(Adapted from Jellinek, M. "Approach to the
Behavior Problems of Children and Adolescents." In T.A. Stern, J.B. Herman,
P.L. Slavin (Eds.) The MGH Guide to Psychiatry in Primary Care. 1998.
New York: McGraw-Hill: 437-443).
can screening for psychosocial problems
- Screening enables
clinicians to recognize problems – quickly – and to provide help,
preferably at an early and effective point. Screening tests are not designed
to yield diagnoses or label children. For example, rather than review
symptoms of diabetes in every child, a urine screening test helps the
primary care clinician determine which children need further evaluation.
Similarly, psychosocial screening is a starting point for further questions
and assessment. See our Figure for a summary
of how psychosocial screening facilitates the referral and treatment of
children in the mental health system.
- A key component
for determining appropriate treatment, as prescribed by the DSM-IV
(Diagnostic and Statistical Manual of Mental Disorder. Fourth Edition)
and the DSM-IV-PC (Diagnostic and Statistical Manual of Mental
Disorder. Fourth Edition. Primary Care Version), is the extent of
impairment or severity. Some presentations, such as psychosis or a serious
suicide attempt, are clearly severe and will need to be referred for possible
hospitalization. Other conditions, however, such as depression or ADHD,
can vary widely in severity and in milder cases will be managed in primary
care settings, some with support or changes in school program; others
with psychotropic medications and more comprehensive treatment programs.
Early recognition, at a point before damage to self-esteem, is both prognostically
better for the child and economically better for the child’s family and
for those funding services.