Problem
My current practicum is in a primary care private practice. We see all age groups. My preceptor works closely with a psychology center here in Albuquerque. The counselors do the initial diagnostic screening and therapy. My preceptor prescribes the medications for the diagnosis. For diagnosis such as ADHD, the patients are consistently screened on each follow up visit to assess how medications are working for them. For pediatric patients, the parents and teachers are given Vanderbilt questionnaires to fill out. The first Vanderbilt questionnaire given to parents and teachers is 43 questions. The follow up is 26 questions. These tests are easily administered and scored. PDF's of the test can be found by a simple google search. Another screening tool we use is the PHQ-9 and GAD-7. This screening tool is used to assess anxiety and depression. It is noted that these diseases are often comorbidities of each other so the scales are given together (Amerijen, 2022). These scales are also easily administered and gives you insight into the current feelings and coping of your patient. The answers to the self screenings can help lead your questions to first and foremost make sure your patient and others are safe and then decide on the needs of your patient through medications and counseling. The very low cost and ease of these screening tools makes it so that everyone who may be in need can have the screening done. I have not seen any bias on the part of anyone at the clinic and the staff is very well versed on mental health and works closely with the psychology center to make sure all patients regardless of ability to pay can be seen and cared for properly. For medications, we make sure to give the patient resource information on how they can get their medications for low cost or free.
One test I learned about in practicum that I like to share is gene sight testing. This is a swab done in office and analyzes how well psychotropic drugs work with your DNA. The report gives you a green, yellow, red printout of the drug to gene interaction. It currently tests 57 medications and 12 genes (Pyzocha, 2021). This is an amazing development for patients who are struggling to find the correct medication. Unfortunately, medications are chosen on best guess and the patients have to wait 4-6 weeks for a response. Then if it does not work they need to try another and another. This leads to many giving up. Gene sight testing is about $300 and not covered by most insurance. Although the company does have assistance programs the expense of the test makes it unavailable to many.
In Practice, we should make sure that we are asking every individual we encounter about their mental health. Often, we focus only on the presenting problem and we need to remember to treat the individual as a whole. Sometimes the presenting problem is caused by things such as anxiety and by asking the proper questions can actually stop the presenting problem by taking care of the root cause. In the community, some patients we only see in emergent situations. The "treat and street" mentality of the emergency department and some urgent cares leads to missed opportunities. Often, the patients are in the ED for many hours. Why not take that time to have them fill out mental health questionnaires. We have a large homeless population here in Albuquerque. Often, there is untreated mental health issues that lead to them self medicating with drugs and alcohol and leads to their homeless situation. Our community centers should focus on a harm reduction approach. We should not turn them away due to not being sober. We should in turn include counseling services in the shelters to help them get on an actual treatment plan. The problem is that we do not have enough councilors to accommodate such a plan. Incentives such as loan forgiveness are a start but being a part of groups that lobby for funding for care for all underserved populations is where we can make a difference.
Task
Thanks for your great review of your clinical situation. It sounds like there are plenty of opportunities to address the mental health needs of your population. The first condition you mentioned is ADHD. I'm wondering how often that occurs as a solitary diagnosis. Is it often accompanied by other problems such as substance use disorder, or anxiety? And if left untreated at an early age, what are the consequences in adulthood when children are untreated?