Mental health is essential to a person’s overall health and well-being. While there’s no denying that physical health can help a person feel great, someone’s mind can affect their body just as drastically. For example, research shows that neglecting mental health can lead to serious physical health conditions, such as high blood pressure and heart disease.

Increasing access to behavioral health care can help diagnose and treat more patients and also help fight the stigma attached to having a mental health diagnosis. Introducing and expanding behavioral health services into your CHC, FQHC, hospital, or health system is an excellent first step towards eliminating stigma in your community and helping more people get the holistic care they need.

Keep reading to learn more about how you can educate your organization on mental healthcare and implement your first behavioral health program.

Educating your organization on mental healthcare

Whether your healthcare organization is planning to start your behavioral health program from scratch or considering expanding your services, your work can significantly impact the community. However, starting that process may feel overwhelming. Remember, a lot of the critical work around building a successful, patient-first behavioral health program starts with your care team.

Here are a few things to keep in mind when talking to your team about mental health care:

1. Education: Effectively preparing your providers to support patients with mental health conditions is all about education. Your organization can educate your staff on different behavioral health conditions and common diagnoses they might encounter and empower them to have better conversations surrounding mental health.
2. Person-first language: One important skill is to teach person-first language (for example, you would say a person diagnosed with schizophrenia, not a schizophrenic). It may seem like a minor change, but switching how you categorize or classify your patients can help them feel more empowered to have real, vulnerable conversations about their situation.
3. Emotional impact: Your care team should recognize that treating people with mental health diagnoses can have a unique emotional impact on providers. Your organization should emphasize the importance of your providers not becoming desensitized to patients’ challenges. You can help your providers prevent burnout by opening up communication channels with them and implementing support systems at the organizational level. It’s essential for your organization to not become desensitized to patients challenges nor take them home with them at the end of the day.

Implementing your first behavioral health program

Once you’ve thought about bringing mental health care into your organization and believe it’s a good fit for your patient populations, now comes the process of implementing behavioral health services into your workflow.

Here are some things to keep in mind as you move forward:

• Your patients will likely be discussing very personal and vulnerable topics when they come in for a behavioral health appointment. That means housing your behavioral health services in a space that allows them to feel comfortable opening up is essential. Your space should be physically and mentally safe for patients and have procedures in place in the event that a patient expresses an intent to harm themselves or others or becomes combative.
• You’ll also need to be ready to make a change in how you schedule providers. Mental health care cannot run on a traditional medicine model in which a patient waits for half an hour to meet with a doctor for a short conversation. You should plan to schedule ample time for the important conversations between providers and their patients.
• If your new program is your organization’s first experience with psychiatry, you’ll want to make sure you hire nurses, medical assistants, and doctors who have experience working in behavioral healthcare. By utilizing a solution like telepsychiatry, you’ll gain access to the best providers from all around the country.
• Check out some of these resources to learn more about the benefits of behavioral health integration from an administrative point of view and directly from nurses in the field.

Integrating holistic care into your organization’s culture

For providers at the frontline of the country’s mental health crisis, it’s important that they feel empowered to seek help if they need it as well. Integrating holistic care into your organization also means ensuring your providers feel supported in their mental health. Often, as behavioral healthcare professionals, it’s easy to fall into the trap of thinking that they’re not susceptible to mental health conditions in the way that others are, but that’s not true. Anyone and everyone can struggle with their mental health, and there’s no shame in reaching out for a helping hand.

Where Iris Telehealth fits in

One of the most challenging parts of starting a behavioral health program can be finding high-quality providers that seamlessly fit into your organization. That’s where telepsychiatry comes in. At Iris Telehealth, we connect organizations with high-quality, specialty providers from all over the country. Our large geographic pool allows us to connect organizations with the behavioral health support they need to help their community thrive. To learn more about how Iris Telehealth can help you implement a telepsychiatry program, contact us, and we’ll be happy to provide you with the information you need to get started.

In October, the American Academy of Pediatrics, the American Hospital Association, and the American Academy of Child Adolescent Psychiatry declared a mental health emergency for youth. Now more than ever, providers and organizations need to learn how to accommodate the mental health needs of LGBTQIA+ youth.

More than 80% of LGBTQIA+ youth reported that COVID-19 made their living situation more stressful.

For many LGBTQIA youth, access to mental health care is difficult due to:

• Inadequate mental health care
• Lack of access to mental health services and workers
• Fear of discussing mental health concerns, their identity being misunderstood, or not being taken seriously
• Concerns with obtaining parent/caregiver permission to receive care
• Lack of available transportation options
• Insufficient information about LGBTQIA+ mental health needs for providers.

