In our “Physician Voices” podcast series, we welcome doctors to share their unique stories, expert perspectives, and helpful insights. In this candid Q&A with Caitlin Zaner, MD, a board-certified pediatrician, we discuss the pediatric mental health crisis, how childhood health affects lifelong outcomes, and why healthcare needs more pediatric leaders.
This excerpt of our conversation is edited for length and clarity. You can listen to the full episode below and find us on Apple Podcasts, Google Podcasts, or your preferred platform.
Q: The impact of childhood health — including mental health — on lifelong well-being calls to mind value-based care. A core tenet of that model is promoting preventive care to avoid more serious complications in the future. However, recent advancements in value-based care have mainly focused on older patients. What is the state of value-based care in pediatrics?
There are a few ways I want to answer that. The chronic illness burden is increasing for pediatric patients. Frankly, children are now surviving — thanks to technological and therapeutic advances — conditions that they used to die from. So managing those more complicated medical conditions is a big focus in value-based care right now.
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As primary care physicians, we are the frontline interface for these patients. We have wonderfully long relationships with our patients. That’s why we went into primary care. We’re able to zoom out and think about longer timelines for children who have multiple subspecialists as part of their plans. We are helping families communicate directly with those subspecialists. But on a more basic level, we think about their physical health, their illness experiences, and their development differently than a child who may not have such a complicated medical story.
We’re doing all of this work to try to keep these chronic conditions stable. To more effectively manage flares. To reduce the chances that children are hospitalized or need more invasive procedures (although, sometimes those things are part of their care plan). And we do all of this to improve their health outcomes while also thinking about their growth, development, mental health, the family’s mental health, illness burden, and the costs related to that for the family. Each of these conditions has a cost related to it, too, and that’s where it funnels back to value-based care.
Q: As a country, we’ve seen a steep uptick in pediatric mental health concerns, especially post-pandemic. How might healthcare evolve to not only address this issue but also improve healthcare delivery overall?
More work needs to be done around expanding access for mental health conditions from preschool onward. Particularly for patients who are maybe more complicated, such as very young preschoolers or kids with compounding medical issues. Kids who are autistic, neuroatypical, or going through a gender-identity journey. These patients are at a higher risk of anxiety or depression, yet the resources for them are fewer and farther between (and often not covered by insurance).
My hope is, over time, as a Privia initiative, there is thought given to expanding access to mental health to directly create referral networks that allow for all patients — particularly our adolescent patients — to access psychiatrists or psychologists for individual group or family therapies. That would expand the age range while giving patients greater, more direct access to intensive programs (such as outpatient, partial hospitalization, or in-patient programs) when needed.
Mental health connects all humans together; it connects the whole system together. We really need system-wide solutions for this. Childhood mental health strongly impacts our mental health in adulthood. If I can do a better job helping a family manage their child’s mental health as a preschooler, school-aged kid, and teenager, I can set them up to be a healthier adult.
We know mental health is absolutely connected to physical health. Our mind and body are connected. Studies have shown that if you have underlying mental health issues that are not well-managed, your physical health deteriorates. Outcomes related to adult health conditions (e.g., high blood pressure, diabetes, and general chronic illness management) are poorer in individuals who have untreated — or are suffering from — mental health conditions. This is true with kids, too.