by Dr. David Kaye, Project TEACH Region 1 Medical Director –
I eagerly opened up the box of chocolates from Sweet Jenny’s and much to my delight they were as good as their locally made ice cream. As is my wont I then opened up the card which was a thank you note from one of the pediatric practices in Western New York we have worked with a great deal over the years. We have worked with all the pediatricians in this group and many cases came flooding to mind. There was the very bright 11 yo boy who had been recognized as having high functioning Autism spectrum disorder and increasing anxiety. There were several calls over a period of 1-2 years while the pediatrician managed his SSRI which helped significantly. By age 15 he was having more severe difficulties adjusting to school and peers and was seen for a face to face evaluation. He was linked with a therapist, we talked through school supports for him (which the school put in place), and for a while the pediatrician continued to successfully manage the medications. But at 16 his behavior escalated to a point that the pediatrician no longer felt comfortable doing so. At that point I was able to expeditiously link him with a child psychiatrist. Over the course of 4-5 years prior to his referral he was managed in his pediatric medical home with a handful of phone calls and then a rapidly scheduled consultation. The family was very pleased, the boy was maintained in the community, and the pediatrician felt supported in helping a child that previously would have otherwise needed a child psychiatrist at age 11 or 12, when there would have been a lengthy wait of 3-6 months to be seen. To boot there was an insurance issue that further limited access to child psychiatrists. Then there was the much more straight-forward case of a 14 yo with OCD who had been treated with an SSRI and therapy but had not improved. In reviewing the case with the PT Child psychiatrist it became apparent that the dosing of the SSRI was modest. The PCP was advised that OCD typically requires higher doses of an SSRI and so the dose was increased. And voila the patient improved. Another situation that would have been difficult to access a child psychiatrist, there would have been a lengthy wait, and with a bit of educational support the PCP was easily able to manage this case successfully. Another win all the way around for patient, family, PCP, and our team. A third case from the practice was a 9 yo who had become depressed. The consultation with the child psychiatrist focused on sorting out when to consider medications in a child this age, what psychosocial treatments were evidence based, and how to actively monitor the child. In the end we decided to hold off on medications and the child improved with a combination of individual and family therapy along with some school modifications. Another win for the home team. So as we come into this time of reflecting on the year, we are grateful for the opportunity to work hand in hand with primary care providers to make a big difference in the lives of so many children and families across New York. Thanks to the NY State Office of Mental Health for their continued funding support for the program. And here’s to another reason that New York is a great state to live in and a healthy, happy, and gratifying 2019 to all.