KU School of Medicine–Wichita
1010 N. Kansas
Wichita, KS, 67214
June 20, 2019
Nicole Klaus, Ph.D., licensed psychologist and associate professor in the Department of Psychiatry & Behavioral Sciences at KU School of Medicine-Wichita, talks to a patient.
By Joe Stumpe
Brian Pate, M.D., was working as a pediatric hospitalist one day last fall when he realized the hospital census included seven children who'd attempted suicide. That was an unusually high number, but still indicative of a disturbing trend.
"We've had an increasing incidence of child and adolescent mental health disorders for a long time without the resources to treat that," said Pate, who chairs the Department of Pediatrics at the University of Kansas School of Medicine-Wichita.
Now, it's hoped that a new grant will better equip primary care physicians and other clinicians to diagnose and treat mental illnesses in Kansas children.
The $1.8 million grant, awarded by the U.S. Department of Health and Human Services, will be used in collaboration by the KU School of Medicine-Wichita departments of pediatrics and psychiatry & behavioral sciences, Kansas Department of Health and Environment, Kansas Department for Aging and Disability Services, and KU Center for Public Partnerships & Research. Kansas is one of three states to receive a Pediatric Mental Health Care Access Grant, which is designed to help those 21 years and under.
"We're hoping this will really address the needs of kids who are suffering," said Rachel Brown, MBBS, professor and chair of the Department of Psychiatry & Behavioral Sciences at KU School of Medicine-Wichita.
For KU, the grant has several components. One is to provide training and mentoring to primary care clinicians in the diagnosis and care of children with mental health problems. This fall in Hays, KU Wichita Pediatrics and KDHE will host a two-and-a-half-day training session for physicians, featuring national experts on psychopharmacology and other topics. That's similar to one for 40 physicians last fall. From those initial groups, the school plans to build a "virtual clinic" on the ECHO (Extension for Community Healthcare Outcomes) model. Twice a month, participants will use the network to present cases to their colleagues and subject experts, getting help and feedback and helping others learn in the process. The network and 90-minute sessions will be open to all primary care providers.
"On a micro level, one doctor gets a very specific patient discussed," Pate said. "On a macro level, we're using the conversation so that everybody benefits from it."
Kari Harris, M.D., associate professor with KU Wichita Pediatrics, who will be medical director for the ECHO, added that the network will provide support of a nonclinical nature, too, since "it can be emotionally taxing for primary care doctors to take care of these patients."
Brown said she has been active in an ECHO network based out of the University of Missouri for physicians treating autism for the past four and a half years and has found it helpful.
"I think it's a great way of spreading knowledge and having knowledge travel to where the patients are located," she said.
A second part of the grant is the establishment of a phone/email line (called the "Warm Line") clinicians can call to consult with mental health experts. The line will be answered by a nurse coordinator who will triage calls, connecting those who need to speak directly to Brown, Nicole Klaus, Ph.D., ABPP, who's a child psychologist, or another clinician.
A third part of the grant, probably to launch in two to three years, will provide patients with more complicated problems appointments with specialists, using telemedicine.
Asked how many physicians and other providers the grant might impact, Brown said, "I'm thinking in the hundreds, over time. We've got four years. We can't reach them all at once, but I'm hoping we'll be able to connect with a lot of people."
The grant is needed because training in child and adolescent mental illness that physicians receive during medical school and residency is "relatively limited," Brown said. "A lot of the time when you get out and into practice, you start seeing more of the stuff than you're prepared for. And a lot of the time it's helping people build confidence in skills they already have."
Harris said the prescribing of medication in children with mental illness is something that some primary care physicians struggle with.
"It is not that physicians can't do it, it's just that they don't have the experience, knowledge and comfort to prescribe medications," Harris said. "The younger the child, the less comfortable the provider is to prescribe it."
"By working collaboratively with child and adolescent psychiatrists and pediatric psychologists, hopefully we can build that skill set."
Pate noted that the field has seen "great advances" in diagnosis, treatment and medication since many of the state's physicians left school.
"The discipline has just advanced so quickly that all of a sudden, physicians can find their medical knowledge in this area out of date," he said.
KDHE ‘s role in the project is to look at the incidence of child and adolescent mental health illness in Kansas, its distribution and efforts to treat it around the state.
"And they'll do outreach through professional organizations across Kansas," said Brown, "like the Kansas Association of Family Physicians, so that people out there who may benefit from what we're doing will know about it."
According to one estimate, nearly 8% of adolescents have tried to end their lives during the previous year, while many more suffer from depression, anxiety and other mental illnesses.
Pate isn't sure what's causing the uptick in mental illness among minors, but has some theories about possible culprits, including increased pressure to succeed and feelings of isolation caused, ironically enough, by the social network and digital worlds.
Pate called the grant a "great example of collaboration and partnership in the state" and credited Brown, Harris and Klaus for their work in landing the grant. "We can't afford to not work together when we look at how diminished resources are. It makes what we're doing more financially efficient."
Brown, in the meantime, predicts the effort will grow and help more youths beyond the lifespan of the grant.
"I'm really excited about it," she said. "It's the kind of thing that you start and it really does blossom. There's so much need out there, and so many kids that are impacted by these kinds of issues."KU School of Medicine-Wichita