The Voice of Experience

From the telephone in his urban SUNY Upstate office, Jud Staller MD addresses a daunting rural challenge: the delivery of psychiatric services to children in rural New York State. In much the way he trains Upstate's psychiatric residents, Staller, a child and adolescent psychiatrist and assistant professor of psychiatry, supervises and tutors nurse practitioners in rural Greene County, three hours away. Due to distance, most of their weekly sessions take place via telephone.

National Dilemma

There are far too few child psychiatrists in rural New York – and in rural America. Psychiatric nurse practitioners can be licensed to provide services and prescribe medication, but they must be supervised by a child psychiatrist. In a groundbreaking arrangement between SUNY Upstate's Department of Psychiatry and Greene County, Staller has been providing this supervision for the past three years. In their weekly sessions, the nurse practitioners present a succinct patient history, then discuss the case with Staller, who makes recommendations for medication management, improved assessment, diagnosis, record keeping and collaboration with therapists and schools.

Multiple Challenges

According to Staller, the young patients under discussion—219, to date—represent a complex and challenging population, even for a child psychiatrist. "These are children who are often from dysfunctional families, with drug addicted or incarcerated parents," he reports. "Many have experienced violence, poverty, mental illness, repeated relocations, foster placement, failure in school and multiple medication trials. "And yet, through this weekly collaboration, many youngsters and teens have made progress," Staller reports. The success of the Greene County arrangement has led to discussions for similar supervision in Jefferson and other counties. Peter Konrad, director of community services in Greene County, says the Upstate collaboration has led to a "dramatic improvement" in child and family services. "It's also very cost effective," he adds. "I really believe this is the model rural counties need to follow."