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Minding the Mental Health Gap in Minnesota

Tuesday, March 3, 2020 - 10:30

At any given time in the United States, about one in seven children has a mood or anxiety disorder — or both — that could be improved with medical intervention and treatment.1 Yet, with only 8,300 practicing child psychiatrists in the country, it can take months for these children to get an appointment with a mental health professional.2 And many pediatricians, who are often the first to see young patients, do not feel adequately trained to identify or treat these conditions.3

Dr. Emily Borman-Shoap (right) shares her expertise with Chief Resident Dr. Vishal Naik (left) and third-year resident Dr. Sandy Liu (center). Photo by Aaron Lavinsky.The pediatric residency program at the University of Minnesota wants to change that. The residents are participating in a nationwide program, funded by the U.S. Department of Health and Human Services’ Maternal and Child Health Bureau, that strives to fill the gaps in mental health training for primary care providers. Through “collaborative office rounds,” the trainees learn ways to better address routine psychosocial issues for children and their families.

“Collaborative office rounds is a concept that’s been in place for about 10 years, and the intent [of ours] is to create opportunities for residents and pediatricians in practice to come together with mental health professionals to discuss some of the cases they’re seeing and get ideas for how to best help their patients,” says Emily Borman-Shoap, MD, Assistant Professor, Director of the Pediatric Residency Program, and Vice Chair for Education in the Department of Pediatrics at the University of Minnesota School of Medicine.

Pediatric residents, local pediatricians, and mental health professionals participate in these monthly collaborative office rounds to understand the impact of mental health issues on their patients and to learn how to spot mental health problems. If they cannot attend in person, they can join virtually. The main goals of the program are to:

  • Participants at collaborative office rounds at the University of Minnesota discuss a pediatric case. From left to right: Danielle Vrieze, child psychologist and Assistant Professor of Psychiatry; Dr. Emily Borman-Shoap; Dawson Hill, psychiatry research fellow; and Dr. Andrew Barnes, Assistant Professor of Pediatrics and Developmental Behavioral Pediatrics Fellowship Program Director. Photo by Aaron Lavinsky.Enhance understanding of psychosocial concerns related to child development;
  • Increase provider availability to help children and families address these issues;
  • Expand the provider ability to distinguish between transient disturbances and more serious referrals;
  • Promote collaboration among primary care providers with mental health professionals; and
  • Facilitate a comprehensive approach to health supervision.

During collaborative office rounds, a presenter summarizes a case for about 15 minutes. After the case is presented, participants can ask clarifying questions before dividing into facilitated small groups of four to six people to discuss the case and to address the questions brought forth by the presenter. After 15 to 20 minutes of small group discussion, the entire group reconvenes for a larger discussion of the case for the remainder of the time. At least one representative from each small group summarizes the points discussed and offers any recommendations or resources for the presenter to consider for ongoing care of the patient.

“Discussing cases with providers provides rich opportunities for shared learning for the residents because we know they need to be ready to do some of the initial steps in helping a young person who is experiencing mental health concerns,” Dr. Borman-Shoap says. “We’d like to get to a point where all pediatricians who graduate from our program and other programs can recognize and diagnose common behavioral health and mental health concerns and initiate the first next steps, whether that be recommending therapy or starting a medication.”

She says the benefit of the conferences is that they help demystify mental health for residents.

“A patient with a behavioral or mental health complaint is like any other patient. You just talk about their presenting symptoms. You take a thorough history. You make a plan, and then you follow up and see how things are going,” Dr. Borman-Shoap says. “We’re trying to get them thinking about behavioral and mental health concerns through that same rhythm that they would think about any other medical problem.”


1Whitney DG, Peterson MD. US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatr. 2019;173(4):389–391. doi: 10.1001/jamapediatrics.2018.5399.
 
2Workforce Issues. American Academy of Child & Adolescent Psychiatry website. https://www.aacap.org/AACAP/Resources_for_Primary_Care/Workforce_Issues.aspx. Accessed December 3, 2019.
 
3Horwitz SM, Storfer-Isser A, Kerker BD, Szilagyi M, Garner A, O’Connor, KG, Hoagwood KE, Stein RE. Barriers to the identification and management of psychosocial problems: changes from 2004 to 2013. Academic Pediatrics. 2015;15:613–620. doi: 10.1016/j.acap.2015.08.006.
 

Top photo: Dr. Emily Borman-Shoap (right) shares her expertise with Chief Resident Dr. Vishal Naik (left) and third-year resident Dr. Sandy Liu (center). Photo by Aaron Lavinsky.
 
Bottom photo:Participants at collaborative office rounds at the University of Minnesota discuss a pediatric case. From left to right: Danielle Vrieze, child psychologist and Assistant Professor of Psychiatry; Dr. Emily Borman-Shoap; Dawson Hill, psychiatry research fellow; and Dr. Andrew Barnes, Assistant Professor of Pediatrics and Developmental Behavioral Pediatrics Fellowship Program Director. Photo by Aaron Lavinsky.