Partnering with Primary Care
By Cassandra Gibson, MD
Primary care providers are on the frontlines of the youth mental health crisis. Pediatricians are known for their holistic, comprehensive approach to the care of their patients. Treating the whole child involves diagnosis of physical concerns, but also recognition of the interplay between family structures, school environments, daily routines, and life stressors.
Stigma & Stressors
Battling stigma is a large part of pediatric work on mental health. Primary care providers see teens with concerning stressors including
distress related to gender questioning
problematic use of electronics
school refusal
substance use impacting mood
bullying, disordered eating
difficulty coping with trauma
They support their patients with suicidal thoughts, suicide attempts, self-harm, or risk-taking behavior who may have recently been discharged from hospitals or be awaiting various levels of care.
Without the capacity to provide the support and resources necessary to address these factors together, families and providers are often disappointed. Without enough mental health providers, overwhelm, frustration and uncertainty are common. Programs like Bradley REACH aim to support the child and family and empower primary care providers in treating complex patients.
Partial hospitalization programs (PHPs) can be useful in multiple circumstances and can be a helpful tool for pediatricians managing behavioral health concerns. Sometimes, a patient may benefit from a brief course of intensive, focused care to get things back on track and avoid crisis, hospitalization, or other comorbidities.
Pediatricians often have concerns in treating mental health conditions that the Bradley REACH virtual partial hospitalization program (PHP) can help to address.
Frequently, primary care pediatricians are the identified seven-day follow-up provider seeing teens within days of a suicide attempt or inpatient psychiatric admission. Similarly, teens not yet connected to care or awaiting care may come in for well-child visits that turn into psychiatric crisis interventions. Concerned providers often do not have the time built into their schedule to provide the psychosocial support, education, and case management that these patients need.
Bradley REACH’s Approach
Our intensive virtual therapy program provides access to evidence-based care for teens from the comfort of their homes. Therapy and medication management are coordinated through the care of a dedicated team of psychiatrists, psychologists, licensed social workers, and nurses. Starting with our initial evaluation, and throughout treatment and discharge planning, our Board-Certified Child and Adolescent Psychiatrists work collaboratively with pediatricians.
Over three-four weeks the treatment team works to provide diagnostic clarity, help stabilize mood, educate the patient and family and simplify treatment plans. Our collaboration includes a detailed treatment course, clinical observations, and case formulation both in writing and through warm handoff calls at discharge. We discuss our insights into family dynamics and ways that the team has engaged with the patient.
Support & Communication
Our psychiatrists share tools and strategies for individual risk assessment and provide recommendations for neuropsychiatric testing, sleep studies, or other medical and neuropsychiatric evaluations and interventions. The transition back to pediatric care is thoughtful and inclusive. We review explanations for clinical decision-making thoroughly with providers and families. Care plans, safety planning, nuanced recommendations, and future pharmacologic considerations are also described.
In partnership with pediatricians and other outpatient providers, Bradley REACH can provide the support and communication needed to empower teens to return to their medical home with improved stability, renewed motivation, and an understanding of their stressors, coping strategies and needs. Our hope is that this enables them to work with their PCPSs on their long-term mental well-being in the community.
DISCLAIMER:
The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment.
If you or your child are in crisis or experiencing mental health problems please seek the advice of a licensed clinician or call 988 or Kids Link in Rhode Island.
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