Along with these barriers, there is also hesitancy to receive care exacerbated by a history of discrimination and lack of acceptance – which make it harder for LGBTQIA+ youth to receive the care and support they need. For example, as of 2022, 60% of LGBTQIA+ youth report they have wanted to receive mental health care but did not. This statistic represents nearly 3 in 5 transgender and non-binary youth as well as 3 in 5 cisgender youth.

Fortunately, there are steps your organization and your provider can take to ensure LGBTQIA+ youth can feel safe and heard.

Best practices for providing effective care to LGBTQIA+ youth

Here are some best practices for effectively supporting and communicating with your LGBTQIA patients:

1. Be mindful of pronouns and names: You can limit the burden for LGBTQIA+ youth by asking directly about what pronouns they use and what their preferred name is. It’s important to correct your staff members if they incorrectly address the patient to foster inclusion and affirm the patient’s identity.
2. Avoid assumptions: In addition to using the patients’ preferred pronouns and names, your care team should utilize inclusive language. By avoiding assumptions about a patient’s identity, it is easier for patients to reveal information at their own pace about their romantic or sexual relationships. Instead of assuming, ask questions like “Do you have a partner?”
3. Honor patient confidentiality: Sometimes LGBTQIA+ youth don’t come from supportive households. It is essential to build rapport with your young patients and reiterate that your conversations during your appointments are confidential — unless they are thinking about harming themselves or someone else.
4. Continue to educate yourself and your providers on LGBTQIA+ matters: Many resources are available for providers and organizations to learn more about LGBTQIA+ mental health care and youth. By paying attention to current issues and statistics around LGBTQIA+ youth, you can further change the type of care you provide by accommodating those needs.

Telehealth specific best practices for providing effective care to LGBTQIA+ youth

There are multiple ways to make your appointments with LGBTQIA+ youth inclusive and accommodating using telehealth.

1. Take steps to ensure patient privacy above all else: Some patients might not feel comfortable speaking openly during their telehealth appointment if they don’t feel like they have adequate privacy in their home (or any other location where they might be receiving virtual care). By asking in the beginning if they are in a space that is private where they are willing to be open and honest with you, you can increase the quality of care. If they don’t have a space that’s safe and private, suggest other ways to communicate with your patient: taking a walk outside and continuing your telehealth appointment there, utilizing text for information that they are too worried to say out loud, or even come up with codewords or aliases for certain things and people to maintain privacy.
2. Offer services in their area: Some patients might not have access to LGBTQIA-friendly providers or physicians. Offer to help them find one in their own area if they need to see an in-person provider for prescriptions, counseling and therapy, or HIV/AIDs management and treatment. LGBTQIA+ youth need to know they have options and access to care that is LGBTQIA-friendly.

How organizations help provide effective care to LGBTQIA+ youth

Creating a welcoming environment for LGBTQIA+ patients is essential. Many LGBTQIA+ people avoid seeking care as a result of bad experiences with providers or because they are discouraged by a lack of services that cater to the LGBTQIA+ community.

To combat that hesitation, make it clear that your organization is LGBTQIA+ friendly by clearly stating it on your websites and other branded materials. Normalizing and validating their experiences can increase the likelihood of seeking out care. Many LGBTQIA+ people look for clues whether an organization is LGBTQIA+ friendly by taking into account how they are greeted by staff and whether non-discrimination policies are posted on their websites or any other public-facing material.

Another way to make your practice more inclusive as an organization is by employing gender-inclusive medical forms. By giving your patients an opportunity to indicate their sex, gender, and sexuality, your organization can increase the quality of care your providers can deliver.

As an organization, make LGBTQIA+ specific training accessible to your providers and your care team. Sometimes, providers will have their own biases about gender and sexual orientation that they might bring to work without even realizing. Training providers on specific LGBTQIA+ topics and making sure they are asking for consent before providing care can erase discomfort in a healthcare setting.

