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SUNY Upstate receives $200,000 state grant to fund child psychiatric outreach efforts

SYRACUSE, N.Y. —SUNY Upstate Medical University's Department of Psychiatry and Behavioral Sciences has received a $200,000 grant from the state Office of Mental Health to develop a new initiative designed to increase access to and enhance the level of psychiatric care for children and adolescents in the community in hopes of preventing hospital admissions or emergency room visits.

The Child Psychiatry Consultation Program will provide support and assistance to primary care physicians, pediatricians and school psychologists in identifying and treating children and adolescents with psychiatric problems. The plan also provides for community conferences and seminars to help families broaden their understanding of psychiatric issues in children and assist them in finding the proper care for their children.

Nationally, there are only 6,300 practicing child psychiatrists. Locally, there is only a handful and none is taking new patients. "Our community is feeling the impact of a nationwide shortage of child psychiatrists," said Wanda Fremont, M.D., SUNY Upstate assistant professor of psychiatry and behavioral sciences, who serves as medical director for the program. "Child psychiatrists are no longer able to meet the growing need in the community: Too many children need care and too few specialists are available to treat them."

Without such specialists, Fremont said, much of the psychiatric care and treatment for children and adolescents becomes the responsibility of the primary care physicians and pediatricians.

"Not all of these physicians are comfortable diagnosing and treating these patients; it's not their specialty area of care," Fremont said. "They are concerned about having the right medical training as well as having adequate time to do a thorough psychiatric evaluation and provide adequate ongoing care. For example, many physicians have said that they feel under increased pressure from patients, schools and society in general to provide quick-fix remedies that usually results in writing a prescription as opposed to non-medication therapy."

The program will address many of these concerns. Under the physician component of the program, SUNY Upstate child psychiatrists will participate in 20-minute phone consultations with primary care physicians and pediatricians at different times and days each week. Prior to the consultation, community physicians will send a patient report (no patient identities will be disclosed) to the SUNY Upstate child psychiatrist. "These will not be curbside consultations," Fremont said, "but rather in-depth confidential discussions about patient history and treatment possibilities."

In addition, SUNY Upstate child psychiatrists will hold monthly one-hour educational conferences for primary care physicians and pediatricians that will feature confidential case management discussions in a group setting. Also, SUNY Upstate child psychiatrist will offer monthly two-hour seminars to community physicians covering a range topics specific to child psychiatry, such as psychopathology, assessment and treatment. Specialty consultations will be offered to staff at St. Joseph's Hospital Health Center's Comprehensive Psychiatric Emergency Program and the Youth Emergency Services mobile team.

This outreach is aimed at refining the level of care being offered. "It is our hope that this informative and consultative strategy will assist primary care physicians and pediatricians in better understanding treatment strategies that can prevent emergency room visits or hospital admissions," Fremont said.

School psychologists and others in the Syracuse City School District also will be recipients of SUNY Upstate faculty expertise and support. A SUNY Upstate child psychiatrist will meet with school psychologists, social workers, nurses, guidance counselors and other student support personnel for a confidential case review twice monthly. Cases involving children from preschool to high school will be considered. Under a program, piloted in Frazer Elementary School, a SUNY Upstate child psychiatrist will provide two hours a month of direct consultation with school staff. At no time during these discussions with school district personnel will the child psychiatrist provide direct patient care.

Fremont said this aspect of the consultation outreach program is noteworthy as oftentimes it is the school personnel who are the first to suggest that a child seek a medical evaluation for psychiatric or behavioral issues.

The family outreach component of the program will feature one two-hour presentation each quarter. Held at the SUNY Upstate Department of Psychiatry and Behavioral Sciences offices, parents will have the opportunity to question a child psychiatrist about diagnosis and treatment issues and concerns, as well as any emotional or psychiatric problems their children are experiencing.

A research portion of the program will measure the program's effectiveness.

SUNY Upstate faculty participating in Child Psychiatry Consultation Program are Fremont, Cindy Carter, M.D., Arun Kunwar, M.D., and Jud Staller, M.D. George Blakeslee serves as program coordinator.

The Child Psychiatry Community Consultation was developed in support with the Onondaga County Child Psychiatry Access Steering Committee, comprising representatives from the New York state, Onondaga County, St. Joseph's Hospital Health Center's Comprehensive Psychiatric Emergency Program and community pediatricians.