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BONUS: Can pediatricians treat psychological disorders? · 20-Minute Health Talk

• 0:04
  Rob: Hello and welcome to another bonus episode of 20-Minute Health talk.
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  I'm Rob Hoell with me in the studio is my co-host Sandra Lindsay.
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  Sandra is Vice President of public health advocacy for Northwell
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  Health.
• 0:15
  Hey Sandra. Thanks Rob, it's great to be with you
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  once again. Today we're taking a second look at an incredible program
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  that takes a new approach to addressing the Mental Health crisis in
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  the United States. It's called project teach and we featured three
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  programs
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  leaders in a recent episode of the podcast, I think it was episode
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  99, which I urge you to come back and listen to including two of its
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  founders, Dr. David Kaye and Dr.
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  Victor Fornari as well as a Statewide lead for its new reproductive
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  Psychiatry Branch,
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  Kristina Deligiannidis. Project
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  teach trains pediatricians and OBGYNs, to handle mild to moderate
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  behavioral issues, right
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  in the primary care office which to me seems like such a great idea
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  and such a great approach and it seems to be working.
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  Sandra Lindsay: That's a game changer.
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  Because they're not enough psychiatrists to deal with all of these
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  issues and especially after the last three years, you know, the data
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  showing how many children need support with behavioral issues is
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  just eye-opening.
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  So to know that a parent can bring their child to their pediatricians.
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  and be able to get help there.
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  That is really amazing.
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  Rob: Yeah kids are used to going to the pediatrician
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  What's cool about this is that the child with the minor issue doesn't
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  have to wait weeks or months to see a specialist.
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  This is expanding the pool of doctors that can help children dealing with
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  issues, like, depression, anxiety, and ADHD.
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  But you listened to that podcast and you wanted to find out more
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  information,
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  so, tell me a little bit about what you did afterwards.
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  Sandra: So, after listening to your conversation, with this group, I followed
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  up with a few pediatricians who
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  actually use project teach. What was interesting about these two
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  separate conversations was how aligned they both were. You could hear
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  the passion, you know, in their voices about this project and how
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  much they're using it. I can't wait to hear that conversation.
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  One is a physician Dr.
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  Maureen Montgomery, and she's an assistant
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  clinical professor of pediatrics at SUNY Buffalo in Upstate New York
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  as well as Dr.
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  David Fagan, who is right in our own backyard at
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  Cohen Children's Medical Center.
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  He's the vice chair of pediatric ambulatory services at Cohen and we
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  quickly learned a big fan of Project TEACH.
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  Dr. Fagan: It's been a lifesaver for Pediatric practices in many, many ways.
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  Now, you know, I have the tools to screen my patients.
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  I have the tools to start medication management and I have a referral
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  source through project, teach that can link my
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  families with therapists in the communities, where they live, who accept
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  their insurance.
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  So it's been night and day.
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  Sandra: Dr. Fagan told us that his team at Cohen
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  Children's Medical Center has seen an increase in a variety of behavioral
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  health conditions
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  during the covid-19 pandemic.
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  A trend that has been seen Nationwide. Of the common diagnosis like
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  Dr. Fagan: depression like ADHD anxiety is the one that
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  has, you know, probably had the biggest blip, it often
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  starts with, you know, somatic complaints.
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  You know, I have a stomach ache, I have a headache things like that,
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  these complaints but what's really behind that is they don't want
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  to go to school because of the anxiety because maybe it's the
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  interaction or even the fear of getting covid
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  Sandra: Pre-pandemic, one in five youth
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  met criteria for at least one psychiatric disorder prior to the age of
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  18.
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  Experts say that the pandemic has almost doubled the prevalence of
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  anxiety and depression.
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  Not a week, goes by where I don't have a patient either scoring
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  positive on a screener for anxiety or depression.
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  And before Project TEACH, I would struggle because I didn't have the
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  resources to, you know, to help
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  my patients and give them what they need.
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  And now, it's a much smoother process to get my patients the help they need
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  Sandra: Not only did he see the benefit for the patient, but Dr.
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  Fagan saw his participation in Project TEACH as an opportunity to
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  lead by example for his staff.
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  Dr. Fagan: I felt it was important that as a leader of general pediatricians,
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  that they saw that I was invested in this program.
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  And found value in it and every time a new pediatrician joins us, this
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  is one of the things that I discussed with them.
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  The importance of taking this training. Across New York State, more
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  Sandra: than 4,400 Primary Care
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  providers, have registered for the program since its inception in
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  2010.
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  This has led to more than 23,000 consultations. One of those
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  consultations for Dr.
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  Fagan helped him adjust medications for a young patient suffering
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  from depression.
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  Dr. Fagan: She said doc, I don't think the medicines doing what it used to do.
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  So this is where I reach my limit and this is where I contacted
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  project teach and presented the case and they made a medication
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  recommendation.
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  And that medication helped the patient greatly.
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  With the help of a child psychiatrist from
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  Project teach, we changed her medication and she did really well
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  Sandra: Not just the one-time service,
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  Dr.
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  Fagan said, cases like this highlight, the ongoing support offered by
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  Project TEACH. And one of the things that I really like is it's
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  never a one-time consultation.
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  They always set up a follow-up appointment because if we're going to
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  implement
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  a new medication or change a dose or whatever it is.
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  They want to know how did it go.
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  Did it help? Are we
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  okay? Or do we need to do something else and the beauty of project
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  teach is you're not out there alone on an island.
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  You have this team of doctors from Project each behind you that you
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  can reach out for consultations.
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  Which is wonderful.
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  Sandra: Dr.
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  Fagan's message to other New York providers, who have yet to sign up
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  for project
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  Teach is simple.
