Training helps doctors spot troubled children – Arkansas Online

Pediatricians and other primary care doctors are taking a different route this weekend to learn about behavioral health problems in children — role-play.

Some 30 Arkansas Children’s Hospital doctors, who are also employees at the University of Arkansas for Medical Sciences, watched Friday as their teachers took turns being children and parents.

The role-play is part of a hands-on continuing medical education program created in 2005 by Dr. Peter Jensen, who now works as the chief psychiatrist at Children’s Hospital and as interim director of UAMS’ Department of Psychiatry’s Division of Child and Adolescent Psychiatry.

The program is part of a suite of tools from a New York nonprofit, the Resources for Advancing Children’s Health Institute, or REACH.

The goal: help those who see children first — nurse practitioners, primary care physicians and family practitioners — but who don’t have sufficient background and training beef up their knowledge of behavioral health problems in children.

“It allows the pediatricians and primary care physicians to know both how to recognize children with challenges, such as autism, and then how to, in conjunction with a treatment plan, treat these children,” said Dr. Jay Deshpande, the chief medical officer at Children’s.

“Behavioral health, in particular, is even more specialized and really a challenge for a lot of families. And if they can get help from their local physicians who are more aware and now, with these tools and programs, are better equipped to help the child,” he said.

The training, which started Friday at Children’s Hospital, is the program’s first implementation in the state and has been a part of Children’s Hospital’s strategic plan, he said.

The long-range goal is to create a network of care for the some 700,000 children in the state.

Putting more knowledge into the first line of defense for children is important, in part, because there are so few child psychiatrists in Arkansas and nationwide, Jensen said.

“If you took all the child psychiatrists here in the state and you assigned us all the kids that need mental health support, we would have a half hour for each child a year,” Jensen said. “And so it just can’t be done.”

Dr. Molly Gathright, who runs UAMS’ child psychiatric intake unit, said there were 31 pediatric psychiatrists practicing in the state when last tallied a few years ago.

Meanwhile, Jensen said primary care doctors, who haven’t had deep training in child mental health, are seeing fewer severe infectious disease cases because of immunizations.

Deshpande said the physicians are still doing routine checks, such as physical exams, but they’re also seeing more child behavioral health and developmental cases.

“There’s a long answer and a long debate about whether the actual frequency is going up,” he said, adding that recognition of behavioral health problems has increased.

“If they are recognized as having behavioral issues earlier, then all the problems they have can be avoided. They’ll do better in school and have better interactions with the family. This is a way of saying that we are really sharing the expertise and providing the tools to help.”

The prevalence of behavioral health or mental health problems depend on age and gender. Younger children typically come in with more attention deficit hyperactivity disorder, or ADHD, while teenagers usually are seen for anxiety or depression problems, the doctors said.

Some 15 percent of Arkansas children have a significant behavioral health concern, Jensen said.

“The sad part is one in three actually get help,” he said. “And when they do have something happen, it’s more likely to be getting kicked out of school or juvenile justice.

“Many times, children make suicide attempts or they drop out of school. So we have a lot of casualties. And we know that most adult mental health problems begin when they’re kids and they’re not intervened with. So it’s very, very critical.”

Some family practitioners and pediatricians are hesitant to diagnose a child in an area they aren’t too familiar with, said Gathright, who is attending the training.

“You can always learn something new,” she said.

She was most excited about “the idea of really beginning to equip pediatricians and primary care folks with tools and making them feel comfortable and confident that they can be a part of a child’s mental health assessment.”

Friday was the start of a three-day intensive training, which brought in faculty from other states. The training costs about $2,000 per person, said Leslie Taylor, UAMS spokesman.

Right off the bat, the teachers call up two doctors from the audience and give one a hard case — a mental health case — and the other an easy case, such as a child with asthma, said Jensen, who established the program in 2005. Other faculty, over loudspeakers, say aloud what each of the doctors are thinking.

“And we start right off with a real play, and so we have one of the faculty play the role of the dad, and one of them play the role of a child, coming into a pediatrician,” he said. “And then we stop the role-play — not very long — and say, ‘What did you see? How would you find out more about this? Why would that be hard for you?’ We’re getting right into their heads.”

The faculty like to start the first day with something less familiar to the pediatricians, such as anxiety disorders. Most of the three days calls for discussions about assessing and diagnosing a child, as well as managing and treating the disorder.

The next two days are similar with role-play scenarios, a way to learn how to talk to parents and learning how to read nonverbal behavior. During that period, the doctors are also equipped with checklists and rating scales to facilitate the assessment and diagnosis, Jensen said.

After this weekend, the doctors will participate in 12 conference calls over the next six months. The calls allow the doctors to present one or two real cases.

And after that, Jensen will select some child psychiatrists and pediatricians and train them to become the new teachers.

“Hopefully within a year, we’ll start additional trainings,” he said. “Part of the challenge is, you know, we need funding support for these subsequent training because we want to train doctors all across the state, not just at Children’s. That’s something that will have to be worked out.”

Metro on 01/09/2016