy People 2020 includes specific screening and treatment goals for depression in adolescents.
One of the most widely used and validated screening tools is the Pediatric Symptom Checklist-17 (PSC-17). While this tool is recommended in the state of Minnesota as a screening questionnaire for psychosocial problems in the pediatric population, screening rates for mental health conditions across the state as reported by the Minnesota Department of Health currently average around forty percent.
The PSC-17 is a 17-item questionnaire developed as a parent-completed screen and designed to prompt recognition of psychosocial problems in pediatric patients aged four to eighteen. As reported in the Journal of Primary Care and Community Health by Valleley et. al. in 2015, studies show that approximately 15 to 25 percent of children presenting to primary care clinics have a behavioral health concern (for example Briggs-Gowan, et. al. reported a prevalence of 16.8% in the Journal of Academic Child and Adolescent Psychiatry in 2000 and Cooper, et. al. reported a prevalence of 23.6% in Pediatrics in 2006). The PSC-17 contains items geared towards identification of internalizing symptoms, attention symptoms, and externalizing symptoms. Positive scores in each of these realms are correlated to risk of specific underlying mental health conditions:
- The internalizing questions relate to risk of depression and anxiety
- The attention questions to attention deficit hyperactivity disorder
- The externalizing questions to conduct or oppositional-defiant disorders
The PSC-17 is short, easy to interpret, and a positive screening result can guide the pediatrician towards further history-taking or diagnostic evaluation. This can allow the pediatrician to initiate appropriate primary care management or the most applicable referral.
While mental health screening is recommended for children at all health maintenance visits, a study by Borowsky, et. al. conducted in eight pediatric practices in the Twin Cities and published in Pediatrics in 2004 evaluated the use of the PSC-17 tool during all visits. Youth presenting for an acute care visit were significantly more likely to score positive on the screen than those presenting for a well visit; thus the use of this standardized tool at all visits may increase the proportion of Minnesota children and adolescents with underlying mental health conditions who receive a diagnosis, and thereafter effective treatment.
- For more information about mental health promotion in primary care, please see the American Academy of Pediatrics Mental Health Initiatives Key Resources.
- Primary care and mental health toolkits can be accessed at the following website: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Pages/Key-Resources.aspx
- Find a copy of the PSC-17 tool, scoring and information and information about the promotion of mental health during health supervision visits: https://brightfutures.aap.org
- The PSC -17 and longer PSC from which it was derived is available to download in several languages: http://www.massgeneral.org/psychiatry/services/psc_forms.aspx