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Can pediatricians treat psychological disorders?
On this bonus episode of Northwell's podcast, Dr. Lindsay speaks with two pediatricians who share their experiences treating youth with behavioral health conditions through Project TEACH
It's a staggering stat: More than 15 million children and adolescents are in need of a pediatric psychiatrist. But finding treatment is anything but easy with just around 8,300 trained pediatric mental health professionals in the U.S. The consequence: Long wait times, worsening symptoms and even higher costs when they do get help. To increase the pool of providers that can offer effective treatments to this population, Project TEACH is training pediatricians, as well as family doctors and Ob/Gyns, to be able to handle mild-to-moderate behavioral health conditions.
On this bonus episode of 20-Minute Health Talk, host Sandra Linday, RN, speaks with two pediatricians using the New York State program, a collaboration between the New York State Office of Mental Health (OMH) and seven top universities and hospitals across the state, led by University at Buffalo (UB). They share their experiences treating youth with mental health conditions like depression, anxiety and ADHD before Project TEACH began in 2010, and how the free training, consultation and referral service has transformed their practice.
This bonus conversation builds on an earlier podcast featuring two of the founders of Project TEACH, David Kaye, MD and Victor Fornari, MD, as well as the new NYS lead for its reproductive psychiatry branch, Kristina Deligiannidis, MD.
Our guests this week are:
- David Fagan, MD FAAP, vice chair of Pediatric Ambulatory Services at Cohen Children's Medical Center, a part of Northwell Health
- Maureen Montgomery, MD, FAAP, assistant clinical professor of pediatrics at SUNY Buffalo
Podcast transcript
Rob Hoell (host): 04:45
Project TEACH trains pediatricians and OBGYNs to handle mild-to-moderate behavioral issues right in the primary care office. Which to me, it seems like such a great idea and such a great approach. It seems to be working.
Dr. Sandra Lindsay (host): 00:58
That’s a game changer because there are not enough psychiatrists to deal with all of these issues and especially after the last three years. The data showing how many children need support with behavioral issues is just startling.
So, to know that a parent can bring their child to their pediatricians and be able to get help there, that is really amazing.
Hoell: 01:28
Yeah. Kids are used to going to the pediatricians, so it’s comfortable. What’s cool about this is that the child with the minor issue doesn’t have to wait weeks or months to see a specialist.
This is an expanding pool of doctors that can help children dealing with issues like depression, anxiety and ADHD. But you listened to that podcast and you wanted to find out more information. So, tell me a little bit about what you did afterward.
Dr. Lindsay: 01:50
So, after listening to your conversation with this group, I followed up with a few pediatricians who actually use Project TEACH. What was interesting about these two separate conversations was how aligned they both were. You could hear the passion in their voices about this project and how much they’re using it.
Hoell: 02:13
I can’t wait to hear that conversation.
Dr. Lindsay: 02:15
One is a physician--Dr. Maureen Montgomery—and she’s an Assistant Clinical Professor of Pediatrics at Suny-Buffalo in upstate New York, as well as Dr. David Fagan who is right in our own backyard at Cohen Children’s Medical Center. He’s the Vice Chair of Pediatric Ambulatory Services at Cohen and we quickly learned a big fan of Project TEACH.
Dr. Fagan: 02:41
It’s been a lifesaver for pediatric practices in many, many ways. Now I have the tools to screen my patients. I have the tools to start medication management and I have a referral source through Project TEACH that can link my families with therapists in the communities where they live who accept their insurance. So, it’s been night and day.
Dr. Lindsay: 03:08
Dr. Fagan told us that his team at Cohen Children’s Medical Center has seen increase in a variety of Behavioral Health conditions during the COVID-19 pandemic—a trend that has been seen nationwide.
Dr. Fagan: 03:24
Of the common diagnoses like depression and like ADHD, anxiety’s the one that has probably had the biggest, biggest flip. It often starts with somatic complaints. “I have a stomachache.” “I have a headache”, things like that.