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  Dr. Fagan: I would say you can do this, I do this, you know in residency training
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  I wasn't trained to do this when I started my career I was not trained
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  to do this but because of project teach I now have the knowledge and
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  the skills to diagnose, identify, manage these types of conditions.
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  And you know, if I can do it,
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  you can do it.
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  Sandra: While Dr.
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  Fagan has been using Project teach for five years, Dr.
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  Montgomery was one of the early adopters and in fact, work with those
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  developing the program including Dr.
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  Kaye, who Rob spoke with
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  on a recent episode of 20-Minute Health Talk.
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  I spoke with her recently and she shared what it was like before
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  project teach when seing patients in need of behavioral
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  health treatment.
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  Dr. Maureen Montgomery: It was terrible.
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  It was terrible.
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  We, as pediatricians and Primary Care
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  Providers are used to handling infections, meningitis, broken bones,
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  concussions, you know, and surgical abdomens and appendectomy
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  trying to diagnose all those medical conditions, but we really didn't
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  get much training in mental health when we were in residency.
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  And so, I had a friend once who came into the office, we were working
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  together
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  and she said, just let me have a meningitis please.
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  I can handle that.
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  Just send me a kid with meningitis.
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  Because these behavioral health conditions, we didn't know what to do
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  with it,
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  we didn't have any expertise.
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  Sandra: The shift, Dr. Montgomery explains, has been dramatic. The same pattern of things that
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  Dr. Montgomery: we do, when we diagnose a physical condition
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  we can now do with a mental health condition.
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  It's changed everything.
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  It's changed
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  the culture of our practice.
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  Actually, it's it feeds, the other doctors as well.
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  If one doctor knows what could help to figure this condition out and
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  provides the information to the next Doctor it goes, it's a contagious
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  thing that spreads through the whole office.
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  So that's really been wonderful to see.
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  Sandra: The benefits of this program
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  she says, often surprised parents who don't expect their child's
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  pediatrician to be able to handle such issues among the many benefits.
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  Dr. Montgomery: This can cut down on, wait times to get a diagnosis and treatment. And
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  even getting into a therapist can take long time.
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  It really can.
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  So we can do a little bit of interventions right in the office with
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  simple
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  interventions teaching children how to ground themselves and become less
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  anxious.
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  Just teaching some CBT skills.
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  Sandra: CBT stands for cognitive behavioral therapy, which is a treatment used
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  for a range of problems, including depression, anxiety disorders, and
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  severe mental illness.
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  It usually involves efforts to change thinking patterns that
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  contribute to behaviors that interfere
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  your day-to-day activities.
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  Dr. Montgomery: It's a, it's a talk therapy with the therapist who teaches skills.
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  And when you learn the skills, you can function very well
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  And recover from these anxiety symptoms or depression
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  symptoms o anything that's causing you to, not be able to be your
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  best.
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  So there really are quite a few things
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  we've learned to do right in the practice for kids.
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  And of course, parents are so relieved to be able to have something to
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  help their children with.
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  It's just, you know, it's a win-win all the way around. During the
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  Sandra: pandemic,
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  the trainings offered by Project TEACH have moved virtual but continue
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  to make a difference for providers and their patients.
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  Dr. Montgomery: The training is intense.
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  It's wonderful.
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  You get so many layers of reinforcement of the education on specific
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  topics related to what we're talking about anxiety,
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  depression, ADHD, aggression. Many, many things that we struggle
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  to understand in Primary Care.
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  Sandra: Covid-19, impact on mental health is well-documented causing untold
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  amount of suffering in all populations.
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  Suicide is now one of the leading causes of death in children 10 to 24
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  a fact not lost on Dr. Montgomery
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  Dr. Montgomery: The Mental Health crisis, it really is a crisis in Primary
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  our offices and could be inundating us to the point
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  where we were able to do much of anything else.
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  If we didn't have the resources that Project TEACH gives us. I don't
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  think we could have gotten through this without Project TEACH.
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  That's a, that's not an exaggeration.
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  ,I don't think we could have in any way.
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  handle the volume of kids who've been coming in with complaints and
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  symptoms of mood disorders, depression, and anxiety, and even
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  suicidality.
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  The rates of suicidality have really increased since the pandemic.
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  Sandra: Despite the many challenges facing providers like Dr.
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  Montgomery, Project teach is giving them reasons for hope.
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  It reinforces our willingness and hope and striving to do better for
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  our patients.
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  It's a very, very validating feeling for us
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  Pediatricians to be able to feel that we can do something for these
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  kids and that's the reason I think Project TEACH is
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  so valuable.
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  Rob: Sandra,
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  that was such a great addition to this topic that we're talking about
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  Project TEACH and I really enjoyed the conversation.
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  Sandra: So Rob, you know, I think it was important after you got kind of the
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  gist of what Project TEACH is to actually speak to people who are
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  using it, so that they can talk us through when a kid comes in from
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  assessment
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  to okay,
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  something is going on here to making the console to project teach to
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  actually get in the follow-up.
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  I think that was really important for people to see that this
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  how it's operationalized then to just get a different angle on it.
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  And these Physicians were so passionate about using project teach.
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  Rob: Such a great conversation, and it's hard to believe that we've done
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  over 100 episodes and we have one more left in
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  Year 2022 and that will be dropping next week, where we will recap the
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  top five Innovations of 2022 as well as the top 5 moments and Sandra,
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  I think you may have be on that list.
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  Sandra: Well, we've been very busy 100 episode that is amazing.
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  You know, I don't know if I'm in that, I guess
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  I'll just have to wait and see.
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  Right?
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  Rob: Maybe more than one that we'll see. For
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  now, I'm Rob Hoell... and I'm Sandra Lindsey.
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  Sandra: Thank you for listening.