Overlooked and underserved: "action signs" for identifying children with unmet mental health needs.
OBJECTIVE
The US Surgeon General has called for new approaches to close the mental health services gap for the large proportion of US children with significant mental health needs who have not received evaluation or services within the previous 6 to 12 months. In response, investigators sought to develop brief, easily understood, scientifically derived "warning signs" to help parents, teachers, and the lay public to more easily recognize children with unmet mental health needs and bring these children to health care providers' attention for evaluation and possible services.


METHODS
Analyses of epidemiologic data sets from >6000 children and parents were conducted to (1) determine the frequency of common but severely impairing symptom profiles, (2) examine symptom profile frequencies according to age and gender, (3) evaluate positive predictive values of symptom profiles relative to Diagnostic and Statistical Manual of Mental Disorders diagnoses, and (4) examine whether children with 1 or more symptom profiles receive mental health services.


RESULTS
Symptom-profile frequencies ranged from 0.5% to 2.0%, and 8% of the children had 1 or more symptom profile. Profiles generated moderate-to-high positive predictive values (52.7%-75.4%) for impairing psychiatric diagnoses, but fewer than 25% of children with 1 or more profiles had received services in the previous 6 months.


CONCLUSIONS
Scientifically robust symptom profiles that reflect severe but largely untreated mental health problems were identified. Used as "action signs," these profiles might help increase public awareness about children's mental health needs, facilitate communication and referral for specific children in need of evaluation, and narrow the child mental health services gap.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA. jensen.peter@mayo.edu
Peter S
PS
Jensen
Eliot
E
Goldman
David
D
Offord
Elizabeth J
EJ
Costello
Robert
R
Friedman
Barbara
B
Huff
Maura
M
Crowe
Lawrence
L
Amsel
Kathryn
K
Bennett
Hector
H
Bird
Rand
R
Conger
Prudence
P
Fisher
Kimberly
K
Hoagwood
Ronald C
RC
Kessler
Robert
R
Roberts
D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D020380:Needs Assessment; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States