Emily Kemper, MD
Seattle Children’s Hospital
As part of Seattle Children’s Pediatric Residency Program’s track focusing on community health and advocacy, I recently had the opportunity to talk to dedicated primary care pediatricians across the state about their experiences treating mental and behavioral health. I heard from pediatricians across the state, rural and urban, large and small practices. No matter the setting, pediatricians all over Washington are seeing the same increasing needs and the same barriers to care. And it is their dedication and hard work that is making a difference for patients.
The pediatricians I talked to estimated that visits involving behavioral health make up anywhere between 10% and 70% of their day, whether scheduled or arising during well-child checks. Though most clinics do not have access to a psychiatrist or integrated behavioral health, those who do have integrated MSWs or counselors clearly felt they were better able to obtain counseling for their patients. When primary care providers try to refer to outside counseling, their patients face enormous barriers based on insurance coverage, availability of providers, and convoluted referral systems that are hard for families to navigate.
How are pediatricians trying to overcome these barriers? The pediatricians I talked to have worked hard to increase their comfort level with psychiatric medications. Most are now regularly prescribing all classes of ADHD medications and starting SSRIs for depression and anxiety. They gained this comfort level while practicing, often based on Partnership Access Line consults they called for patients in their panels. One provider said, “I take notes every time I call the PAL line, and I keep a running list of if-thens to be able to generalize to other patients.” Another joked, “My PAL handbook has another handbook written in the margins.”
At the same time, pediatricians are seeking more education. “I have different questions now than I did 5 years ago, and my questions are different than those of my colleagues who are just starting out,” one provider explained. The most popular formats for learning involved a social aspect: live webinars, in-person conferences, or ongoing relationships with a consistent psychiatrist were among the ideas requested.
As I worked on this project, I was blown away by the incredible dedication to patient care shown by primary care providers. Despite feelings of isolation, emotionally draining visits, and constant time pressure, the amazing pediatricians I talked to continue to commit extra time and energy towards improving mental health care for kids. Thank you to everyone I interviewed, and to all those working so tirelessly for kids’ mental health. The problem may seem overwhelming, but never doubt that you are making a difference.