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.

Read More

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.

Read More

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.

Read More

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.”

Read More

Helping patients deal with school shooter anxiety

According to the National Center for Education Statistics, 92% of public schools had formal active shooter plans in 2016, and 96% conducted lockdown drills. These measures are intended to keep children safe, but they may do as much harm as good. The title of a September 4 New York Times article sums it up: “When Active Shooter Drills Scare the Children They Hope to Protect.” We asked REACH faculty member Jasmine Reese, MD, MPH, about how students react to active shooter drills and what pediatric primary care providers (PCPs) can do. Dr. Reese is Director of the Adolescent and Young Adult Specialty Clinic at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. “We have yet to see data on whether these drills are causing more anxiety and other mental health issues among students,” said Dr. Reese. “But it seems clear in practice that they can either cause anxiety and depression or exacerbate existing issues.”

Read More

Helping patients manage the transition to college

“Going to college is exciting, but students need to know that this experience, though positive, may also be stressful,” said REACH faculty member Elena Man, MD. Dr. Man recommends resources and strategies that pediatric primary care clinicians can use to prepare patients for this significant transition to a new environment for learning, living, and friendships.

Read More

How PCPs can prevent teen suicide

“It’s not just that we’re more aware of adolescent suicide,” said Michael Scharf, MD, chief of child and adolescent psychiatry at the University of Rochester Medical Center and a REACH faculty member. “The rate really is going up. Teen suicide is still rare, but it’s increasing.” Primary care providers (PCPs) can help teens at risk of suicide, first of all, by being willing to talk about it. “Some people think that asking about suicidal ideation makes the kid more likely to act,” said Dr. Scharf. “But evidence shows that asking either has no impact or has a relieving effect; it frees the patient to talk about the issue.” “You need to think ahead of time of what to ask and how, so you feel comfortable,” said Dr. Scharf. “You need a go-to way to assess risk and how likely the kid is to follow through.” (See Resources below.) The assessment results can range from “nothing to do here” to “send this kid to the emergency department.” “The tricky part,” Dr. Scharf said, “is what to do in between.”

Read More

5 Tips on Coding for Mental Health in Primary Care

Some pediatric primary care providers (PCPs) are nervous about providing mental health services because they are not sure they can be paid. However much they may want to treat patients with mental health disorders, they can’t afford to practice for free! Evaluation and management of mental health conditions is time-intensive. PCPs wonder, “How can I spend 90 minutes doing intake?” Those who work in large healthcare systems worry about the WRVUs (work relative value units) by which their productivity is judged. Providers in small practices worry about getting paid for visits that involve primarily talk. “Primary care providers absolutely can be paid for mental health care,” said Dr. Eugene Hershorin, a coding expert in the Pediatric Department in the University of Miami Health System and a REACH Institute faculty member.

Read More