One in five youths has a diagnosable mental disorder and one in 10 has a mental health challenge that impairs their ability to function, but only 30 percent of youngsters under age 17 receive services. In urban areas, where children are at greater risk for trauma, that number could be even higher.
Pediatricians are on the front line of early detection and management of behavioral, developmental and social functioning problems, but they often lack the experience and time to perform an assessment during office visits.
To help children get the proper diagnosis and care, Rutgers University Behavioral Health Care (UBHC) and New Jersey Medical School have partnered with Essex County pediatricians to give training on behavioral health screening and assessment and provide consultation, care coordination and direct service to youths and their families.
Funded by a grant of $555,555 from the New Jersey Department of Children and Families, the Collaborative Behavioral Health Care Project – Essex HUB is expected to serve about 60 pediatricians and 100 non-physician professional or administrative staff at 20 primary care practices throughout the county in screening, managing and improving access to care for approximately 120,000 youths.
“If we can increase pediatricians’ capacity to identify and treat their patients’ emotional and behavioral challenges, it would fill a need for many families who are not getting services,” says Evelyn Orozco, the program’s director. “In a perfect world, you would have a psychiatrist who works at every pediatric office. That’s not realistic, but this model comes close.”
Major mental illnesses are thought to begin in mid-adolescence, and youths who are from low-income households, who are involved in the child welfare and juvenile justice system or who are in military families are at higher risk. The most common issues are behavioral problems, anxiety and depression, says Orozco.
The Newark-based team includes behavioral health professionals, including a psychiatrist, licensed certified alcohol and drug counselor, licensed clinical social worker and case manager. The team provides monthly training to educate the county’s pediatricians and residents at New Jersey Medical School using evidence-based, culturally sensitive screenings to support early detection of behavioral health, substance and alcohol use and trauma.
During office hours, pediatricians can call a hotline at 973-972-7889 for consultations with UBHC staff; a psychiatrist will be available. If the pediatrician has telemedicine capabilities, staff also can consult face-to-face with the physician and the patient’s family in the exam room.
Once a pediatrician identifies the need for a psychiatric evaluation, UBHC will contact the family within 24 hours to schedule an evaluation; the results will be shared with the pediatrician. Youths with more severe problems are referred to UBHC for services like ongoing therapy, medication and referrals as needed.
Providing such services in an urban center like Essex County is critical. “Urban youth are at a higher risk for exposure to trauma, which can result in emotional and behavioral symptoms that can be easily misdiagnosed,” Orozco says. “Early treatment is essential in preventing disorders from becoming more chronic and debilitating.”
The program also serves as a model for addressing the shortage of child and adolescent psychiatrists nationwide. “The lack of psychiatrists in this specialty is staggering: It is projected that by 2020 their numbers will be 30 percent below the demand,” she says. “We cannot meet this tremendous need, so we have to shift how we are thinking and get creative.”