Resources and education opportunities about LGBTQIA+ youth for providers

Many resources are available for providers and organizations to learn more about LGBTQIA+ mental health care for children and adolescents. By paying attention to current issues and statistics around LGBTQIA+ youth, you can further improve the care you provide by accommodating those needs. Here are a few resources that can help you provide quality care to LGBTQIA+ youth:

• The Trevor Project: The Trevor Project is a national organization that specializes in suicide prevention and crisis intervention for LGBTQIA+ youth. They are constantly working to provide updated research and statistics on LGBTQIA+ youth and the challenges they’re facing. In the past, they’ve conducted a recurring National Survey on LGBTQIA+ mental health that gives context to the state of mental health in the U.S. for LGBTQIA+ youth.
• The American Academy of Child and Adolescent Psychiatry: The American Academy of Child and Adolescent Psychiatry is a non-profit organization that focuses on topics related to youth and adolescent psychiatric care. Their gender and sexuality resource page has evidence-based guidelines for providers, including various tips to improve care with LGBTQIA+ youth during the pandemic, clinical guidelines and training for providers, and LGBTQIA+ specific topics frequently encountered while treating LGBTQIA+ youth.
• The National LGBT Health Education Center: The National LGBT Health Education Center is part of The Fenway Institute. Their mission is to ensure access to quality and culturally competent mental health and medical care for the LGBTQIA+ community. They have a guide for providers on how to provide inclusive services for the LGBTQIA+ community. In addition, they have various continuing medical education (CME) and continuing education units (CEU) opportunities like webinars, learning modules, and training credits for providers looking to further their understanding of how to provide quality care for LGBTQIA+ communities.

How telehealth can help

LGBTQIA+ youth have many barriers at an individual level, provider level, and systemic level. By utilizing telepsychiatry, LGBTQIA+ can overcome some of these barriers.

Between 2.9 million to 3.8 million LGBTQIA+ people live in rural areas. Telehealth can make mental health care more accessible to LGBTQIA+ patients, especially in rural and underserved areas where there might not be access to non-discriminatory mental health care. By having the option of telehealth available, LGBTQIA+ youth can see their providers from the comfort of their own homes.

And remember, harassment in a medical setting is common –especially in areas where LGBTQIA+ populations face discrimination and larger barriers to access. For patients who’ve been a victim of harassment in the medical setting in the past, having providers who are trained to build rapport and provide comfort can dispel distrust that the LGBTQIA+ community has against some providers.

Where Iris fits in

At Iris Telehealth, we work hard to match providers with the populations they have the most experience and interest in, LGBTQIA+ included. It’s important to us that everyone has access to mental health services no matter where they live and what they identify as. Contact us today to implement an effective telepsychiatry program to help LGBTQIA+ youth at your organization.

Culturally competent care effectively meets social and cultural needs by addressing issues like language barriers, low literacy rates, and lack of knowledge about racial and ethnic minority health. This approach to care can help providers and organizations improve health outcomes, increase the quality of care, and move closer to eliminating ethnic and racial health disparities.

Social determinants of health can create and exacerbate mental health conditions, hindering people’s ability to access the care they need. For example, one of the five categories of social determinants of health is access to quality care. Without cultural competency, quality care is hard to find for people who come from different backgrounds, especially when there are language or cultural barriers.

However, health care services that put patient values, beliefs, and behaviors first can help ensure your organization is delivering culturally competent care. Commitment to cultural competence begins by recognizing that healthcare is constantly evolving and patients deserve to have the care they need without fear of being misunderstood.

The importance of cultural competence

Currently, racial and ethnic minorities make up about a third of the U.S population. By 2055, they are expected to become the majority, according to Cigna. With an increasingly diverse population, the likelihood of people having limited English proficiency, less adherence to Western cultural norms, and more unique social and cultural needs might lead to larger healthcare disparities.

By practicing cultural competency and maintaining mutual respect and increased understanding between providers and patients, everyone benefits. According to the Agency for Healthcare Research and Quality (AHRQ), incorporating culturally competent strategies can lead to better communication and experience, better information, and improved patient-provider matching.

Additionally, the Health Research & Educational Trust highlights three other benefits of cultural competence:

• Business benefits: practicing cultural competence helps with the efficiency of care services, decreases barriers, increases overall the market share of an organization, and incorporates different perspectives.
• Health benefits: implementing cultural competency can lead to collecting patient data and improving treatment, reducing medical errors, incorporating preventative care, and reducing health care disparities for various patient populations.
• Social benefits: executing cultural competency also leads to cultivating mutual respect and understanding for both providers and patients, increasing overall trust, and promoting inclusion of all community members.

With the implementation of cultural competency, everyone involved can benefit greatly. While it is almost impossible to know everything about every culture, you can be one step closer to providing culturally competent care for your patients with the right approach.

How to provide culturally competent care through telehealth

It can be difficult for individuals living in rural areas to find a provider who can understand and engage with their culture. Issues like language barriers and lack of innate trust in receiving care from providers who are not part of their cultural group can pose an enormous challenge.

Telehealth gives access to patients looking for a provider who can better understand their culture. Regardless of where a patient lives, telehealth can connect them with a provider who can better relate to their experiences.

