Nationally more than four million children and teens have a diagnosed behavior problem. Another four million suffer with anxiety, according to the Centers for Disease Control & Prevention.
And their number is increasing. In a 2019 Beyond ABC study, Children's Health reported a growth of 143 percent between 2013 and 2018.
Yet, there is a shortage of providers to help with their needs. In 2015, the CDC reported that only 2.7 psychiatrists and 4.9 psychologists per 10,000 children, aged 0-17 years, were available to help in Collin County.
The COVID-19 pandemic has only exacerbated the problem.
“My days these days are spent doing well checks, checking to see if someone has COVID, or checking for recovery from COVID,” says Dr. Seth Kaplan, the president of the Texas Pediatric Society, a chapter of the American Academy of Pediatrics, an organization of 67,000 pediatricians from around the country.
“The usual illnesses are not spreading the same way because of the masks. But visits that used to be about physical health have been replaced with mental health concerns,” Kaplan says.
Shortage of Help
For many, the primary-care physician is the first point of contact in mental health assessments, diagnosis, and interventions.
A new program called Child Psychiatric Access Network, CPAN, offers physicians access to mental health resources in real time. When families turn to their primary care provider for help, the provider can then turn to CPAN for guidance and answers.
“There is a shortage of child and adolescent psychiatrists to provide the care these children desperately need,” says Dr. Mili Khanderia, the CPAN medical director. “[It] underscores the need to empower pediatricians and primary care providers with guidance about treatment options to address those needs.”
The CPAN program, launched in May 2020, is funded by the Texas state legislature to help pediatric patients with mental health challenges. The support is at no cost to the family or provider. The program allows providers to give evidence-based care for mental health concerns with support in real time, allowing families to avoid waitlists that then can span weeks or months.
Texas Sen. Jane Nelson, R-Flower Mound, chairwoman of the Senate Finance Committee, filed Senate Bill 10 in February 2019 to create a consortium to help coordinate state mental health initiatives. It also allowed youth to be screened for mental health issues through telemedicine and offered $100 million in new funding, leading to the creation of the CPAN program.
CPAN currently has 2690 providers in Texas, including experts from Children’s Health and UT Southwestern in Dallas.
“We have long needed resources for mental health, and CPAN is a valuable resource,” Dr. Kaplan says. “I am seeing increasingly complex issues. Now with assistance and training from CPAN, I am more comfortable helping my clients.”
Causes of Concern
Though some children thrive with remote learning, many more are struggling emotionally and mentally with it, Dr. Kaplan says. “This has been a really rough year for kids and families. Kids who had anxiety or depression prior to COVID are having a much harder time. I am also seeing an explosion of kids with eating disorders, and an increase in suicide attempts.”
Some root causes to the increase in mental and behavioral health issues include academic pressures, increased exposure to social media and online bullying, traumatic events such as a family member’s death, violence at home or neglect or abuse.
Dr. Khandheria added that quarantining during COVID has also been problematic.
“The social isolation our children and adolescents are experiencing is unprecedented and has led to worsening symptoms of depression and anxiety that we have seen across the board,” she says.
Dr. Kaplan says that doctors are now using telemedicine to meet with children, teens and their families, cutting out the need to go somewhere to get help. Instead, help is available from home.
“Through telemedicine we can learn a lot about a child and the situation,” Kaplan says. “We can see their rooms, their environment, and get a window into home life. We can see what’s going on and have more information as we work to help.”
Some of the signs that Kaplan says parents need to know include changes in the child's behavior, changes in sleep patterns -- too much or too little sleep -- or if the child is holed up in a room, ask what’s going on. The next step would be to call a pediatrician.
“If parents have concerns, reach out for help,” Kaplan says. “It’s best to start early when you first notice a problem. Don’t wait until it grows bigger, because it may be harder to address.”
CPAN Program Offers Real-time Help
Within 30 minutes of picking up the phone, a physician who is facing a child or teen with behavioral or mental health concerns can get help from a child psychiatrist or licensed counselor. During this call, experts will help advise on questions related to diagnosis, treatment and testing, medication and resource options for next steps and ongoing care.
Dr. Dawn Johnson, the medical director of Children's Health Pediatric Group, claims CPAN has helped her with better diagnoses, offering a safer and more effective medication management.
“I have learned to do more management on my own from teaching that naturally takes place during consults,” Dr. Johnson says. “The next time I am in that situation I know what to do or where to begin.”
In addition to phone consultations in real time, CPAN offers “Psych Advice” for the Pediatric Primary Care Provider on the second Wednesday of each month. This is a free lecture series on various behavioral health topics. Lectures are open to family medicine physicians, nurse practitioners, and physician’s assistants as well as to pediatric primary care providers and pediatricians.
“For me, CPAN has been a big help also in gathering vetted resources,” Dr. Kaplan says. “If I don’t know someone with a needed specialization, like cognitive behavioral therapy, CPAN can help me find a resource.”
CPAN also offers ongoing training opportunities for physicians. “I have used their training and gotten familiarity with evidence-based guidelines,” Dr. Johnson says. “I have confidence in my diagnosis and treatment plan, instruction on how to manage common co-morbidities and medication side effects.”
Dr. Johnson has encouraged more doctors to use CPAN.
“It will help us pediatricians to save lives and to prevent ED visits for mental health,” he says. “It will help to make sure kids are on the right medicine for the right diagnosis at the right dose.”