Resources for Promoting Healthy Behavioral and Emotional Development in Adolescents
October 2019

Lauren Geary, MPH, American Academy of Pediatrics
Kathy Janies, American Academy of Pediatrics
Jane Bassewitz, MA, American Academy of Pediatrics

 

The American Academy of Pediatrics (AAP) and Bright Futures are committed to advocating for optimal health and well-being of all infants, children, adolescents, and families. Bright Futures operationalizes this vision by supporting pediatric and other health care professionals in providing care to children and adolescents according to the Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition.1 The AAP and Bright Futures understand that emotional well-being and mental health are as important as physical health throughout childhood and adolescence. To that end, content specific to emotional well-being and healthy behavioral development is woven throughout the Bright Futures Guidelines, 4th Edition, and can be found in the Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule), within each health supervision visit, as well as in health promotion themes focused on mental health and the social determinants of health.1

A 2019 report from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates around 26 percent of young adults ages 18-25 had a mental illness within the past year.2 In 2018, an estimated 3.5 million adolescents had a major depressive episode within the past year.2 As reported by Kessler et al., almost half of all adults with behavioral health problems indicate their disorders first appeared in early adolescence.3 Given these statistics, states, communities, and health care professionals need to be equipped to promote emotional well-being, as well as screen for potential concerns, on a regular basis. Bright Futures, and other AAP resources, support the implementation of annual psychosocial/behavioral assessment and adolescent depression screening in the context of healthy behavioral and emotional development of adolescents in states, communities, and clinical settings.

Mental Health Within Bright Futures

An emphasis on emotional well-being is woven throughout the Bright Futures Guidelines, 4th Edition. This information can be found within each of the health supervision visits and health promotion themes (e.g., Promoting Mental Health). Pediatric health care professionals, states, and communities can use this content to ensure that programs and recommendations align with current evidence-informed guidance.

Bright Futures Health Supervision Visits

Annual Bright Futures health supervision visits provide ongoing opportunities for health care professionals to address specific concerns identified by adolescents and families. The visits are also an opportunity to identify strengths and protective factors while minimizing the negative impact of potential environmental and structural risk factors affecting adolescents and their families. Bright Futures identifies five priority topics for each visit; emotional well-being is a priority topic for each annual adolescent visit. Health care professionals are encouraged to talk with adolescents and their families about mood regulation, mental health, healthy sexuality, and other related topics that may arise during a visit.

Screening for Behavioral Health Issues

Connecting with adolescents at their annual health supervision visit is a significant opportunity to promote social, emotional, and behavioral health as well as identify and address any emotional and behavioral health concerns. According to the Periodicity Schedule, psychosocial/behavioral assessment should be conducted annually, beginning at the newborn visit through age 21.4 Per the Periodicity Schedule, this assessment should be family centered and may include an assessment of caregiver depression and social determinants of health.4 In addition, the Periodicity Schedule recommends universal screening for depression beginning at age 12, and continuing annually until age 21. Considering social determinants of health and the family’s emotional well-being helps to identify structural risk factors and strengths in the adolescent’s own environment that can significantly impact healthy development and emotional well-being.

A list of commonly used behavioral and psychosocial screening tools can be found on the Bright Futures website.

Anticipatory Guidance

Because emotional well-being is a priority for every adolescent visit, the Bright Futures Guidelines provide sample questions and anticipatory guidance (see examples within the Adolescence Visits content) health care professionals can use when discussing these topics with adolescents and their families. In addition, Bright Futures facilitates appropriate referrals to specialists/specialty services and links to community-based resources.

Bright Futures Health Promotion Themes

Bright Futures contains 12 health promotion themes about important issues related to child and adolescent health. Promoting Mental Health provides a state-of-the-art overview of mental health throughout childhood and adolescence. The theme contains information and guidance specific to the four main stages of development. This detailed information enables health care professionals to tailor their anticipatory guidance, recommendations, and resources based on the age of the child or adolescent. States and communities looking to inform their pediatric mental health programming should refer to this theme.

In the health promotion theme, Promoting Lifelong Health for Families  and Communities, the 4th Edition reviews the emerging sciences of early brain development and epigenetics that can alter the developmental trajectory of adolescents. This important theme discusses the impact of social determinants of health on child and family health and well-being and provides insight to how this deeper understanding of the sciences can be applied in both clinical settings and on the state and community levels.

Adolescent Health Promotion at the AAP

In 2016, the Committee on Adolescence (COA) authored a policy statement entitled “Achieving Quality Health Services for Adolescents.”5 The statement focuses on adolescent care within the medical home model, and offers practical recommendations related to confidentiality, developmentally appropriate care, and transition into adult care. In 2018, the COA endorsed the statement entitled “Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management.”6 As a companion implementation resource, the GLAD-PC Toolkit can be found at http://www.glad-pc.org. In 2015, the AAP released the “Promoting Optimal Development: Screening for Behavioral and Emotional Problems”3 clinical report. This report offers potential improvements in practice and the health system and research needed to create change. Other key resources can be found on the AAP Adolescent Sexual Health and Mental Health Initiatives webpages.

For more information about Bright Futures, visit BrightFutures.aap.org, email us at brightfutures@aap.org , or call (630) 626-6783.

References

    1. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017
    2. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19‑5068, NSDUH Series H‑54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
    3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.
    4. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine and AAP Bright Futures Periodicity Schedule Workgroup. 2019 Recommendations for Preventive Pediatric Health Care. Pediatrics. 2019;143(3):e20183971
    5. American Academy of Pediatrics Committee on Adolescence. Achieving quality health services for adolescents. Pediatrics. 2016;138(2):e20161347
    6. Zuckerbrot R. A., Cheung, A., & Jensen, P. S., et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3):e20174081

This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $5,000,000 with 10 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

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