Start

2

Initial psychosocial assessment (Expedite by using previsit data collection and review)

Perform S-E/MH screening & surveillance, including ACEs, social determinants, routines, relationships, functioning (school, home, peers), parenting, parental MH, trauma exposure, family disruptions, and environmental risks
Explore positive findings
Observe child & parent; perform examination as indicated
Elicit and reinforce strengths throughout

3

Concern other than normal variation?

4

RHS

Provide reassurance
Promote healthy S-E development & resilience per Bright Futures

End

6

Incorporate brief mental health update

9

Emergency?

8

Complete acute, chronic, or subspecialty care visit

11

Brief pediatric intervention(s)

All visits: Engage by using “common factors”; add patient to practice registry

Acute, chronic, or subspecialty care visit: Complete visit; address MH concern now (as in the bullets below) or plan follow-up visit

RHS visit or visit for MH concern: Take one or more of the following actions:

Expand assessment (eg, secondary screening; behavioral diary; collateral data collection from school, child care, previous MH evaluation)
Offer focused problem-solving, common elements intervention, stress reduction, assistance with behavior change, and/or self-help resources
Facilitate referral of family member for MH specialty or social services, if indicated
Schedule return(s) or outreach as needed to assess response, complete RHS, try additional interventions, or advance to step 12

10

Facilitate referral for emergency services
Request results
Return to algorithm at step 17 when resolved

13

Monitor for symptoms and functioning
Reenter at step 9 if concerns recur

16

Full diagnostic assessment

Refer to MH, DBP, or SUD specialist for diagnostic (re)assessment
Request results

15

Full diagnostic assessment

Provide full diagnostic assessment in primary care
Interpret findings to youth and family

17

Family-centered care plan

Summarize strengths & needs (patient & family)
Articulate patient’s & family’s goals
Reach agreement with family, school, agencies (+ MH specialists & pediatric subspecialists, if involved) on care components, including psychoeducation & plan for emergency care
Define roles of family and others

18

Care plan implementation, comanagement, and monitoring
(May require collateral data, information exchange, visits, and/or outreach)

Apply and schedule monitoring mechanisms
Coordinate with family and other clinicians
Schedule RHS for age
Revise plan as needed
For adolescents, articulate plan for transition to adult care

21

Monitor for symptoms and functioning
Reenter at step 9 if concerns recur

20

Return to step 14