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Doctor/therapist: How a NYS program is expanding access to behavioral health care
On this episode of 20-Minute Health Talk, three essential contributors to project TEACH discuss how it can benefit medical professionals across the country
While we associate mental health care with psychologists and psychiatrists, primary care doctors are often the first to see children and families with behavioral health issues. To strengthen and support doctors' ability to deliver that care, a state-wide program called Project TEACH provides free psychiatric consultation support and training. Since its inception in 2010, Project TEACH has enrolled nearly half of the 9,000 primary care physicians in New York State, leading to more than 23,000 consultations with pediatric patients. This is a critical resource amidst an ongoing maternal and child mental health crisis in the US.
On this episode, two of the founders of this unique program discuss this 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). Our third guest explains how a recent 5-year, $16.8 Million grant from New York State has enabled the expansion of Project TEACH into behavioral health services that support OB/GYNs, family physicians and other clinicians who work with women who are pregnant or have recently given birth.
Meet our guests
- David Kaye, MD, professor of psychiatry and vice chair of academic affairs at the University of Buffalo, and executive director, Project TEACH.
- Victor Fornari, MD, vice chair and director of the division of child and adolescent psychiatry at Northwell and site medical director, Project TEACH.
- Kristina Deligiannidis, MD, director of women’s behavioral health at Zucker Hillside Hospital and the new medical director of reproductive psychiatry, Project TEACH.
Podcast transcript
Host: 02:06
Reproductive psychiatry is a new branch of Project TEACH created through a recent, five-year, $16.8 million grant from New York State which expands the program's behavioral health services to now also support OB/GYNs, family physicians and other clinicians who work with women who are pregnant or have recently given birth. As a statewide lead, Dr. Deligiannidis will oversee the effort to combat maternal depression and other prenatal mental health disorders using Project TEACH’s uniquely collaborative approach. Dr. Deligiannidis, thanks for being here.
Dr. Deligiannidis: 02:52
It’s my pleasure.
Host: 02:54
The number of Americans who could benefit from access to mental health care is staggering, and there aren’t enough providers to meet the demand. Dr. Deligiannidis, among women who are pregnant, who have recently given birth, how many are in need?
Dr. Deligiannidis: 03:06
Yeah, the number is quite large. Approximately 80 percent of all women who give birth have some time-limited transient symptoms. Changes in their mood, their sleep obviously. They can experience periods of feeling overwhelmed. But these don’t impair their functioning and they don’t require clinical treatment, so for most women, they’re able to transition after the delivery, and within two weeks they feel like themselves again.
But for one in four women, they are diagnosed with a perinatal psychiatric disorder, so that’s 25 percent of all women who are pregnant or postpartum. We know a subset of these women with severe psychiatric illness can have suicidal ideation or other complications. In New York State, one in eight women with a pregnancy-related death is due to suicide in the first postpartum year, and 100 percent of those deaths are preventable.
In this new state-funded program from the Office of Mental Health, the Project TEACH Maternal Mental Health Initiative, we really seek to be able to reduce maternal psychiatric morbidity and mortality in our state and in our patients.
Host: 04:24
Yeah, sometimes just having that conversation is so important.
Dr. Deligiannidis: 04:27
Absolutely.
Host: 04:29
Dr. Fornari, the pandemic has had a huge impact on emotional health in general. How has it impacted our youth when it comes to behavioral health?
Dr. Fornari: 04:37
Well, currently we’re in the midst of a national child mental health crisis. Prior to the pandemic, one in five youth already met criteria for at least one psychiatric disorder prior to the age of 18. For many of those disorders, the pandemic has really almost doubled the prevalence of anxiety and depression. So we’re really struggling because our youth are really in crisis.
Host: 05:02
Yeah, and I guess empowering doctors and primary care physicians through Project TEACH is making a huge impact.
Dr. Fornari: 05:10
Well, there’s simply not enough child and adolescent psychiatrists to meet this unmet demand. Project TEACH really supports pediatricians and other primary care health providers to care for children, adolescents, and their families who have mild to moderate mental health problems; who otherwise wouldn’t seek services. We hear from our colleagues across the state that participating together in this program is one of the most gratifying professional experiences they have because the work is so meaningful.
Host: 05:41
Dr. Kaye, how did Project TEACH begin and can you explain how it works?
Dr. Kaye: 05:46
The New York State Office of Mental Health initiated the Project TEACH in 2010. We are a consortium of seven academic centers across the state of New York and we provide all the services for the program. We think of the program as a three-legged stool and our seven groups work together to offer these services.
- Real-time phone consultation. We have a toll-free number — 855-227-7272 — that health care professionals, physicians can pick up the phone, call us, and they can speak with an expert child psychiatrist or reproductive psychiatrist immediately or within 30 minutes or at their convenience. So they have real-time phone consultation support.