These complaints, but what’s really behind that is they don’t want to go to school because of the anxiety because maybe it’s the interaction or even the fear of getting COVID.
Dr. Lindsay: 03:56
Pre-pandemic, one-in-five youth met criteria for at least one psychiatric disorder prior to the age of 18. Experts say that the pandemic has almost doubled the prevalence of anxiety and depression.
Dr. Fagan: 04:14
Not a week goes by where I don’t have a patient either scoring positive on a screener for anxiety or depression. For Project TEACH, I would struggle because I didn’t have the resources to help my patients and give them what they need. Now it’s a much smoother process to get my patients the help they need.
Dr. Lindsay: 04:37
Not only did he see the benefit for the patient, but Dr. Fagan saw his participation in Project TEACH as an opportunity to lead by example for his staff.
Dr. Fagan: 04:51
I felt it was important that as a leader of general pediatricians, that they saw that I was invested in this program and found value in it. Every time a new pediatrician joins us, this is one of the things that I discuss with them—the importance of taking this training.
Dr. Lindsay: 05:11
Across New York State, more than 4,400 primary care providers have registered for the program since its inception in 2010. This has led to more than 23,000 consultations.
One of those consultations for Dr. Fagan helped him adjust medications for a young patient suffering from depression.
Dr. Fagan: 05:37
She said, “Doc, I don’t think the medicine’s doing what it used to do.” So, this is where I reach my limit.
This is where I contacted Project TEACH and presented the case. They made a medication recommendation. That medication helped the patient greatly. With the help of a child psychiatrist from Project TEACH we changed her medication and she did really well.
Dr. Lindsay: 06:09
Not just a one-time service, Dr. Fagan said cases like this highlight the ongoing support offered by Project TEACH.
Dr. Fagan: 06:20
One of the things that I really like is it’s never a one-time consultation. They always set up a follow-up appointment because if we’re going to implement a new medication, or change a dose, or whatever it is, they want to know, “How did it go? Did it work? Did it help? Are we okay or do we need to do something else?”
The beauty of Project TEACH is you’re not out there alone on an island. You have this team of doctors from Project TEACH behind you that you can reach out for consultations which is wonderful.
Dr. Lindsay: 06:58
Dr. Fagan’s message to other New York providers who have yet to sign up for Project TEACH is simple.
Dr. Fagan: 07:05
I would say, “You can do this.” I do this. In residency training, I wasn’t trained to do this. When I started my career, I was not trained to do this.
But because of Project TEACH, I now have the knowledge and the skills. I know to identify/manage these types of conditions and if I can do it, you can do it.
To help address the ongoing maternal and child mental health crisis in the U.S., a NYS program is expanding the pool of doctors who can treat behavioral health issues. Hear from the experts leading this effort on this 20-Minute Health Talk.
Read more
Dr. Lindsay: 07:33
While Dr. Fagan has been using Project TEACH for five years, Dr. Montgomery was one of the earlier doctors and in fact, worked with those developing the program including Dr. Kay who Rob spoke with on a recent episode of “20-Minute Health Talk”.
I spoke with her recently and she shared what it was like before Project TEACH, when seeing patients in need of Behavioral Health treatment.
Dr. Montgomery: 08:03
It was terrible! It was terrible! We—as pediatricians and primary care providers—are used to handling infections, meningitis, broken bones, concussions and surgical abdomens, appendectomies, and trying to diagnose all those medical conditions. But we really didn’t get much training in mental health when we were in residency.
I had a friend once who came into the office. We were working together and she said, “Just let me have a meningitis, please. I can handle that. Just send me in a kid with meningitis” because these Behavioral Health conditions we didn’t know what to do with. We didn’t have any expertise.
Dr. Lindsay: 08:44
“The shift—” Dr. Montgomery explains, “—has been dramatic.”
Dr. Montgomery: 08:51
The same pattern of things that we do when we diagnose a physical condition, we can now do with a mental health condition. It’s changed everything. It’s changed the culture of our practiceactually. It feeds the other doctors as well. If one doctor knows what could help to figure this condition out and provides the information to the next doctor, it’s a contagious thing that spreads to the whole office. So, that’s really been wonderful to see.
