A Health Policy Perspective

We appreciate the opportunity to comment on the review by Garland et al. (2013). Over the years, we have come to appreciate the significance of the Institute of Medicine (IOM) finding that: ‘‘The lag between the discovery of more efficacious forms of treatment and their incorporation into routine patient care is unnecessarily long, in the range of about 15–20 years. Even then, adherence of clinical practice to the evidence is highly uneven (IOM 2001, p. 155).’’ This delay in the translation of evidence to practice is unacceptable and must be addressed at both the policy and operational level. The Director of the National Institutes of Health (NIH) opined during his fiscal year 2013 Senate Appropriations Committee hearings that the newly established National Center for Advancing Translational Sciences (NCATS) would be a viable vehicle for beginning this process, especially in the area of drug development. Basic discovery and the development of therapies are interconnected and occur on a continuum. The translation of basic biological discoveries into clinical applications is a complex process. Despite huge investments in biomedical science and technology, current translational science in the public and private sectors has not been able to address the bottlenecks that lead to delays, long development times, high failure rates, and high costs. NCATS is dedicated to developing new methods for conducting translational science and bringing new medical products, particularly medications, to patients more efficiently. We would contend that NCATS and the establishment of a parallel entry (perhaps within the National Institute of Mental Health (NIMH)) for the translation of non-drug related therapies are critical for the mental health of children and adolescents. As the Director indicated, NIH possesses the expertise and enthusiasm to tackle this historical and most unfortunate implementation delay as a scientific problem. ‘‘By focusing on the development of innovative new methods for conducting translational science, as opposed to developing therapeutics themselves, NCATS can enable others to bring new medical products to patients in a highly efficient, costeffective manner (Collins 2012)’’. As noted by Garland et al. (2013), problems with access to mental health and developmental services are well documented in the pediatric realm. In addition, we appear to be taking steps backward in the provision of routine care services in the pediatric primary care community. Despite a 66 % increase in the coding of pediatric attention deficit/ hyperactivity disorder (ADHD), care for ADHD has shifted away from pediatricians who have traditionally provided this therapy to specialists (e.g., psychiatrists) (Garfield et al. 2012). The US Preventive Services Task Force (USPSTF) recommends that adolescents only be screened for major depression if systems are in place to ensure accurate diagnosis, psychotherapy and follow-up (AHRQ 2009). Given the frequency of pediatric and adolescent ADHD and major depression diagnoses and the paucity of pediatric mental health professionals of all disciplines, we P. H. DeLeon (&) American Psychological Association, Uniformed Services University of the Health Sciences, Bethesda, MD, USA e-mail: patdeleon@verizon.net