American Academy of Pediatrics – CA2 Peds@CA2 eNews – May 2023 Danielle Shaw, MD, FAAP, FAPA
April showers bring May flowers. For those who are struggling with a mental health issue or have a loved one with a mental health issue, April showers are the tears we shed over not having access to the services needed to bring the May flowers of recovery.
My story regarding lack of access to mental health services is both personal and professional. As a parent, I was unable to obtain adequate mental health services for my daughter, whom I adopted at birth. Despite being a pediatrician, I didn’t know how to help her. I later learned that she was exposed to methamphetamine, alcohol, and tobacco during pregnancy. The worst of these exposures is alcohol. It wasn’t until I attended a pediatric conference in Yosemite that I learned about Fetal Alcohol Spectrum Disorders (FASD) from Dr. Ira Chasnoff. As he presented how youth present with an FASD, I sat in the audience recognizing that he was describing my daughter. Majority of children with adverse effects of prenatal alcohol exposure do not have notable facial features or growth issues of Fetal Alcohol Syndrome (FAS). I have also come to realize the extent of the emotional trauma she experienced from my ex-husband and how that impacted her life. My daughter experienced three mental health hospitalizations during her freshman year of high school. She went from being thin with a normal body mass index, to becoming obese from the psychotropic medications she was prescribed during puberty. I couldn’t obtain an IEP for her. Intensive Outpatient Programs didn’t exist at the time for youth who didn’t also use substances. I can understand the struggles of parents and youth who suffer. I also met challenges helping patients and their families obtain access to mental health care in my pediatric practice.
My experiences with my daughter and my patients led me to train in child and adolescent psychiatry. There is a Post Pediatric Portal Program for pediatricians to train in child and adolescent psychiatry in 3 years, rather than the traditional 5-6 years. Training in general psychiatry for 3-4 years is required to enter a 2-year child and adolescent psychiatry fellowship program.
Despite the shortage of child and adolescent psychiatrists, there are things we can do to improve access to care. First, the American Academy of Pediatrics (AAP) is providing resources to improve pediatric education in mental health. For example, for our Maintenance of Certification (MOC), we were given articles to read on depression and anxiety. The AAP also has a clinical practice guideline for ADHD, and Vanderbilt rating scales freely available. The AAP also has an FASD toolkit as well as periodic webinars on FASD. Lastly, the AAP has an annual conference on Diagnosis and Treatment of Common Pediatric Mental Health Disorders.
In addition to resources from the AAP, the American Academy of Child and Adolescent Psychiatry (AACAP) has some wonderful resources for parents and pediatricians. I highly recommend the Parents’ Medications Guides, which provide information regarding treatments for anxiety, ADHD, autism, depression, impairing emotional outbursts, and sleep disorders. The AACAP has a Families and Youth Page which includes additional information.
I created a Pediatric Mental Health Collaborative in Ventura County where pediatricians can network with local mental health providers, share resources, and learn from each other. One of the biggest struggles has been access to psychotherapy. Not all mental health diagnoses require seeing a psychiatrist, and most require psychotherapy which also includes the parents. There are new laws in California that require access to non-physician mental health services within 10 business days and follow up appointments within 10 business days, if indicated by the provider. We need to hold health plans accountable to these laws. Health plans tell therapists that their panels are full or offer to pay less than it costs to provide the service, hence there is inadequate access. The California Department of Managed Health Care has the access information on their website with information on filing a grievance. Please share this resource with your patients! Encourage them to let their health plan know that they are aware of these new access laws when they call. They can also request a case manager. Sometimes it is a struggle for a family in crisis to do one more thing... and realize that they are doing the best they can and may be in survival mode.
I talk to pediatricians who feel that they aren’t doing anything to help their patients, especially when they don’t feel comfortable prescribing psychotropic medications. By listening to your patients and validating their experience, you are doing more than you realize. Healthy nurturing relationships are a buffer for stress and protective against toxic stress. Let us advocate for mental health access so that our patients with mental health struggles can blossom like the May flowers.
Danielle Shaw, MD, FAAP, FAPA is a native Californian who completed her education in California public schools. After graduating from medical school at UC Irvine in 1993, she then completed her training in pediatrics there in 1996. After moving to Ventura County, she worked for two medical groups prior to opening her solo pediatric practice in 2004. In 2013, Dr. Shaw closed her pediatric practice to train in general and child and adolescent psychiatry in Augusta, Georgia. In February 2018, Dr. Shaw joined Casa Pacifica Center for Children and Families as their Staff Psychiatrist. She also founded a local Pediatric Mental Health Collaborative to bring pediatricians together with local mental health professionals. Additionally, she is on the AAP CA Chapter 2 ACEs Committee.
Resources: AAP ADHD Clinical Practice Guideline - https://publications.aap.org/pediatrics/article/128/5/1007/31018/ADHD-Clinical-Practice-Guideline-for-th e-Diagnosis
AAP Fetal Alcohol Spectrum Disorder Overview - https://www.aap.org/en/patient-care/fetal-alcohol-spectrum-disorders/
The American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA) have developed Parents’ Medication Guides to help individuals make informed decisions about treating mental disorders in children and adolescents. - https://www.aacap.org/AACAP/Families_and_Youth/Family_Resources/Parents_Medication_Guides.asp x
AACAP Families and Youth Page - https://www.aacap.org/AACAP/Families_Youth/AACAP/Families_and_Youth/Home.aspx?hkey=fb0befff -aae9-4867-958b-d8b45f5ecb2f
The California Department of Managed Health Care - https://www.dmhc.ca.gov/healthcareincalifornia/yourhealthcarerights/timelyaccesstocare.aspx https://www.dmhc.ca.gov/Portals/0/Docs/DO/TAC_accessible.pdf