While cultural competency takes time and effort, with practice, your organization can provide care to your patients with their beliefs, culture, and values in mind.

Here are just a few ways providers can practice cultural competency through telehealth:

1. Don’t make assumptions. When it comes to telehealth, not everyone knows how to use technology. So, being patient and adaptable can make a huge difference in offering competent care as a provider. Furthermore, mental health is stigmatized in many communities. Stigma often comes from a lack of understanding or fear, so it is important to be patient, not assume that everyone knows about mental illnesses, and be open to teaching.
2. Have concise and thorough explanations. English is not everyone’s first language, and language accessibility is critical. By keeping answers simple and easy to understand, people can better understand their course of treatment. Long explanations can take away from adequately diagnosing or treating people. In some cases, providing professional interpreting services or hiring bilingual staff as medical interpreters can help to navigate complex conversations.
3. Withhold judgments. Shared-decision making is standard in other cultures, like big decisions related to a family member’s health. Along with shared decision making, when a patient makes a choice about their health, try to respect it. When patients understand their options and course of action for their health and want to go another route that is aligned with their culture, respect is essential. In addition, many cultures may use alternative treatment instead of relying on Western medicine. By making an effort to understand a patient’s traditional health beliefs and practices, explaining their course of treatment can be more manageable.
4. Accommodate and educate. Teach patients about techniques or technologies and find culturally accommodating alternatives when possible. For example, some people will not know how to use laptops or computers with ease. Teaching them and being patient can mitigate some discomfort. Always ask about their preference before accommodating.
5. Be aware of cultural differences. Through telehealth, non-verbal communication can play a prominent role. Make sure that the use of gestures, eye contact, and facial expressions are appropriate and respectful within your patient’s culture. It’s okay to ask!

How organizations can accommodate

Providing culturally competent care for your patient population can become a reality by institutionalizing changes at your organization. Here are a few ways your organization can help your providers deliver culturally competent care and accommodate the needs of your patient populations:

1. Be intentional about recruitment. Ideally, an organization’s staff should be at least as diverse and multicultural as your patient populations to help provide appropriate care. With a diverse team of providers, your practice will have a more comprehensive cultural knowledge base to pull from when it comes time to provide care.
2. Collect REAL data. According to the AHA, organizations should collect race, ethnicity, and language preference (REAL) data. Collecting this data will help your organization identify and report disparities, increase diversity and minority workforce pipelines, and make cultural competency an institutional priority.
3. Offer training and resources. Make sure you give your providers ample time and resources around culturally competent care. Remember to encourage your providers to take some time to develop skills and knowledge to effectively navigate an industry that works with people of many backgrounds.
4. Assess and address. Your organization and providers will not become perfect at providing culturally competent care overnight. It’ll be vital to identify and address areas of underperformance on an ongoing basis through your organization’s REAL data and feedback from your patients and providers.

Resources for providers and looking towards the future

As a provider, learning about cultural competency can feel overwhelming, and knowing where to start might feel confusing. By taking steps to improve your cultural competency, you will be better equipped to serve the needs of a variety of patients from different backgrounds.
Here are a few resources and ways that can help you practice and advocate for cultural competence in the workplace:

1. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Resources on Cultural Competence: SAMHSA has resources and online training for providing cultural competency for both organization leaders and providers.
2. The Health Research and Educational Trust and the American Hospital Association (AHA): This guidebook has resources for healthcare organizations and leadership. It outlines multiple benefits of culturally competent care, next steps for hospitals and care systems, and how to provide effective staff education.
3. Agency for Healthcare Research and Quality (AHRQ): The AHRQ has their Health Literacy Universal Precautions Toolkit on improving linguistic competency when delivering health care. The toolkit gives information about how to learn from patients, from other staff, and other sources like websites and courses. It also gives guidance on how to track your progress among your providers.
4. Think Cultural Health: This website has resources, CME, and information for providers about culturally and linguistically appropriate care services. The website is sponsored by The Office of Minority Health (OMH) at the U.S. Department of Health and Human Services (HHS).

Where Iris Telehealth can help

At Iris Telehealth, we work with other healthcare organizations around the nation to bring high-quality, specialized psychiatry services to people who need them the most. Contact us today to see if our telepsychiatry services can help your providers and organization provide culturally competent care for your patients.

Social determinants of health (SDOH) are defined by the conditions of an environment where people are born, live, and work. Depending on an individual’s circumstances, these conditions can create and exacerbate mental illness and make it difficult to access mental health care.

