Children - Key Activity 14C

KEY ACTIVITY #14C:

Manage Treatment of Adolescents’ Behavioral Health Needs in Integrated, Person-Centered Ways

This key activity involves all seven elements of person-centered population-based care: operationalize clinical guidelines; behavioral health integration.

Overview

This activity provides general recommendations on treatment of adolescents’ behavioral health needs in integrated and person-centered ways. As with adults, evidence-based care practices include the following singularly or in combination:

• Psychopharmacology, including referring out or leveraging same-day consults with child psychiatrists (described below) when needed.
• Behavioral health interventions such as Motivational Interviewing, Acceptance and Commitment Therapy, Problem Solving Therapy-Primary Care, Cognitive Behavioral Therapy, Interpersonal Counseling, Behavioral Activation, Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT).
• Peer support.

For additional information regarding behavioral treatment in general, please refer to the PHMI People with Behavioral Health Conditions Guide activity around embedding evidence-based care practices. The provision of these services differs for adolescents, as it is ideally provided by clinicians who have training, experience and comfort in responding to the behavioral health needs of adolescents.

Model recommendations for treatment that resonate with youth include:

• Involving youth as partners in project design.
• Implementing and monitoring recommendations made by youth.
• Considering the ways that a fundamental understanding and respect for youth can be incorporated into ongoing outreach efforts.

Confidentiality and adolescent care

Youth list concerns about confidentiality as the number one reason they might forego medical care. For this reason, youth need assurances of privacy and confidentiality from their healthcare providers. However, many providers feel overwhelmed or in the dark about the myriad of laws governing confidentiality and their responsibilities in minor consent laws and reporting child abuse. It is beyond the scope of this activity to include all relevant details, but it is encouraged that teams take advantage of resources, such as Understanding Confidentiality and Minor Consent in California: An Adolescent Provider Toolkit and familiarize themselves with charts, such as California Minor Consent and Confidentiality Laws. Given that parents’ rights to access adolescent medical records depend upon the health service provided, who consented or could have consented for the service, and the service provision site, in most cases, parents will have a right to access their child’s records. However, in some cases, parents cannot access records until their teen provides them with written authorization.

Teams need to consider what processes and workflows are necessary to maintain confidential records in the EHR setting. This includes training staff to know how to document in a manner that maintains adolescent confidentiality. In addition, they should provide education about parental access to medical record information to adolescents and their families. As communication such as texting and portal emailing become more ubiquitous, teams must consider alternative mechanisms by which to communicate with adolescents about the elements of their medical record that they want to be kept confidential.

Evidence base for this activity

Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. practice preparation, identification, assessment, and initial management. Pediatrics [Internet]. 2018 Feb 26;141(3):1–21. Available from: https://pediatrics.aappublications.org/content/141/3/e20174081