Montefiore Medical Center Leading The Nation On How Children’s Mental Health Is Approached

From the Wall Street Journal:  Yahaira Ramos, 6, and her parents, Priscilla Ramos, right, and Jonathan Sirera Jr. with pediatric psychologist Dana Crawford at Montefiore Medical Center in the Bronx, N.Y. Yahaira, after coming in for a pediatric appointment, was seen by Dr. Crawford and later a psychiatrist for ADHD-related behavior. BRIAN HARKIN FOR THE WALL STREET JOURNAL
From the Wall Street Journal: Yahaira Ramos, 6, and her parents, Priscilla Ramos, right, and Jonathan Sirera Jr. with pediatric psychologist Dana Crawford at Montefiore Medical Center in the Bronx, N.Y. Yahaira, after coming in for a pediatric appointment, was seen by Dr. Crawford and later a psychiatrist for ADHD-related behavior. BRIAN HARKIN FOR THE WALL STREET JOURNAL

The Wall Street Journal reports that Montefiore Medical Center in The Bronx is at the forefront on how access to mental health care for children is approached and will be the largest program of its kind in the country.

In The Bronx, as well as the rest of the nation, there still persists stigmas associated with mental health issues.

Susan Blumenthal, MD, former US Surgeon General as well as Public Health Editor at The Huffington Post wrote the following with Deepa Kannappan (who at the time was an undergraduate at Stanford University):

Despite the prevalence of mental illness, the stigma is so profound that many consider mental health problems to be the result of personal character flaws rather than real illnesses, like heart disease or diabetes. Addressing mental illness as a serious 21st-century public health challenge means:

  • Focusing on specific age, racial/ethnic and gender-related risk factors

  • Improving public education and reducing stigma so that more people are willing and able to seek help

  • Strengthening the role of primary care doctors in screening for mental illness and referring patients to mental health professionals

  • Creating a comprehensive therapeutic approach that combines culturally competent, psychotherapeutic approaches with medication, if indicated.

  • Providing parity for health insurance coverage for mental illness

Coupled with the fact that a study in 2012, by Citizens’ Committee for Children of New York, Inc. on behalf of NYC Citywide Children’s Committee and NYC Early Childhood Strategic Mental Health Workgroup, showed that there is a serious gap in The Bronx in terms of prevalence of mental health issues and access to mental health care in our borough for children from ages 0 – 17 years of agethese grim statistics leave a sense of helplessness for our residents.

The study revealed that out of 281,629 children between the ages of 5-17, an estimated 56,326 had any mental health disorder and half of that group, 28,163 were estimated to have serious emotional disturbances.

In conversations with Jonathan Giftos, MD, a primary care physician at Montefiore’s Comprehensive Health Care Clinic (CHCC) on 161st and Park Avenue in Melrose said of the integrated care model, “At the end of the day, expanding access to and quality of mental health services is pivotal to improving health outcomes in all communities. This is especially true in the Bronx, where there is a shortage of mental health providers — especially Spanish-speaking ones — in many neighborhoods.”

Dr. Giftos added that, “In my experience, the integrated care model reduces logistical barriers, allows for a warm hand-off in clinic between the doctor and mental health provider, and facilitates teamwork necessary to holistically address the patients’ physical and mental health concerns.”

The Wall Street Journal reports further on the issue and Montefiore:

It is little wonder that only about 1 in 5 children with diagnosable mental-health problems gets treatment.

Now, more pediatricians are embedding mental-health professionals into their practices, where they can help spot problems early, provide care fast or reassure parents that a child’s behavior is normal.

Integrated care, as it is called, has other advantages: Pediatricians often see patients annually for a decade or more and follow families closely. If issues arise, instead of giving parents a referral, they can do a “warm handoff,” personally introducing them to a therapist down the hall. In some practices, mental-health professionals evaluate patients and devise treatment plans that pediatricians or nurses carry out.

Currently, it often takes eight to 10 years from when symptoms are first noticed before children get care for mental-health issues, says Gregory Fritz, president-elect of the American Academy of Child and Adolescent Psychiatrists, which endorses integrated care. By combining forces with primary-care doctors, “the potential to intervene early and make a lifelong difference is huge,” he says.

Watch Wall Street Journal’s Video on the topic:

There is growing recognition that many mental-health problems start in childhood; half of all adult cases had symptoms before age 14, according to government surveys. Although data is limited, many experts believe giving children and families the skills to address issues such as anxiety, depression and obsessive-compulsive disorder early on can foster resilience and head off more severe problems later.

“Everything starts somewhere. That full-blown anxiety disorder where the child can’t go to school started three years earlier with him chewing on his shirt,” says Rahil Briggs, director of Pediatric Behavioral Health at Montefiore Medical Center in Bronx, N.Y.

Dr. Briggs oversees what will be the largest integrated-care program in the country. Montefiore is making mental-health services available in all 19 of its pediatric clinics, which serve more than 90,000 children.

Screenings for mental-health and developmental problems, in the form of questionnaires for parents, are part of every well-child visit at Montefiore. From birth to age 4, questions focus on social and emotional issues, signs of autism and communication and motor skills. “That’s where we work really intensely. Toxic stress at that age can actually change the architecture of the developing brain,” says Dr. Briggs.

Parents of newborns are asked about their own childhood experiences, which studies show can impact parenting skills. They are offered counseling as needed.

School-age children are screened for attention difficulties, internalized issues such as anxiety and depression, and externalized problems that affect behavior and conduct. Parents complete the surveys until children reach age 12; adolescents and teens complete their own.

Roughly 20% of Montefiore’s young patients screen positive for some issue, which the pediatrician explores further. “Not all those kids need treatment. Some might just need to take a deep breath before a quiz,” Dr. Briggs says.

If the situation warrants further investigation, the doctor may suggest the family speak with a social worker, psychologist or psychiatrist experienced with the issue. After an assessment, the behavioral-health team may decide a patient with severe problems needs specialized treatment elsewhere. But most care can be provided at the pediatric clinic.

Dr. Briggs’ team has developed short-term treatment protocols for addressing anxiety, depression, attention difficulties, conduct disorders and mild trauma in four to six sessions each. “That’s very different from how most mental-health professionals are trained,” she says. “But if we are providing long-term care, we won’t get to even a fraction of those that need help.”

Yahaira Ramos, 6 years old, showed clear signs of attention-deficit/hyperactive disorder, or ADHD, at a well-child visit at Montefiore last fall. She has since met with psychologist Dana Crawford four times, learning some rules for behavior and skills to handle frustrations, and she has started on medication prescribed by psychiatrist Jason Herrick.

Her parents say the difference in Yahaira is striking. “Her teacher said she’s moved up three reading levels since September,” said her mother, Priscilla Ramos, as her daughter quietly made clay sculptures during a visit to Montefiore last week.

Dr. Crawford says she will probably do two more sessions with Yahaira. “I don’t believe therapy has to take 25 years,” she says. Dr. Herrick will remain available to consult and says Yahaira’s pediatrician can help manage her medicines going forward.

Read the rest via Tot Therapy: Psychiatrists Join Up With Pediatricians – WSJ.

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Ed García Conde

Ed García Conde is a life-long Bronxite who spends his time documenting the people, places, and things that make the borough a special place in the hopes of dispelling the negative stereotypes associated with The Bronx. His writings are often cited by mainstream media and is often consulted for his expertise on the borough's rich history.