Posts by The REACH Institute
When and how to send kids to the emergency room
“The first thing I would say to any clinician is that it’s never wrong to send a child to the emergency room,” said Amy Dryer, MD, pediatrician and REACH faculty member.
Having spent 10 years in a hospital emergency department, Dr. Dryer is intimately familiar with the criteria ER physicians use to decide to admit psychiatric patients: a medical condition, suicidal ideation with a lethal plan, homicidal ideation, or active psychosis.
However, she emphasized that your decision to refer to the ER doesn’t hinge on whether the patient is likely to be admitted. “If what they’re telling you makes you uncomfortable,” she said, “go ahead and refer them.”
Read MoreIngrid Swanson
After you screen for anxiety, then what?
As you’ve heard, the US Preventative Service Task Force (USPSTF) recently issued draft guidelines recommending that primary care providers (PCPs) screen all adults aged 19 to 64 for anxiety disorders. Guidelines recommending anxiety screening for children aged 8 to 18 were finalized last week. The question is, if the screener indicates that anxiety is an issue, then what do you do? Patty Gibson, MD, a psychiatrist on the REACH Adult Behavioral Health faculty, shared some basics from the course to answer the question.
Read MoreTreating pediatric trauma
“The biggest predictor of having something bad happen to you is having had something bad happen to you in the past,” said Brooks Keeshin, MD. Dr. Keeshin, a child abuse pediatrician and child psychiatrist at the University of Utah, co-developed the new REACH Institute course Addressing Trauma in Pediatric Primary Care. At least 66% of…
Read MoreOne teen, 10 psychiatric drugs. This must stop!
On August 27, The New York Times ran an article by Matt Richtel titled “This Teen Was Prescribed 10 Psychiatric Drugs. She Is Not Alone.” It documents the practice of “polypharmacy”: prescribing multiple medications—most of which have not been tested either in children or in combination with one another—to manage young patients’ depression or anxiety.
That young patients are being prescribed potent cocktails of untested drugs is obviously wrong. The question is, how did we get to this point, and what can we do about it?
Read MoreJami Schwartz
IEP and 504 school accommodations for mental health needs
Children with mental health diagnoses may need special accommodations in order to succeed in school. Patients with attention-deficit hyperactivity disorder (ADHD) or autism come immediately to mind. However, children with depression and anxiety disorders may also struggle in the classroom.
Pediatric primary care providers (PCPs) and therapists can help families get the school accommodations their children need. Mark Wolraich, MD, REACH faculty member and retired professor of pediatrics at the University of Oklahoma Health Sciences Center, emphasizes that children are best served when professionals take a team approach to mental health care.
Read MoreADHD medication “holidays”?
As summer rolls around, families may ask whether their children can have a “holiday” from their psychoactive medication, especially for attention-deficit hyperactivity disorder (ADHD). We asked Lawrence Amsel, MD, MPH, a REACH faculty member and associate professor of psychiatry at Columbia University, to lay out the pros and cons.
Read MoreOvercoming anxiety about the news
In the wake of the Texas school shooting tragedy, your young patients–and their families–may be experiencing anxiety that can affect normal functioning. That anxiety can manifest in many ways, from reluctance to go to school to increased aggressive tendencies.
In fact, pediatric primary care providers (PCPs) have been observing the effects of news consumption on their young patients for years now. The spike in anxiety at the beginning of the Covid pandemic is another example. Families may be experiencing trauma as they watch scenes of devastation and displacement in Ukraine. Every act of terrorism or mass violence inspires more fear. The examples go on.
As your families’ trusted PCP, you can influence how patients and families deal with anxiety over recent events and the continuous barrage of bad news that characterizes today’s media culture.
Read MoreScreening for trauma in pediatric primary care
Asked the top three things a pediatric primary care provider (PCP) needs to know about child trauma, Brooks Keeshin, MD, said, “Trauma happens. That’s numbers 1, 2, and 3.”
In fact, up to 80% of children experience trauma by the time they are 18. A large body of evidence indicates that childhood trauma affects physical and mental health, both short term and long term.
Dr. Keeshin, a child abuse pediatrician and child psychiatrist, is developing a new REACH Institute course to teach PCPs to assess and treat child trauma.
“Trauma reactions can look like other mental health conditions,” said Dr. Keeshin. “Traumatic stress can present with symptoms of ADHD, depression, or anxiety. If the pediatrician knows a child has been exposed to trauma, that changes what they do. But first they need to know.”
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