Primary Care Providers Train in Child Behavioral Health

By Ben Boulden

A nationwide shortage of child psychiatrists is the root cause underlying the long wait to see a child psychiatrist.

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Alice Alexander, M.D., left, takes notes for the team of health care professionals she was teamed with for training in treating child behavioral health problems.

To fill that care gap, UAMS and ACH in collaboration with the REACH Institute, a New York-based non-profit organization, have begun training pediatricians and other primary care providers to recognize behavioral health problems in children and adolescents.

The initial component of the training took place Jan. 8-10 at Arkansas Children’s Hospital with more than 30 pediatricians from the UAMS Department of Pediatrics, primary care physicians and advance practice nurses. The training program eventually will be expanded throughout the state. Although this training has been done in multiple states and Canada, it was the first opportunity for Arkansas providers.

“Resources for mental health services are limited everywhere, particularly in the state of Arkansas,” said Chris Smith, M.D., regional associate dean at UAMS’ northwest Arkansas campus, who participated in the training sessions. “It will greatly help physicians statewide, but especially in rural areas as they become more comfortable with helping to treat these conditions. The course truly provided a good synopsis of the conditions and medications and good tools to screen children and adolescents.”

Peter Jensen, M.D., interim director of the UAMS Department of Psychiatry’s Division of Child and Adolescent Psychiatry and the chief psychiatrist at Arkansas Children’s Hospital, led the training session along with a group of nationally prominent pediatricians. Jensen is also president and chief executive officer of the REACH (Resource for Advancing Children’s Health) Institute that develops tools and techniques to help physicians, teachers, counselors and parents dealing with children with emotional and behavioral disorders.

The training is designed to educate physicians and nurse practitioners who regularly see young patients but have not had sufficient background and training in the diagnosis and treatment of psychiatric illnesses like depression, anxiety, oppositional defiant disorder, or attention deficit hyperactivity disorder (ADHD).

“Roughly 15 percent of the children in Arkansas have some form of significant behavioral health concern, whether it’s ADHD or depression,” said Jensen, also program director of the UAMS Child Psychiatry Fellowship. “Given Arkansas’ severe shortage of child psychiatrists, we are going to be working with the primary care providers because they are the ones on the front lines – the first responders when it comes to helping these kids.”

According to the American Medical Association, from 1995 to 2013 the U.S. population increased by about 37 percent while the number of adult and child psychiatrists rose by only 12 percent, from 43,640 to 49,079. This translates into a severe shortage of physicians with the knowledge necessary to treat children with behavioral health disorders, said Jensen.

“The training gave us some useful tools to help assess patients with mental health disorders in primary care,” said Alice Alexander, M.D., assistant professor of medicine and pediatrics and associate program director of the internal medicine-pediatric residency program.

“I hope to be able to teach our residents about how to screen for mental health issues and monitor treatment. The course empowered us to manage the more straightforward cases of mental and behavioral health problems, relieving some of the burden on child and adolescent psychiatrists. It also taught us how to more efficiently assess more complicated cases that need referral.”

With REACH, a non-profit organization created in 2006, Jensen has led training and developed programs for physicians in New York, Idaho, Minnesota, Nebraska and North Carolina.

Like Alexander, Smith said he’s eager to pass on to residents what he learned and is excited by what the training can eventually do to improve care for the children and adolescents who have behavioral health problems.

“Without proper treatment, many of these children with psychiatric disorders end up turning to illegal drugs or acting aggressively,” Jensen said to health care professionals who attended the weekend training sessions. “You really can make a big difference in their lives and keep them out of prison or worse. You’ll find this can be a very rewarding part of your practice.”