Mental Health Blog

Why Clinicians Should Consider Coding by Time for Mental Health Care

“Many primary care providers are still coding by medical decision-making for mental health care,” explains Eugene Hershorin, MD, a REACH faculty member and medical coding expert. “However, time-based coding is both easier and often results in higher coding levels and therefore higher payment rates, especially for pediatric patients who require ongoing care for mental health…


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ADHD and Racial Disparities: What Clinicians Can Do

“When a parent of color raises concerns about their child’s behavior, clinicians should always stop to assess for underlying disorders,” explains child and adolescent psychiatrist Brittainy Erby, MD. “I see many children and adolescents of color who have been diagnosed with a behavior disorder, but they actually have untreated ADHD.” The research reinforces what Dr.…


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When Adolescent Patients Transition to College: The Provider’s Role

“Any transition is a time that our patients can trip and fall,” explains Tina Nicholson, MD, a family doctor specializing in children and youth mental health. The transition to college, especially if it involves moving away from home, is no exception.  To understand how providers can help adolescents navigate this transition, we spoke with REACH…


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Is it autism, or something else?

  • August 23, 2024
  • The REACH Institute
  • Autism

With Autism Spectrum Disorder, early screening and intervention are essential—with diagnosis ideally made in early childhood. But as shared in our recent article about how autism may present at different ages, less severe cases may not be detected until children are school-aged or adolescents, especially among girls.  We asked REACH faculty member Ron Marino, DO/MPH,…


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Navigating Parent Concerns About Children’s Medications

“Many parents’ biggest concern about starting their children on medication is committing to an intervention they won’t be able to stop in the future,” explains child and adolescent psychiatrist Laurence Greenhill, MD.  Research shows that parental beliefs and concerns are a top contributing factor to whether children and adolescents receive proper treatment for mental health…


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Untangling ADHD and Anxiety as Comorbidities

  “ADHD and anxiety presenting together is very common in children and adolescents. But it can be difficult to discern which is the primary condition and which to treat first,” explains Kari Overstreet, DNP, APRN, CPNP-PC, PMHS, a pediatric nurse practitioner focused on child psychiatry and a Patient-Centered Mental Health in Pediatric Primary Care (PPP)…


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Burnout, Mental Health, and Practical Tools for Pediatric Providers

  • May 22, 2024
  • The REACH Institute

“As clinicians, our training has not encouraged us to look inward and care for ourselves,” explains Rachel Petersen-Nguyen, MD, a primary care pediatrician and Medical Director at Children’s Minnesota in St. Paul. “But we are humans who have real human needs – to rest and rejuvenate and care for ourselves. You can’t just keep pushing…


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How Autism May Present at Different Ages

  “No two kids with autism spectrum disorder are identical. The presentation often depends on the degree of severity and the age of the child,” explains Ruth E.K. Stein, MD, a Professor of Pediatrics at Albert Einstein College of Medicine and the Children’s Hospital at Montefiore.  Now recognized as a spectrum disorder, autism may be…


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Diagnosing Seasonal Affective Disorder

  “Seasonal Affective Disorder (SAD) is more than just the winter blues,” explains Maureen Montgomery, MD, a pediatrician based in Buffalo, NY. “It’s a subtype of clinical depression that has very specific characteristics.”  As the name suggests, SAD is a seasonal and cyclical type of depression. In most cases, SAD occurs during the fall and…


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Racism as trauma: A pediatric mental health perspective

After learning about the alarming rise in suicide rates among Black children and adolescents, Brittainy Erby, MD, set out to understand the impact of racial trauma and how to improve pediatric patient care.


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When parents’ mental health affects children

“When we’re thinking about children’s mental health, we’re also thinking about the health of the family unit,” explains Alyx Holden, MD. “In order for children’s neurobiology to develop, they need the support and context of healthy caregivers.”


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Managing challenging behaviors in children

  “There is a lot of research on programs to help parents manage their children’s behavior. It is not complex for clinicians to learn key evidence-based principles and share them with parents, even in brief office visits,” explains Elena Man, MD, a board-certified pediatrician and faculty member at The REACH Institute. We asked Dr. Man…


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How to help families awaiting an autism diagnosis

“Wait times to get a formal autism diagnosis from a qualified program range from six months to two years. It’s very frustrating for parents and their children who need services,” explains Dr. Mark Wolraich, MD, a REACH faculty member and retired professor of pediatrics at the University of Oklahoma Health Sciences Center. 


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Navigating the ADHD stimulant medication shortage

“The ADHD stimulant medication shortage is affecting patients, families, pharmacists, and clinicians,” explains Andrew Adesman, MD, a developmental pediatrician specializing in ADHD.


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Sleep Smart: Back-to-School Edition

REACH faculty, Dr Kowatch, emphasizes that it’s essential for caregivers to recognize the challenges that can arise when transitioning from summer to a more structured school routine. “Parents have got to anticipate there may be an adjustment period for the first week or two.”


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How Social Media is Impacting Teens

The most important question that we can ask teens isn’t if they use social media, it’s how. Just last May, the Surgeon General’s advisory on social media use in youth exposed some shocking statistics: Among 13 to 17-year-olds, up to 95% use social media, with 35% saying they use social media “almost constantly.”


