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The latest evidence, clinical insights, and practical perspectives on pediatric mental health — written specifically for primary care clinicians.
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Eating Disorders in Adolescents: A Guide to Screening, Assessment, & Treatment for PCPs
April 14, 2022
Eating disorders are life-threatening mental health conditions—and they are not limited to affluent white girls! Eating disorders affect people of lower socioeconomic status, members of non-white ethnic groups, preteen children, and boys. LGBTQIA young people are at particular risk. DSM-5 defines four main categories of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder, along with several atypical disorders.
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Child abuse and neglect
March 21, 2022
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 African-American children with mental health issues
February 16, 2022
Last week I saw two children, both African American, who were having suicidal thoughts. In neither case did the child or the parents come in asking for mental health support. One, a 13-year-old girl I’ll call Simone, wrote on her PHQ-9 depression screener that she had attempted suicide. In our interview, she revealed that she had had sex with a man she met online and that she had been cutting herself. Yet the reason she and her parents came in was an ADHD medication check! Pediatric primary care providers (PCPs) need to realize that African-American families may not seek help for mental health issues. The reasons for the lack of disclosure are rooted in the stigma around mental health in the African-American community. The stigma, in turn, is rooted in the trauma associated with being Black in America.
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New treatments for ADHD
January 21, 2022
Newer treatments approved by the Food and Drug Administration (FDA) for pediatric patients with attention-deficit/hyperactivity disorder (ADHD) include two medications that address some of the common issues families have with standard stimulant treatments. Another development is use of devices to manage ADHD symptoms.
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Helping families deal with holiday stress
November 17, 2021
“In some ways the holidays this year will be harder than last year for many people,” said Deborah Buccino, MD, pediatrician and REACH board member. “Earlier, we had pretty clear-cut rules about what you could and could not do safely. This year, we have a lot more gray areas.”
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8 Tips for Working with Mental Health Therapists
October 20, 2021
Many patients who have mental health conditions need talk therapy in addition to the treatment you provide as the pediatric primary care provider (PCP). If you practice in an area where therapists are available, we hope you have developed referral relationships, as you learned in your REACH training. You may also see patients who are already working with a therapist. In either case, the communication between you and the therapist makes a huge difference in the quality of care the two of you provide. To learn how PCPs and therapists can collaborate to improve the mental health of children and adolescents, we talked with clinical psychologist Kevin Stark, PhD, a founder of The REACH Institute’s CATIE program, and pediatrician Hilary Bowers, MD, director of behavioral and mental health services at Children’s Primary Care Medical Group, a large pediatric practice in San Diego and Riverside counties in California.
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Getting through to difficult patients and families
September 8, 2021
It’s 10:30 Monday morning, and you’re 45 minutes behind. Earlier, you had to confront a receptionist about coming in late again. You have to get out today by 4:30 so you can get to your daughter’s softball game. Beating under all this stress is worry about your mom, who has been diagnosed with stage 2B breast cancer.
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Cross-titrating psychiatric medications
July 26, 2021
If you struggle with titrating psychiatric medications for your pediatric patients, you are not alone. Even for some alumni of the REACH program Patient-Centered Mental Health in Pediatric Primary Care, lack of comfort with psychiatric medications can hamper effective treatment. What does it take to dose and cross-titrate effectively? We asked two REACH faculty members: Peter S. Jensen, MD, REACH founder, and Amy Kryder, MD, education lead of the statewide REACH program in Virginia.
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7 ways to support LGBTQIA+ youth
June 23, 2021
In a recent national survey, 46% of young LGBTQIA+ respondents said that they wanted counseling for psychological or emotional health issues and couldn’t get it. As a pediatric primary care provider (PCP), you may be well aware of the challenges your LBGTQIA+ patients face. To help you help them, we gathered suggestions from two experts, both of whom were panelists in our May webinar on supporting LGBTQIA+ youth: • Andersen Guske, nonbinary 22-year-old LGBTQIA+ advocate • Amy Dryer, MD, pediatrician and REACH faculty member Together, they offered 7 suggestions.
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