Despite these challenges, healthcare organizations have the power to make meaningful change by bridging the gap between underserved populations and high-quality mental health care. By investing in solutions like telepsychiatry, healthcare organizations can positively impact their communities’ mental health.

Read on to learn more about why social determinants of health and mental health matter to healthcare organizations, how healthcare organizations can address them, and additional resources to help reach those who need care the most in your community.

Why SDOHs matter to healthcare organizations

Healthcare organizations are catching on to the importance of addressing social determinants of mental health. In a survey of 300 hospitals and health systems, the Deloitte Center for Health Solutions found that 80% of hospital respondents said their leadership team is committed to establishing and addressing social needs in clinical care. Providers see the value, too. The Commonwealth Fund reports that 80% of physicians consider addressing a patients’ social needs as critical as addressing their medical needs.

And, the potential financial impact of not addressing SDOH is substantial. An article by Modern Healthcare highlights a Chicago-based health system that discovered 26% of its medical inpatients had a co-occurring behavioral health issue that cost approximately $26 million annually in excess healthcare costs and increased the average length of stay by 1.07 days.

Taking an integrated approach that encompasses mental and physical healthcare needs is essential to helping underserved patients and maintaining organizational costs.

Identifying who needs help in your community

For those experiencing SDOH, lack of access to routine mental and physical healthcare can impact their quality of life. And the effects are widespread. In fact, in a study by Anthem, 60% of Americans believe their community faces at least some health issues related to SDOH. 23% say access to good doctors and hospitals is a major problem for those in rural parts of the country.

Anthem also found that Americans of color are disproportionately affected by the consequences of SDOH, citing mental health, safe communities, and access to affordable and nutritional foods were components significantly impacting their health.

Along with these challenges, there are specific factors that stand between individuals experiencing SDOH and a more sustainable quality of life:

• More than 500K Americans are experiencing homelessness
• 38 million people are food insecure
• 37.2 million people are living in poverty

Whether your organization aims to help a specific population or contribute to solving a unique issue in your community, you should consider a few things before getting started.

How healthcare organizations can address SDOH

With a pandemic and a growing provider shortage at play, helping patients get appropriate and affordable mental health care has never been more important or challenging.

So what can hospitals and health systems do to help relieve the burden on overworked providers while facilitating high-quality care for their patients? It starts by ensuring your teams are set up to address these challenges.

Consider the following:

• What type of geographic access does your population have?
• What resources are available?
• Are people motivated to utilize these resources?
• Do they have a support system?

When addressing SDOH in the community, chances are you might face some challenges related to stigma, transportation, and socioeconomic status. While these might be difficult to address, there are four solutions to these challenges that can help your organization realize optimal outcomes:

• Stigma: For those facing stigma in their communities, providing a telepsychiatry option can be helpful. That way, they can receive effective treatment from the comfort of their homes, or through their primary care provider’s office, without the worry of being exposed for seeking help.
• Culturally competent care: Using telepsychiatry can help organizations access providers who speak a specific language or have experience with a particular culture. This connection is highly beneficial to individuals who may not have someone locally who speaks the same language or can understand the unique aspects of their culture.
• Technology and digital literacy: By partnering with organizations that seamlessly integrate into your organization, patients in your community can access providers from across the country at their local clinic, regardless of what personal access they may have at home.
• Transportation: If patients have trouble getting to their appointment because of transportation challenges, telehealth can help them get the care they need from home. Along with a virtual approach, your organization can consider offering free transportation, or partnering with a ride-share company, to help individuals make it to their appointment.

Additional Resources

If you’re looking for additional resources to reach your community, check out some of the options below:

American Psychiatric Association: The American Psychiatric Association has collected a series of factsheets that provide an inside look into current mental health disparities experienced by diverse populations. This is a meaningful resource that your organization can reference when determining how and who to help.

Iris Telehealth: Iris Telehealth provides high-quality behavioral health services for patients across the country. Wherever the need, Iris meets people where they are, helping to break stigmas and defy geographic and economic barriers.

AHA Resources: The AHA provides recommendations on improving health equity or check out what they suggest your organization can do to ensure access to care. Whatever the need, AHA has a bounty of resources for reference.

RHIhub SDOH in Rural Communities Toolkit: RHIhub has compiled a toolkit of resources, including content around care coordination, community health workers, health promotion, telehealth, rural transportation, and more.

Where Iris Telehealth fits in

Iris Telehealth works with healthcare organizations across the country to bring high-quality, specialty psychiatry services to people who need them most. If you’re a healthcare organization looking to increase access in your community, Iris Telehealth can work with you to seamlessly integrate behavioral health services. Contact us today.