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Responding to the Alarming Rise of Depression in Adolescent Girls

Gain a deeper understanding of the challenges faced by adolescent girls and the proactive steps clinicians can take to support them.


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Supporting mental health needs in rural areas

Rural healthcare providers can be overwhelmed—and understaffed with specialists. Discover how REACH inspired Elizabeth Wallis, M.D., to build a community to support her patients.


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Dealing with mental health issues in injured student athletes

When student athletes can’t play, their mental health may suffer.


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Don’t panic about panic attacks

“The impairment from a panic attack doesn’t come from the episode itself,” said REACH faculty member James Wallace, MD. “It comes from the patient’s and family’s reaction.”


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Assessing and treating substance abuse

“The risk of substance use starts at about age 10,” said Sam Chang, MD, a child and adolescent psychiatrist on the REACH faculty. “Prevention has to start before that. By the time kids reach adolescence, the horse has left the barn.”


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Is it ADHD? Or something else?

Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral health disorders, affecting approximately 9% of all children and adolescents. About 75% of pediatric patients with ADHD have comorbid mental health conditions, ranging from oppositional-defiant disorder to anxiety and mood disorders.

What is a busy clinician to do? How do you discern whether a child who is, say, having difficulty focusing at school and at home has ADHD, anxiety, both, or something else?


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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.”


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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.


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Treating 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…


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One 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?


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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.


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ADHD 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.


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Overcoming 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.


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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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Assessment & treatment of eating disorders in adolescents

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

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

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

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

“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

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

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

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

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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Helping children who have lost a parent

More than 40,000 children have lost a parent due to COVID-19. Black children, who constitute 14% of children in the US, are 20% of those who have lost a parent. Chances are good, then, that some of your patients have been through one of the most significant losses they will experience in their whole lives. The support they receive now to grieve in a healthy way can make the difference between their ability to thrive and their descent into adverse outcomes ranging from school failure to death by suicide.


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Helping AAPI patients cope with racism

Discrimination and hate crimes against people of Asian American and Pacific Islander (AAPI) descent have risen during the COVID-19 pandemic. You may be wondering how you can help your AAPI patients cope with feelings that arise from experiences of racism.


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Back to school for special populations

Although some schools have been open in person for months, some larger districts are just beginning to welcome students back on campus. Children, families, educators, and medical professionals have mixed feelings. To help you support different patient populations as they return to school, we talked to Jennifer Walton, MD, MPH, a co-author of a call for an “URGENT Coordinated Effort to Re-Open Schools” by the National Medical Association (NMA). Dr. Walton is chair of the NMA’s Pediatric Section, an assistant professor of clinical pediatrics at The Ohio State University, and a developmental behavioral pediatrician at Nationwide Children’s Hospital.


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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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New coding guidelines for 2021

2021 brings big changes to coding for mental health visits in pediatric primary care! The new coding guidelines issued by the Centers for Medicare and Medicaid Services (CMS) reduce the documentation burden and increase the levels of payment (work relative value units or wRVUs).


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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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Working with challenging families

You’re in the consultation room with Anita, who first brought her 15-year-old son Vic to you two weeks ago. Vic has been suspended from school several times for increasingly dangerous behavior. Anita uses a wheelchair because she has multiple sclerosis. Today she is distraught. Last night, she forbade Vic to leave the house, but he went anyway. He didn’t come home last night or go to school this morning. Anita has called everyone she can think of, but no one knows where he is. The police won’t help until he has been missing at least 24 hours. Anita has come to you as a last resort. When you saw Vic, you were troubled by his history of uncontrolled behavior and his uncooperative stance. You were hoping to get him to open up in a follow-up visit. But now Anita is here alone, frantic because she doesn’t know where Vic is. What do you do?


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Promoting healthy grief

COVID-19 has changed the way children experience the death of a loved one. Although difficult under any circumstance, bereavement is even harder when mourners can’t gather. Barriers to comforting mourning rituals and supportive social communities can make it harder for children to grieve in healthy ways, while increasing the risk for maladaptive grief reactions.


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Building family resilience

“Families provide a kind of protective membrane for children when crazy things are happening around them,” said William Saltzman, PhD. Dr. Saltzman is a faculty member of the REACH program Child/Adolescent Training in Evidence-Based Psychotherapies. “Families really have been on the front line throughout the pandemic,” Dr. Saltzman said. “It’s been a rollercoaster ride from the beginning, with abrupt school shutdowns; the exhaustion of becoming the 24/7 caregiver, teacher, playmate, and breadwinner; and now having to figure out largely on their own how to navigate the upcoming school year.”


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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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Helping patients deal with trauma

A medical appointment can be intimidating and scary for a child with a history of trauma. Still, this visit might be the first time a patient shares that they have been sexually or physically abused or that they are terrified to live with their fighting parents during COVID-19. Your role as a primary care provider (PCP) is critical. Your interactions with your patient need to feel safe. As constrained as your time is, you must make every minute count toward establishing a connection.


