As a longtime family physician, Dr. Michael Havekost has plenty of experience in managing behavioral health issues like anxiety and depression in his adult patients.
But children are different. They won’t necessarily talk about how they’re feeling. They show it through symptoms, like not wanting to come out of their room or go to school. “They’re not just little adults,” he said.
So Havekost, of Beatrice, Nebraska, is spending the weekend in Omaha, joining 44 other primary care providers for three days of intensive training intended to help them identify, treat and manage the mental health conditions in the children and teens in their care.
The session marks the launch of Children’s Hospital & Medical Center’s Outreach for Provider Education, or COPE, program. Organizers hope to train up to 200 primary care providers over the next three years. The program also will feature a dedicated consultation line that providers can call to seek advice in managing behavioral health care for kids, no matter whether they’ve been through the training.
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Dr. Jennifer McWilliams, Children’s division chief of pediatric psychiatry and the program’s medical director, said the shortage of behavioral health providers in Nebraska, like that across the country, has placed primary care providers “on the front lines” of caring for children and teens with mental health challenges, often without much support or backup.
While many primary care providers have had some training in behavioral health care, she said, such schooling typically has been limited or occurred years ago. A third of Nebraska counties have no behavioral health provider of any kind. Meanwhile, both the state and the nation have seen a sharp increase in the number of children and teens reporting mental health challenges.
“A lot of them feel very unprepared for this onslaught of kids with mental health concerns,” McWilliams said.
Havekost said Beatrice is among communities that do not have pediatric psychiatrists. With training, he said, primary care providers can handle most behavioral health cases. Having the consultation service will allow him to ask questions, get ideas and check his conclusions, just as he would with kidney and heart specialists.
“We want to treat them correctly and help them out,” he said, noting that he’s also a familiar face for his patients and their families who can recognize when something like grades aren’t quite right.
Other providers apparently agree. McWilliams said she worried initially that this weekend’s session might not fill, given that it launched with relatively short notice.
But all 45 slots filled within 48 hours. Attendees represent a mix of providers, including nurse practitioners and physician assistants, as well as pediatricians and family physicians. About half are from the Omaha-Lincoln area and the rest practice in rural areas.
“We’re really excited about that,” McWilliams said. COPE is planning another session in the fall and two to three more next year.
For the inaugural training, Children’s is partnering with the REACH Institute, a long-standing provider of behavioral health training for primary care providers. Providers will learn how to assess and manage conditions like depression, anxiety, bipolar disorder and ADHD in children and teens.
Havekost said participants will continue to meet by Zoom every two weeks for about five or six months so they can ask more questions and discuss cases.
Both the training and the call line are funded by $1.8 million from Nebraska’s federal American Rescue Plan Act funding. Additional money for staffing is provided by a grant from the Behavioral Health Education Center of Nebraska.
Children’s received separate ARPA funding to develop pediatric mental health urgent care in the state. The Nebraska Legislature last year designated a total of $40 million of its ARPA funds for behavioral health projects.
McWilliams said Children’s has had an informal consultation line for Children’s Physicians clinicians and some others for some time. Participants in the weekend training will be offered access afterward as a sort of soft opening.
At the end of the month, the COPE team will host the medical directors of Project TEACH, a training and consultation program for providers in New York. Programs like COPE have been implemented in 38 states. By that time, she said, COPE’s organizers hope to have hired a project manager for the program. Once the project manager is in place, they hope to formalize the phone line and a website.
Among the tools the trainers and primary care providers are exploring this weekend are screening tools used to quickly assess for anxiety and depression. The training will walk providers through the therapies and medications that are effective in such cases. If those don’t help, providers can call the consultation line to consider next steps.
“This has been my career passion, recognizing there is no physical way myself and my colleagues in child psychiatry ... can see all the kids who need to be seen,” McWilliams said. “I’m just so excited that we’re moving this forward and making this happen.”