The COVID-19 pandemic has left a seismic impact on the hearts and minds of people across the world — whether through job loss, the grief of losing a loved one, difficulty paying bills, or trouble finding quality healthcare.

In tandem with these experiences, the state of mental health has plummeted. According to data published by The Lancet, 76 million people have reported pandemic-related anxiety, a number that increased by 26 percent between 2019 and 2020.

As the pandemic continues, we’re pausing to look back at the unique experiences of different populations across the country, the long-term effects on mental health, and how to help decrease the impact of COVID-19.

Long-term effects on families, rural Americans, and underserved populations

The COVID-19 pandemic has affected everyone differently and has been particularly challenging for families, Americans in rural parts of the country, and underserved populations.

Families and children

For families, the pandemic transformed daily life. Social determinants of health have been exacerbated, and paying bills has gotten harder. In fact, The Commonwealth Fund reported that 7.7 million workers lost their employer-sponsored health insurance (ESI) jobs due to the pandemic-induced recession. This loss also affected 6.9 million dependents across the country.

Additionally, nearly 93% of school-aged children were engaged in distance learning, creating changes and new dynamics in the home. Today, as kids transition from a more controlled, virtual environment to one that’s in-person with more people, noise, and different expectations, it may trigger separation anxiety or underlying fears that could potentially impact their development.

The compounding stress has been so significant that the American Academy of Pediatrics, alongside the Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association, recently declared a national state of emergency in children’s mental health.

Rural America

During the pandemic, 30% of rural Americans reported suffering from anxiety or depression. While finding care can prove challenging, many rural Americans turned to telehealth. In fact, 43% say they have used telehealth for mental health and/or substance use treatment services once a month or more over the past year.

Telepsychiatry works to reach people to get them the right care when and where they need it. For healthcare organizations located in rural areas looking to impact their communities and improve their services in the wake of COVID-19, telepsychiatry can make a real difference in the short and long term.

Underserved Populations

The impact COVID-19 had on underserved populations was especially hard. A survey by The Commonwealth Fund found that Latino and Black people, women, and people with low income are most at risk of mental health concerns because of the pandemic.

The COVID-19 pandemic has underscored the need for health equity. By making mental healthcare more accessible and equipping communities with the right mental health resources, these populations will have the care they need throughout and after the pandemic.

Provider shortages and increased need

Healthcare organizations were hit hard throughout the pandemic, further exacerbating the pre-existing psychiatrist shortage and causing people to delay mental and medical care. At the height of the pandemic, 1 in 5 adults in the U.S. reported they could not get care or delayed care for serious problems, and 57% reported negative consequences. Additionally, a report by the Kaiser Family Foundation (KFF) found that the pandemic and the economic recession created new barriers for those experiencing mental health conditions. In a July 2020 poll, KFF reported specific negative impacts on adults:

• 36% had difficulty sleeping
• 32% had difficulty eating
• 12% experienced an increase in alcohol consumption or substance use
• 12% experienced worsening chronic conditions due to worry and stress

While there’s mounting pressure on healthcare organizations, there are steps they can take to help relieve shortages and empower patients and providers.

Solutions for healthcare organizations

This lack of access to care for both mental and physical health throughout the pandemic decreased overall wellness. So, what can healthcare organizations and providers do to help set their patients up for success? There are three solutions every organization should consider.

1. Incorporate an integrated care program

Conditions like generalized anxiety disorder, social anxiety, agoraphobia, and more have been exacerbated. When mental health goes untreated, certain medical conditions can worsen over time. The Centers for Disease Control and Prevention (CDC) calls mental and physical health equal components of overall health.

That’s where integrated care programs come in. These programs can play a significant role in helping hospitals, health systems, Federally Qualified Health Centers, and Community Health Centers recover from the pandemic. This convergence of medical and behavioral health facilitates true collaboration between providers, offers patients the best possible care, and mitigates downstream medical costs.

2. Invest in telepsychiatry

As the demand for care increases due to unmet needs, staffing up healthcare organizations with telepsychiatry solutions can help hospitals keep up with demand, support providers, and provide high-quality care to patients. This solution is beneficial for patients in need of specialty care who may not have time to sit on a waiting list or in an emergency room.

By incorporating this solution, hospitals will have a specialist on call 24/7 in the emergency department to consult with inpatient services or support outpatient services to drive better outcomes. Telepsychiatry makes it possible for people to get the care they need when they need it.