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Alleviating coronavirus anxiety

We don’t have to tell you that virtually everyone feels anxious about the spread of COVID-19. An appropriate level of anxiety can be helpful if it inspires people to follow CDC recommendations on hygiene and social distancing. An unnecessary level of anxiety, however, can impair both mental and physical health. Many of your patients and families are suffering from unhealthy anxiety–whether they present with possible COVID-19 symptoms or come in for an unrelated complaint.


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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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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.”


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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.


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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.”


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What if the child’s caregiver has mental health issues too?

“Mental health flows in both directions, not just downhill from parent to child,” said Peter S. Jensen, MD, founder and board chair of The REACH Institute. The effects on children when caregivers suffer from mental health problems are well documented (see Resources below). Another pattern is that parents and children can share an inherited tendency toward the same disorder. Furthermore, a child’s struggles can trigger disorders such as depression or anxiety in a caregiver. “Blaming parents for their children’s mental health issues is not only a tactical mistake,” said Dr. Jensen, “it’s also simply incorrect.” Pediatric practitioners have to tread carefully when they suspect that the caregiver of a child they are treating has mental health issues.


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How Pediatric Professionals Can Use Cognitive Behavioral Therapy to Address Anxiety

“Pediatric primary care providers can have a big impact on child mental health simply because we see children early and often,” said Dana Kornfeld, MD, REACH board member and associate clinical professor of pediatrics at George Washington School of Medicine. Dr. Kornfeld, who practices at Pediatric Care Center in Bethesda, MD, endorses the use of cognitive behavioral therapy (CBT) techniques in primary care to nip potentially crippling anxiety in the bud.


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Why Can’t This Kid Sleep? (Teen Edition)

Alana, age 17, comes into your office complaining that she can’t sleep at night and struggles to stay awake during school. If she can, she sleeps until noon or later on weekends. “Diagnosis of sleep disorders is often easier with teens than with younger children, as long as you ask the right questions,” said Robert Kowatch, MD, a REACH faculty member who is a pediatric sleep expert at Ohio State University Medical Center/Nationwide Children’s Hospital.


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Why Can’t This Kid Sleep?

Alana, age 17, comes in complaining that she is tired all the time and struggles to stay awake during school. Or perhaps it’s six-year-old Miko, whose mother tells you that Miko avoids going to bed and often gets up in the middle of the night. Miko says he doesn’t feel sleepy, but his teachers say he is often inattentive and sometimes quarrelsome. The most common sleep problems among young patients are these and other forms of insomnia or insufficient sleep, according to REACH faculty member Robert Kowatch, MD …


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GLAD-PC Toolkit Is Here to Help You Treat Depression

The new edition of Guidelines for Adolescent Depression in Primary Care (GLAD-PC) is now available on The REACH Institute website. This practical toolkit offers dozens of resources to help pediatric primary care providers diagnose and treat depression.


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How to Manage School Refusal

Ryan, age 12, has missed almost three weeks of school so far. He complains of nausea and headache most school days and has to be cajoled into getting out of bed, but his mother says he is fine on weekends. The mother, who is eight months pregnant, is frantic; she can’t afford to take any more time off work before she delivers. School refusal can have serious consequences. On the short term, the child falls behind academically, both the child and the family experience disruption and distress, and there can be legal and financial ramifications. Long-term consequences for school refusers include violent behavior, school dropout, early marriage, and unemployment. “The main goal of treatment is to get the child back to school as soon as possible,” says Lisa Hunter Romanelli, PhD, REACH Institute CEO and clinical psychologist. “Being absent from school is highly reinforcing.” Like many school refusers, Ryan presents somatic complaints. After you rule out physiological causes– not only for these complaints but also for any underlying conditions that can produce depression or anxiety–what’s next?


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Culturally Responsive Mental Health Screening Tools

As you’ve dealt with back-to-school (and back-to-sports) visits, you probably have been challenged by the gap between what’s needed and what’s practical. This visit may be the only time you see this child this year. You know that emotional and mental health is as important as physical health. But you have only so much time for each check-up. Screening tools are a big help…


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Mental health support for children in foster care

“We have kids who come in here on three, four different medications,” says Dr. Elizabeth Wallis, MD, “and we don’t know why. We don’t know what data were used to make those decisions.” Dr. Wallis, director of the Foster Care Support Clinic (FCSC) of the Medical University of South Carolina and a REACH faculty member, was expressing just one of the challenges of treating children and youth in the foster care system.


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Getting smarter about child mental health

“For these straightforward cases, when you can identify uncomplicated ADHD in patients without co-occuring depression or anxiety – well, everyone in primary care should be able to do this.”


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“Now people have a place to go”

In the absence of a single child and adolescent psychiatrist anywhere in Cape May County, New Jersey, The REACH Institute training enabled Rainbow Pediatrics to help families who had nowhere else to turn.


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“REACH offered a safe environment to learn and share in It was, and continues to be, a supportive, invigorating process! It was motivating and has increased my confidence in assessment, diagnosis of mental health cases in my day to day life and practice.”

Dayna Leavens, CPNP, MSN
Twin Falls, ID