Screening patients provides a baseline. A frame of reference to help guide and tailor care. One looming question remains: When do you screen a patient? At birth? At a specific age? While obvious, the optimal time for screening will vary in accordance to the particular disease of interest. When is the appropriate time to screen for mental health concerns?
Like physical illness, it depends on mental health concerns are of interest. For ill or injured children and families, the Pediatric Psychosocial Preventive Health Model (PPPHM) suggests screening for medical traumatic stress universally and at regular intervals throughout the course of treatment and/or recovery. Mental health screening for well children ideally would follow the same PPPHM model.
The nature of the patient-physician relationship in pediatrics places pediatricians in a unique situations to screen not only for medical traumatic stress, but also adverse childhood experiences (ACEs). As pediatricians develop this relationship, they often may be the first to hear about exposure to ACEs and/or see the first warning signs of mental health concerns, or the "pink flags", as Rahil Briggs, a child psychologist, explains:
"I don't want to wait until a child has missed five days of school because his anxiety is so bad that he can't get on the school bus. That to me is a red flag," she says.
Instead: "I want to see the pink flags."
What she means by that is when a child "starts to chew on his shirt a little bit when you say, 'tomorrow is school.' Just very early, early warning signs of something going wrong."
The best place to spot these pink flags, she believes, is in a pediatrician's office. It's a place all new parents bring their babies regularly and a place they trust."
In fact, traumatic stress experts suggest pediatricians ask all their patients at all well-child visits a very simple question: "Since the last time I saw you, has anything really scary or upsetting happened to you or your family?" This simple, less intimidating, question opens a door for children and families to bring up concerns and experiences affecting their lives and ultimately their present and future health. It allows pediatricians to gauge whether the family needs basic guidance, further assessment, or referral to a mental health provider. As a pediatric provider, do you screen patients for medical traumatic stress or adverse childhood experiences?