3. Ask questions

When providers take the time to ask people how they are and how COVID has affected their lives, it can open up critical communication channels that can ultimately help your organization better serve your patients. For example, if a patient is experiencing food insecurity, providers can point them toward a food bank. Or, if they need to get tested for COVID but don’t know where to go, your organization can help them find a testing location. Asking the right questions can reveal core issues, reduce stress, and encourage connection.

Healing long-term effects through self-care and awareness

Stress can take a toll on us all. For providers who are already dealing with high rates of burnout, it’s imperative to set aside time for self-care. Incorporating lifestyle medicine principles into your life can help heal long-term physical and mental effects. The pillars of this solution include staying hydrated, eating nutritious foods, exercising, getting adequate sleep, limiting substance use, and emphasizing social connectedness.

Taking care of your mental health and turning your awareness towards self-care can make a big difference in helping heal the long-term effects of the COVID-19 pandemic.

Where Iris Telehealth fits in

If you’re looking to incorporate telepsychiatry into your organization but don’t know where to start, Iris Telehealth is here to help. Together, we can help your organization combat the long-term effects of the COVID-19 pandemic. Contact us today!

Thank you for following along the journey through common pediatric care disorders and treatments! This is our fourth and final post in our series on pediatric behavioral health conditions. For more, visit our posts on pediatric stress and trauma, pediatric depression, and pediatric anxiety.

In this post, we’ll discuss the prevalence and risk factors surrounding pediatric eating disorders, screening challenges, and treatment for eating disorders in primary care — while considering additional challenges that have popped up during the COVID-19 pandemic. Because you’ll probably see Anorexia Nervosa and Bulimia Nervosa most often in pediatric care, we’ll spend more time on those two.

We hope this guide will empower you to understand and treat this increasingly prevalent pediatric health condition.

Anorexia Nervosa is a battle against body and mind

Anorexia Nervosa (AN) is a tricky disorder that’s not just physical, but a combination of psychological characteristics leading to physical changes. Common characteristics associated with Anorexia Nervosa include:

• Lower body weights than minimally expected (less than 85% of expected BMI)
• Intense fear of gaining weight
• Persistent behavior that interferes with weight gain
• Undue influence by body weight or shape
• Failure to recognize low body weight
• Secret exercising and/or compulsion to stand or move
• Baggy clothes and complaints of being cold

Look out for AN in children who participate in activities where weight or appearance plays a role and picky eaters or children significantly affected by societal pressure.

As always, keep an eye out for comorbidities as AN is comorbid with at least one other psychiatric disorder in 55.2% of cases.

Restricting type and binge eating/purging type are the two subtypes of Anorexia Nervosa, though binging and purging is less likely in children than adults:

• The restricting type is defined by restricted food consumption, and you’ll see symptoms such as fasting or avoiding “risk” foods.
• The binge/purging type includes children who demonstrate both binging and purging symptoms and are severely underweight.

The good news is that prognosis for teens with Anorexia Nervosa is more promising than the same diagnosis for adults. If you can catch and treat Anorexia Nervosa in a patient’s childhood years, you can take the necessary steps to improve their development.

Screening and treating Anorexia Nervosa is a family affair

Screening for AN is tough. Children may keep their eating disorder a secret by including attempting to pad weight by putting objects in their pockets during weight checks, drinking excessive water prior to appointments, or explaining weight loss through a medical illness. And they may deny the psychological characteristics of AN.

For this reason, an honest parent/child rapport is essential for diagnosing children with AN. You’ll need to advise parents about symptoms to watch throughout the screening process, especially if they note any unexpected weight loss or failure to gain expected weight. Also, be sure to require a medical workup to understand the physical symptoms children may be experiencing and schedule frequent follow-up visits.

Remember that family relationships can be essential to effective treatment. One of the most commonly used treatment models, the Maudsley Model, includes intensive family therapy to educate and empower parents. It’s an outpatient model and includes programs that meet regularly for 6-12 weeks. It has proven successful in weight restoring children, who in turn learn increased autonomy over time.

For children who don’t have access to family therapy, we’d recommend a model focused on individual therapy to restore autonomy over eating.

Bulimia Nervosa is another secret battle

Anorexia Nervosa goes hand in hand with Bulimia Nervosa (BN). Approximately 60% of patients diagnosed with AN develop BN, and BN often develops at 14-22 years of age. As with AN, Bulimia Nervosa (BN) can be a secret battle, and patients can have BN symptoms for up to five years before seeking treatment. The good news is that 50% of patients are symptom-free 5-10 years after receiving treatment.