Dr. Lindsay: 09:19
“The benefits of this program—” she says, “—often surprise parents who don’t expect their child’s pediatrician to be able to handle such issues. Among the many benefits, this can cut down on wait times to get a diagnosis and treatment.”
Dr. Montgomery: 09:39
Even getting into a therapist can take a long time. It really can. So, we can do a little bit of interventions right in the office with simple interventions teaching children how to ground themselves and become less anxious. Just teaching some CBT skills.
Dr. Lindsay: 09:56
CBT stands for “Cognitive Behavioral Therapy” which is a treatment used for a range of problems including depression, anxiety disorders and severe mental illness. It usually involves efforts to change thinking patterns that contribute to behaviors that interfere with your day-to-day activities.
Dr. Montgomery: 10:22
It’s a talk therapy with a therapist who teaches skills. When you learn the skills, you can function very well and recover from these anxiety symptoms, or depression symptoms, or anything that’s causing you to not be able to be your best.
So, there really are quite a few things we’ve learned to do right in the practice for kids. Of course, parents are so relieved to be able to have something to help their children with. It’s a win/win all the way around.
Dr. Lindsay: 10:57
During the pandemic, the trainings offered by Project Teach have moved to virtual, but continue to make a difference for providers and their patients.
Dr. Montgomery: 11:09
The training is intense. It’s wonderful. You get so many layers of reinforcement of the education on specific topics related to what we’re talking about—anxiety, depression, ADHD, aggression—many, many things that we struggle to understand in primary care.
Dr. Lindsay: 11:27
COVID -19s impact on mental health is well documented causing untold amount of suffering in all populations. Suicide is now one of the leading causes of death in children 10-24—a fact not lost on Dr. Montgomery.
Dr. Montgomery: 11:50
The mental health crisis—it really is a crisis in primary care— is flooding our offices and could be inundating us to the point where we wouldn’t be able to do much of anything else if we didn’t have the resources that Project TEACH gives us.
I don’t think we could’ve gotten through this without Project TEACH. That’s not an exaggeration. I don’t think we could’ve in any way handled the volume of kids who’ve been coming in with complaints and symptoms of mood disorders, depression and anxiety, and even suicidality. The rates of suicidality have really increased since the pandemic.
Dr. Lindsay: 12:29
Despite the many challenges facing providers like Dr. Montgomery, Project TEACH is giving them reasons for hope.
Dr. Montgomery: 12:38
It reinforces our willingness and hope in striving to do better for our patients. It’s very, very validating for us pediatricians to be able to feel that we can do something for these kids and that’s the reason I think Project TEACH is so valuable.
Hoell: 13:04
Sandra, that was such a great addition to this topic that we’re talking about—Project Teach—really enjoyed the conversation.
Dr. Lindsay: 13:11
So, Rob, I think it was important after you got kind of the gist of what Project TEACH is to actually speak to people who are using it, so they can talk us through when a kid comes in from assessment to, “Okay, something is going on here” to make him the consult to Project TEACH, to actually get in the follow-up.
I think that was really important for people to see how it’s operationalized then to just get a different angle on it. These physicians were so passionate about using Project TEACH.
Hoell: 13:54
Such a great conversation and it’s hard to believe that we’ve done over 100 episodes. We have one more left in this year—2022—and that will be dropping next week where we will recap the Top Five Innovations of 2022 as well as the Top Five Moments. Sandra, I think you may be on that list!
Dr. Lindsay: 14:13
Well, we’ve been very busy—100 episodes! That is amazing! I don’t know if I’m in that. I guess I’ll just have to wait and see, right?
Hoell: 14:24
Maybe more than one. I don’t know. We’ll see. For now, I’m Rob Hoell--
Dr. Lindsay: 14:29
I’m Sandra Lindsay. Thank you for listening.
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