- Help with linkage and referral for their patients
- Formal CME education. All of our consortium psychiatrists and program personnel work together on this to have one consistent program across the entire state.
Host: 06:59
Dr. Kaye, can you give us an example of when a pediatrician might use Project TEACH?
Dr. Kaye: 07:05
What we do is we will talk with a child’s pediatrician, for example, and the pediatrician will call us and say, "This child is on X medicine. They’re not eating anymore. What should I do? What can I do to help with this issue?" So we get calls about medications, about therapy, about other community resources. So we help the pediatricians, the family docs, the obstetricians; psychiatrists can call us. In essence, we’re teaching them to fish.
Host: 07:51
Dr. Kaye just mentioned the many types of health care providers that this program supports. Sandra Lindsay, the newest addition to our team here at 20-Minute Health Talk, recently spoke with two pediatricians about their experience using Project TEACH. Here’s a snippet of her conversation with Dr. Maureen Montgomery, a pediatrician at SUNY Buffalo.
Dr. Lindsay: 08:11
This has been a huge shift for you.
Dr. Montgomery: 08:13
Yes, it has.
Dr. Lindsay: 08:14
How has the resources and the tools from Project TEACH prepared you to handle this increase?
Dr. Montgomery: 08:21
It’s a real shift in your skillset, first of all. You become more aware of what the symptoms are. Then we had so many tools that the Project TEACH has given us to use to screen for different kinds of conditions. There really are quite a few things we’ve learned to do right in the practice for kids. Simple interventions teaching children how to ground themselves and become less anxious. Just teaching some CBT skills and actually those tools are invaluable. It’s changed everything. It’s changed the culture of our practice.
Host: 09:01
To hear more firsthand experiences using Project TEACH, check back next week for Sandra’s full interview with Dr. Montgomery as well as Dr. David Fagan, vice-chairman of pediatric ambulatory administration at Cohen Children’s Medical Center.
Dr. Fornari, tell us how a typical consult may go.
Dr. Fornari: 09:20
Well, we would receive a telephone call on our one line that people would see on our website, and it would go to someone who would take the information, our liaison coordinator. And depending upon the request, then the call would be channeled either to a child psychiatrist who is then covering the phone or to the perinatal psychiatrist. They would take the call in real-time if available or but certainly call back within 30 minutes if they were tied up on another call. The liaison coordinator would have taken some preliminary information so we had a general idea of the age, the grade, and other clinical aspects of the child, but no name because really this is for education, not clinical care, so that we didn’t establish a doctor-patient relationship, but rather we’ll talk hypothetically about how one would proceed with a child of this age with the nature of the concern.
Then we would discuss the case with the primary care physician, make some recommendations, oftentimes asking them to get some rating scales or to obtain additional history. Many of the calls might include follow-up telephone call several weeks or a month later. After each call, we ask whether or not we accomplished what they wanted, if they were satisfied, and really from the primary care feedback response, the satisfaction was very high.
Host: 10:49
How unique is this program nationally? Because I really wouldn’t think of a pediatrician or an OB/GYN as someone who would be treating something like anxiety or an issue that’s similar to that. Are there other programs like this in other parts of the country?
Dr. Fornari: 11:03
Approximately 30 states around the United States have some theme in variation of a collaborative care program. However, the one in New York State is the most robust to provide education for primary care. We know from the hits on our website that they are people in 40 states and 50 countries around the globe who are accessing our resources.
Host: 11:25
Dr. Deligiannidis, are there major differences between the pediatric and the perinatal sides of this program?
Dr. Deligiannidis: 11:31
We actually function very similarly to our colleagues in the child and adolescent psychiatry side. All of our services are at no cost to prescribers in the State of New York. I would say the one main difference is that the child and adolescent psychiatry side does provide some face-to-face consultations, but we do not provide that service on the perinatal psychiatry side as of yet.
Host: 11:55
Okay. Does it help to have the rest of the team’s experience now in its 13th year and how has it helped you develop your team?
Dr. Deligiannidis: 12:05
The expansion of the access program to include maternal mental health was a need for a great time in this state. But nationally, it was good to hear the numbers from Dr. Fornari. There are approximately 16 programs in the United States that are perinatal psychiatry access programs. They’re all structured quite differently. When you look at the data, the programs are not just diverse, but they’re mainly disconnected from their child and adolescent psychiatry access program. So there will be states that have the child side but don’t have the perinatal side and vice versa.
We’re so fortunate that we are funded by one funder because some states are funded by different entities, they’re run differently, they have different aims and goals. We have just an expanded mission now. It’s still the same mission, the same stool, but now we provide it to pregnant and postpartum patients. We’ve just benefited so much as we’ve got this up and running as of January 1st this year from the wisdom of our child and adolescent psychiatry team and will continue to grow.
