Center for Promotion of Child Development Through Primary Care

A 2001 Surgeon General's report, "A National Action Agenda for Children's Mental Health", warned of a health care crisis in the identification and treatment of children's mental health problems. "Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by those very institutions, which were explicitly created to take care of them." Nearly 21 percent of U.S. children aged 9 to 17 have diagnosable mental health disorders, and 10 percent suffer from mental illness severe enough to cause significant impairment. Fewer than 20 percent of these children receive any mental health treatment, and most of these receive services only in school.

The long-term consequences of untreated childhood mental illness are costly. Children with undiagnosed and untreated mental health problems are at increased risk for dropping out of school, using drugs and alcohol, and, ultimately, in some cases, ending up in the criminal justice system.
As President Bush's New Freedom Commission on Mental Health observed in its July 2003 Report, lack of early screening and treatment of childhood mental health disorders may "lead to a downward spiral of school failure, poor employment opportunities and poverty in adulthood."

Both the President's New Freedom Commission on Mental Health and the Surgeon General's "National Action Agenda" highlighted the need to improve the assessment and recognition of children's mental health needs in primary health care settings. Most pediatricians have no training or expertise in mental health issues, and families often fail to recognize early indicators of mental health problems in children, and thus fail to report these problems to their primary-care providers. According to the New Freedom Commission Report, "[w]hile primary care providers appear positioned to play a fundamental role in addressing mental illnesses, there are persistent problems in the areas of identification, treatment, and referral."

Recognizing the potential to improve mental health diagnosis and treatment by primary care providers, two Johns Hopkins faculty pediatricians established the Center for Promotion of Child Development through Primary Care in 2000. A main focus of the Center has been the development of a computerized behavioral assessment system - known as CHADIS -- that will assist health care providers in diagnosing mental health problems, and provide information and resource referrals to families. CHADIS is designed to be used during pediatric primary care visits. Prior to meeting with the pediatrician, a parent completes a computerized questionnaire identifying any concerns regarding the child's behavior. Based on the parent's answers to the questionnaire, CHADIS provides immediate information to the pediatrician regarding any developmental, behavioral, or emotional problems the child may have. In addition, the system provides both the pediatrician and the parent with information about mental health resources in the community, ranging from informational books and videos to mentoring programs and mental health care providers.

With a $341,000 grant from The Abell Foundation in 2001, the Center initiated a pilot project using CHADIS in two inner-city Baltimore pediatric clinics. The pilot project seeks to assess the impact, if any, of CHADIS on children's mental health and behavioral outcomes by comparing children who receive standard pediatric care with children whose pediatric visits are assisted by CHADIS. The preliminary data have been promising, showing that CHADIS is both highly accurate in identifying psychiatric disorders in children, and much more effective than pediatricians in diagnosing these conditions. Data collected from children in the control group in this project found 27 percent of children had a diagnosable mental health disorder, and an additional 28 percent had a mental health "problem" (a diagnostic category that indicates concerns that fall short of disorder, but can develop into a disorder if left untreated), whereas the pediatricians treating these children identified a total of 23 percent with some type of mental health concern. Moreover, CHADIS was much more specific than the pediatricians, making 32 different diagnoses, compared to just three formal diagnoses used by the pediatricians.

Based on these promising findings, the Foundation awarded a second grant of $131,000 to the Center in 2005 to complete the pilot project. The Center will collect baseline mental health data on children receiving standard pediatric care and on those whose care is assisted with CHADIS, and will follow up with both groups of children one year later to determine if there has been any change in their conditions. Results of the study will be published and will be used to improve the design of the CHADIS system. The CHADIS system is already beginning to garner national attention. The Center is in the process of establishing a partnership with the American Academy of Pediatrics to assist in disseminating CHADIS to pediatricians and developing new CHADIS screening modules.