Childhood Depression Is on the Rise, Pediatricians Develop Strategies

Between 2010 and 2015, the number of teens exhibiting symptoms of depression surged 31 percent, teen suicide attempts increased 23 percent, and suicide among 13 to 18 year-olds jumped 31 percent. The rise in depression and suicide among teens isn’t just making national headlines, it’s also finding its way into pop culture. Netflix’s hit show “13 Reasons Why” – exploring a young girl’s challenges with depression – reinvigorated a national conversation around mental health of adolescents in the United States.
In an effort to explore how independent pediatricians are tackling this issue among their patient panels, I sat down several pediatricians in Privia Medical Group to learn more.
Through this research I found that PMG providers are responding to the rise in teen depression by making optimal use of the group’s proprietary Electronic Health Record (EHR) and creating their own innovative solutions, such as in-house mental health services for their patients.

What are some ways providers are properly identifying mental health needs and appropriately targeting the correct population?

Steven Brown, MD – Primary Pediatrics (Laurel, MD)
“Previously, the exchange of information from hospitals and specialists was inadequate, especially when it came to mental health issues. Many times, I have been surprised at a well-child visit or consult visit to learn that my patient had been admitted to a psychiatric unit without me being informed. Privia’s use of their proprietary EHR is making it much easier to receive timely information by making admission, discharge, and transfer (ADT) feeds readily available and easy to access.”
Elizabeth Flynn, MD – Manassas Pediatrics in Virginia (Manassas, VA)
“The availability of the PHQ-2/9 in our customized EHR has been the biggest asset to us. Before Privia, we had to print the questionnaires and hand them to the patient and then enter the information manually, but that was was cumbersome and hard to remember to do. Now, I have the Quality Management tab, which acts as a reminder to have the patient complete the questionnaires. Discussions about depression are easier to document.”

How are providers ensuring that children with mental health needs are being seen in a timely manner? What resources can be provided at the community level to address the increase in mental health needs?

Valorie Anlage, MD – Primary Pediatrics (Laurel, MD)
“It’s a huge problem when a teenager gets hospitalized for suicidal gestures, yet upon discharge, cannot get an appointment with a psychiatrist due to lack of availability or lack of appropriate coverage from their insurance,” said Dr. Valorie Anlage.
She emphasized that providers and patients need access to the appropriate resources to help coordinate care.
Steven Brown, MD – Primary Pediatrics (Laurel, MD)
“We saw some advances in resource allocation after joining Privia. Our participation in Blue Cross Blue Shield’s Patient-Centered Medical Home (PCMH) program has given us access to patient care coordinators who help find necessary and appropriate care while expediting the process of booking appointment. Continued coordination of care is part of the program.”
Some providers are also developing their own innovative solutions by offering in-house mental health services for their patients. For instance, Primary Pediatrics recently hired a mental health counselor who provides convenient access for patients and facilitates communication of diagnosis and treatment plans between the practitioner and the counselor. There are various models of providing this service, including having the counselor as a separate provider that the practice bills for their services. “In our case, the counselor is a separate entity who provides their own billing and scheduling, but performs services under our roof,” Dr. Brown explained. “It’s a win-win solution for everyone.”
For providers located in the Washington, D.C. region, the University of Maryland’s BHIPP (Behavioral Health Integration in Pediatric Primary Care) is an option that allows providers to call anytime with the patient’s information and request a counselor. Within hours, BHIPP will provide a list of places where the patient can access immediate counseling. BHIPP uses the patient’s insurance to see what is covered and will search for referrals that have availability. The BHIPP program even allows provider-to-provider coordination. Having access to a psychiatrist via a quick phone call allows for optimal coordination, where the PCP can manage the patient’s medications while the patient sees the therapist at an appropriate frequency.

How can physicians learn from each other?

Pediatricians within Privia Medical Group meet quarterly for their Pediatric Collaborative to discuss trends in their quality metrics within value-based contracts, opportunities for business development specific to pediatricians, and how to further develop their referrals to cost-efficient and quality physicians within the PMG network.
Steven Brown, MD – Primary Pediatrics (Laurel, MD)
“Pediatric Collaborative meetings have been instrumental in driving improvement in the mental health arena. Currently, we are tackling ADHD on our agenda and are spearheading further discussions about other mental health issues in order to improve care in this growing area of concern.”
Source: Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time