Dr. Fornari: 13:19
I just want to add in addition to this, based on our presentations and some of our publications, we’ve been contacted by other states to help them to develop collaborative care programs in other regions of the United States. Now we’ve also been contacted by other countries to try to help them to develop this kind of a program that would fit with the resources of their communities.
Host: 13:42
There’s such a stigma sometimes with mental health and we’re normalizing the conversation, we're having the conversation. How important is that to have resources like Project TEACH and to be able to advocate for it?
Dr. Fornari: 13:51
Well, I think if there is a silver lining to the pandemic and there are several, one of them is that mental health has become part of the public discourse, and I think there’s a general understanding that there’s no health without mental health and that’s something that all of us really believe in.
Dr. Kaye: 14:09 I think also bringing this into primary care and into the mainstream really helps to destigmatize mental health issues. What we’re doing is helping pediatricians, family docs, OB/GYNs to embrace this agenda, to feel comfortable, to have some confidence, to have some skills in discussing this so that they’re taking advantage of the already established relationships that they have and the trust that they have with people. I think that it really helps from that end as well.
Host: 14:54
Dr. Kaye, how does it feel being a co-founder of this program to see it take off the way it has and how people are getting the help they need?
Dr. Kaye: 15:02
Oh, it’s just a total joy and pleasure and honor to be able to do this. Every week that I’m on the phone, I get feedback from the pediatricians, the family docs and so forth about how helpful the program is.
Host: 15:22
That’s awesome. Dr. Deligiannidis, have you seen that ripple effect?
Dr. Deligiannidis: 15:26
Yeah, so we’re starting off, right -- we began January 1st -- and I think we’re starting as the child psychiatry and adolescent psychiatry programs started a decade ago that we’re starting with many maternal health providers that are very eager to do this. They recognize the need and they recognize the impact of untreated psychiatric illness in pregnancy or after delivery for their patients and for their families. So they’re eager to learn and to partner with us and collaborate. But we’re at the very beginning. Much of what we need to do is establish who we are as a resource for them across the state, then create those partnerships, create those relationships with individual practices and providers.
I was on call yesterday and a couple of the calls that I had were repeat calls, and just checking in again on patients they were caring for and managing and felt competent in doing so and comfortable doing so. They’re so comforted to know that they have me in their back pocket, and so they can just ring up and they know when they’re going to get me or one of our wonderful team members, and just having that immediate real-time support allows them to do this work. It’s incredibly gratifying. They’re just so thankful at the end of the call. It’s so gratifying.
Dr. Fornari: 16:56
Yeah, when things work well, it’s really a joy, and we’re so grateful to the New York State Office of Mental Health for really being forward thinking, for supporting this, for increasing the reach by now including maternal mental health. So it’s really been something that’s been very gratifying, and without the collaboration from the Office of Mental Health, this program would not have been possible.
Host: 17:25
That’s awesome. Well, we always like to end on a positive note here on 20-Minute Health Talk, so I want to ask all three of you this question, but I’ll start with you, Dr. Deligiannidis. What gives you hope? What gives you optimism going forward?
Dr. Deligiannidis: 17:37
This program provides incredible hope. Just to see what we’ve been able to accomplish in the first several months has been amazing. To be able to bring together the seven academic hubs and create a cohesive educational platform, identify areas of need in our primary care clinicians, lives. To start doing that face-to-face and sometimes virtual outreach and networking and creating relationships. This all provides us hope.
We also have a real robust clinical program at Northwell at Zucker Hillside Hospital. We lead numerous training programs so that we’re training our OB/GYN residents, our pediatric residents, our psychiatry residents in perinatal psychiatry, so we’re changing, right, they’re going to have this early on and not learn about it once they’ve been in practice for 10, 20, 30 years. So we’re changing the face of medical education.
Then we’re pushing the envelope in our research program for postpartum depression. So we have a federally funded research program at Northwell. We’re developing the novel therapeutics. We’re trying to understand why perinatal patients are at risk for developing mental illness. So with all of these different facets, all of that just gets me so excited every morning when I head to work.
Host: 19:02
That’s awesome. Dr. Kaye, what gives you hope? What gives you optimism going forward?
Dr. Kaye: 19:07 It’s just a total joy to be able to collaborate with experts around the state to work together on something bigger than ourselves that is of service to so many kids and families and women. I would say that’s what gives me hope and pleasure.
Host: 19:35
Awesome. Dr. Fornari, same question. What gives you hope? What gives you optimism going forward?
Dr. Fornari: 19:39
Well, I think being able to talk about mental health problems as we would any health problem gives me hope because we know that shame and stigma often interfere with people’s access to care, and without access to care, really the risks for these young people are tremendous. So I think the open conversation without shame, without stigma really is the most hopeful thing.
Host: 20:08
That’s great. Well, I want to thank all three of you for joining us here on 20-Minute Health Talk, and for you the listener, thank you so much for tuning in. I’m Rob Hoell. Have a great day and stay safe.
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