Screening 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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Child abuse and neglect

In a study sponsored by the Centers for Disease Control and Prevention, 10.8% of adults reported having been physically abused as children, and 11.1% reported psychological abuse. Infants and young children are at greater risk than older children; neglect is more commonly reported than physical, psychological, or sexual abuse, according to the National Child Abuse and Neglect Data System.

As a pediatric primary care provider (PCP), you play a vital role in detecting and preventing child abuse and neglect.

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Helping patients through divorce

“Parents who are going through a divorce really want to believe their children are OK,” said Lisa Blum, PsyD, a licensed clinical therapist on the faculty of The REACH Institute’s CATIE program. “They’re terrified that they’re hurting their kids. So if Sally is doing her homework and Johnny isn’t acting out, the parents think, ‘Whew, good, they’re fine!’ But often they’re not fine.” Though divorce rates in the US have been declining for years – including, according to early reports, during 2020 – the rates are still high. Each divorce or separation brings loss, disruption, and pain to any children involved.

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10 ways to help families through the holidays

If you’re like most pediatric primary care providers (PCPs), you’ve seen an increase in child mental health issues due to COVID. Research shows that the pandemic, with its consequent disruption and isolation, has increased adolescents’ risk of trauma, depression, and anxiety. Families are dealing with grief, the anxiety of whatever “school” means this week or this month, and, in many cases, loss of income. Families of color and low-income families have been hardest hit by the pandemic itself, by the economic and social fallout, and by the attendant impairment of mental health. And now come the holidays.

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How to talk with patients about racism

Once pediatric primary care providers (PCPs) recognize the importance of having conversations about race with their patients and families, the next question is how to begin.

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Your patients need you to talk about race

“The first thing clinicians need to know about racism and discrimination is how important it is to talk about it.” Open, honest, and effective conversations about race and racism are crucial to young people’s mental health.

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Suicide crisis among Black youth

As suicidality among adolescents generally has declined in the past three decades, suicide attempts among Black adolescents have risen, according to a November 2019 article in Pediatrics. A report to the Congressional Black Caucus (CBC) says that rates of suicide death have risen more for Black youth than for any other racial or ethnic group. A growing concern is that Black youth are less likely to report suicidal thoughts but more likely to attempt suicide; Black males are more likely to suffer injury or death as a result. Suicidality is also increasing among younger children. The reasons for these changes are not clear. However, the risk factors for suicidality and underlying mental health conditions among Black children and youth are myriad.

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Helping patients & families cope with chronic disease

In treating young patients who have chronic physical conditions, health care professionals focus — as they must — on alleviating the physical suffering caused by the disease. However, as a graduate of the REACH course Patient-Centered Mental Health in Pediatric Primary Care, you know the importance of supporting the mental and emotional health of young patients and their caregivers. A new article in Pediatrics highlights the importance of mental health care for families dealing with chronic illness.

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New AAP policy on mental health in pediatric care

The American Academy of Pediatrics (AAP) has released a new policy and an accompanying technical report on mental health competencies for pediatric clinicians. REACH faculty member Cori Green, MD, MS, is a lead author of both documents. We asked Dr. Green, director of behavioral health education and integration at Weill Cornell Medicine in New York City, what the AAP policy and technical report mean for alumni of the REACH program Patient-Centered Mental Health in Pediatric Primary Care. “I hope they’ll be excited to see that what is being endorsed by AAP is essentially what they were taught in their REACH training,” Dr. Green said. In the technical report, the REACH course is described as a promising practice in continuing medical education.

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Building a team to counter school refusal

“When it comes to school refusal, getting all the adults on the same page is the bottom line,” said James Wallace, MD, a REACH faculty member. “Until you have that, you have nothing.” Dr. Wallace, who teaches child psychiatry at the University of Rochester (New York) Medical Center School of Medicine and Dentistry, described an approach to school refusal that unites primary care providers, schools, and mental health professionals in helping families make choices that support regular school attendance. “An evidence-based approach to school refusal, and the anxiety or depression that usually underlie it, includes cognitive behavior therapy and sometimes medication,” said Dr. Wallace. “But there’s a third piece: getting all of the adults involved, including the parents, to address the social-emotional components of school attendance in a consistent way.”

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