Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Thursday, January 27, 2011

Infant-parent mental health care-where does it fit in?

When I tell friends, office staff and even some colleagues in pediatrics that I am building a behavioral pediatrics practice that is focused on infants, they sometimes give me a puzzled look. I was recently asked to write a guest post for a blog called "FreelanceMD:the cure for the common physician." The blog advertises itself as being for doctors taking charge of their own practice of medicine,and even has a section entitled "non-traditional medical careers". As the way I practice pediatrics doesn't fit into any defined category, I thought this might be a good community to join. I invite you to take a look at my guest post today, Inside Infant-Parent Mental Health Care. It has some similar themes to what I have written about elsewhere on this blog, and offers a specific example of what a pediatrician who follows the principles of the discipline of infant mental health actually does.

Extensive research has shown the long term negative effects of maternal depression and anxiety on child development. Untoward effects on development occur even when symptoms are below the level to qualify for a diagnosis, as is common in today's culture where new mothers are often struggling with minimal help and/or emotional support. We need to intervene early, when these brains are rapidly growing, when an infant’s brain is making as many as 1.8 million neural connections per second.

This kind of work fits very well in a primary care practice, where mothers and babies are seen early and often. Many programs that implement the principles of parent-infant mental health care are in university settings, or in large cities or specifically target high-risk groups. Being seen in a primary care practice avoids the stigma that still may be associated with a referral to a mental health care practitioner. It also offers the opportunity to help families that might not fit into an identified high risk category, but are struggling nonetheless.This is a model that could be applied in practices of any size in any location.The first step would be to integrate the growing ranks of mental health professionals who practice parent-infant psychotherapy into primary care practices. Next would be a large scale effort to teach these principals and practices to primary care providers themselves.

This model has worked well for me for many years. At first I did both primary care and behavioral pediatrics, but when my children reached school age and I could not meet the needs of my family if I were to continue taking call, I switched to doing exclusively behavioral pediatrics, but within a primary care practice. As far as the insurance companies are concerned I am credentialed as general pediatrician. I have always been well reimbursed for my services even when I see patients often and for 50 minute visits.

I hope that many pediatricians will follow a similar path.

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