National Nonprofit Teaches Primary Care Pediatricians New Tools to Address Mental Health Crisis

Cook Children’s primary care pediatricians now have new tools at their disposal to address the spike in mental health issues among the youth in the wake of the pandemic.

Earlier this month, about 60 Cook Children’s primary care physicians attended virtual training sessions conducted by The REACH Institute, a nonprofit organization dedicated to ensuring the most effective, scientifically proven mental health care reaches all children and families. The Patient-Centered Mental Health in Pediatric Primary Care Program (PPP) includes three-day intensive training, followed by six months of case-based sessions in which small groups meet every two weeks with national primary care and child/adolescent psychiatrists to solidify their learning.

Anu Partap, M.D., M.P.H., Cook Children’s Medical Director of Health Equity, says the training program is a way to ensure equitable access to mental health care by advancing the skills of primary care pediatricians to whom families first come for help.

“Our families need our support,” she says. “The risk of missing or delaying care is too high.”

The training broadens Cook Children’s reach of mental health care “across families’ incomes, ethnicities, languages and communities,” Dr. Partap says.

“With the REACH program, we’re training about 60 pediatricians who all touch different geographies and patient populations,” she says. “This allows us to start more comprehensive treatment for a family earlier in the process. We still might have to refer for therapies or additional psychiatric care, but REACH allows our teams to do a lot more in-depth treatment early on.”

National reports show almost one in five children have a mental, emotional or behavioral disorder and about 20% receive care from a specialized mental health care provider.

Cook Children’s 2021 Community Health Needs Assessment parent survey results indicated 63,120 children (ages 0-17) in its eight-county service area went without needed mental health care. The survey was conducted by Cook Children’s Center for Children’s Health.

For most families, accessing mental health care for children has presented a challenge, even before the pandemic. Mental health care providers are scarce, whether in rural or urban settings, due to a longstanding national shortage of child psychiatrists and psychologists. Families, some of who must travel long distances for mental health specialists, often face lengthy waiting lists, meaning it may take months before their children are seen.

Peter Jensen, M.D., board chair and founder of The REACH (Resource for Advancing Children’s Health) Institute, says pediatricians on the frontline could make a difference in treating those children.

Dr. Jensen, who the is the former head of child psychiatry at the National Institute of Mental Health and former director of Columbia University’s Center for the Advancement of Children’s Mental Health, formed The REACH Institute in 2006 after noticing the lack of resources for children’s mental health care following the 9/11 terror attacks. Since then, Dr. Jensen along with fellow child psychiatrists and pediatricians designed a training program for pediatrics that uses common tools for assessing, interviewing, forming family partnerships and prescribing medications for the treatment of mental health issues.

The children’s mental health care system was already overwhelmed, but the pandemic strained it even more, he says. Between 14 to 16 million children in the United States — about 20% — have “significant mental health issues at one time or another during any given year,” Dr. Jensen says.

“We now know from national surveys, of all those kids, only a third get care from a mental health specialist. And of the third, a quarter of those — maybe 7% or 8% — are actually seen by a child psychiatrist,” he says. “We also know from other research that it takes six to 10 years, on average, from when a problem emerges to when some kind of help is actually received. Families typically go through 11 different contacts before they find the person who works for them. It’s a terrible, urgent search.”

To put it in perspective of a child psychiatrist, “if you take those 16 million kids, there are only enough child psychiatrists to give each of those kids a half-hour of our time per year. We can’t do it. There are just too few of us.”

Often pediatricians will send children with anxiety, depression or ADHD to child psychiatrists to be diagnosed, Dr. Jensen says, but these types of conditions “are fairly straightforward” and “can be managed with an easy set of tools, including therapy and medication” as long as pediatricians have been trained how to do it.

“They can do it. They’re going to change children’s lives,” Dr. Jensen says. “We’ve had so many pediatricians tell us about the joy they’ve experienced when a kid that they didn’t know how to help comes back in and has improved and gives them a big hug. We hear that a lot.”

More complex mental health cases should be referred to child psychiatrists, he says.

Part of what makes The REACH Institute courses so effective is how they empower pediatricians and psychiatrists to work together to find mental health solutions for children, says Lisa Khan, director of the PPP program.

“We staff our courses with three pediatricians and a psychiatrist,” she says, adding that in one session, pediatricians present a course that typically would be considered a psychiatric unit. “In everything we do…it’s so they (primary care pediatricians) can see that you can do it, too. This is how you do it, here is how I do it, and we can all do it. It’s so important.”

Cook Children’s M. Scott Perry, M.D., head of neurosciences, is participating in The REACH Institute courses because many of his patients have behavioral or mental health issues, particularly those with epilepsy.

“More than 50% of my patients will suffer from depression, anxiety or a variety of other things,” Dr. Perry says.

The training has already come in handy when treating a recent patient who had behavior issues, he says. After using assessment tools, Dr. Perry determined his patient needed treatment for ADHD.

“Now we’ll contact the pediatrician and say, ‘Listen, we’ve got clear ADHD here. I can tell you what I would treat them with. I can’t see them as frequently, so if you will work with me in treating this, we can get this done, and this kid is going to do a lot better developmentally,’” he says. “Now I can help with those tools, communicate with the primary care provider and create a team approach.”

Cook Children’s pediatrician Alice Phillips, M.D., also says she was able to immediately use what she learned through REACH training and describes it as a “must-have in my tool belt as a pediatrician.” It gave her the “skills and confidence to tackle the challenges my patients are facing,” she says.

“As the pandemic has drawn on, it has become obvious to all of us through studies, as well as personal experience within our clinics that our kids need us,” she says. “The rates of depression and anxiety have dramatically risen, and I want to help.”

An unforeseen added bonus of the REACH training is an increased “sense of community” with her peers, Dr. Phillips says, adding she and fellow pediatricians are sharing experiences and learning points that “make us all better doctors.”

“This not only improves care for our patients but also, I believe, helps us as doctors as we too struggle to emerge from the pandemic,” she says.

In providing this type of training, Cook Children’s is helping lead the effort to show the important role primary care pediatricians have in treating children struggling with mental health, Dr. Partap says.

“I think this is part of why we became primary care physicians. Our families trust us and come to us for help. Treating mental health is in line with all the other things we do with families,” she says. “Dr. Jensen reminded us that pediatricians have relationships and skills to support children and families, especially now.”