BN patients are often within the normal expected weight range, making it more challenging to see the physical characteristics of the condition. However, teens with BN may be secretive and note difficulty with interpersonal relationships, and males with BN may overexercise or use steroids.

Keep on the lookout for BN as it’s relatively prevalent — 1-2% of adolescent females and 0.5% of males meet DSM-5 criteria for BN.

Of course, differential diagnoses also exist, so be wary as you diagnose patients with BN. What may appear as Bulimia Nervosa could be the Anorexia Nervosa binge/purge subtype, Binge Eating Disorder (BED), or other conditions.

Family and social factors are risk factors for Bulimia Nervosa

Family factors such as PTSD or perfectionistic temperaments are major risk factors for Bulimia Nervosa. These risk factors are compounded with dieting and social pressures to be thin, and when combined, they can create the feelings of guilt and shame we associate with BN.

Remember comorbidities as you’re investigating factors. One study showed lifetime psychiatric comorbidity of 88%, and most teens had at least one comorbid psychiatric illness with BN.

As a provider screening for Bulimia Nervosa, you must stay vigilant

As with Anorexia Nervosa, you’ll face significant challenges screening for Bulimia Nervosa. Adolescents with BN will often want to keep their eating disorder a secret and be ashamed of binging and purging symptoms. Because weight is often within the normal range, physical characteristics are less obvious than AN. Children with AN may not be aware of their feelings or able to verbalize shame, and they may not even understand their behavior is abnormal.
As with AN, patients will often deny the psychological aspects of BN, and you’ll have to stay suspicious throughout screening to understand the full picture.

Treating Bulimia Nervosa is a family affair

Research on both therapy and medication for Bulimia Nervosa is still ongoing. The two therapy types for BN include Family-Based Treatment (FBT) and Dialectical Behavioral Therapy (DBT). As with AN, family-based Maudsley therapy is the most effective. Educating the entire family system also alleviates behaviors that will encourage binging and purging. DBT should also be integrated into any therapy for eating disorders to help cope with stress symptoms.

COVID-19 is making eating disorders worse

During the first lockdown period in spring 2020, grocery shopping, doctor visits, and social support systems were interrupted, exacerbating eating disorders.

In some cases, children who liked the sense of control that came with a scheduled routine turned to controlled, disordered eating to cope with the uncertainty. Social distancing made hiding restrictive behaviors and weight loss easier for children who wanted to keep their behaviors secret. On top of this, virtual appointments have made it more difficult to assess vital signs, weights, and labs, causing eating disorder screenings to be less accurate.

While telehealth, virtual nutrition coaching, and more have led to some creative solutions to address eating disorders, the reality is that COVID-19 is making eating disorders more prevalent and more difficult to treat as a whole.

Keep up the great work!

We understand eating disorders are challenging to diagnose and treat, and the societal pressure on appearances makes your job as a provider even tougher. Know that as you’re supporting children and families, you give them the best chance to overcome their eating disorders and live fulfilling lives.

Research on eating disorders is ongoing, so be sure to follow the most updated guidance. For now, here are a few resources we recommend:

• Practice Parameters for the Assessment and Treatment of Children and Adolescents with Eating disorders, 2015
• Multi-Service Eating Disorder Association (MEDA)
• National Eating Disorders Association (NEDA): helpline to call/text for support, resources, treatment options, Crisis Text Line

As always, Iris Telehealth is here as a resource for providers who need support. If your organization feels the pressure of increased numbers of patients experiencing pediatric eating disorders, contact us today.

This is our third post in our series on pediatric behavioral health conditions. For more, visit our posts on pediatric depression and pediatric anxiety.

Children experience trauma differently than adults. As a pediatric care provider, it’s important to understand these differences, how you can spot them, and best practices for treating them.
Keep reading for a discussion of the types of trauma and their prevalence, risk factors and protective factors for child and adolescent PTSD, review screening and assessment for PTSD in primary care, and the algorithm for treatment.

Almost half of children in the U.S. have experienced trauma

The survey on adverse childhood experiences by the National Survey of Children’s Health (NSCH) indicated that nearly 50% of children in the United States have experienced one or more types of serious childhood trauma. Most children are resilient after traumatic exposure, but a minority of children develop significant mental health problems as a result.

Traumatic experiences can impact a child’s neurological development, trust, emotional regulation, and social skills. These essential skills help children function, and your ability to help treat children for these PTSD-related conditions will aid their growth.

Also, remember that research has shown complex trauma impacts both the mental and physical health of children. Both short-term somatic effects and long-term effects on childhood development can result from complex trauma.

COVID-19 has been a mass, traumatic event for children

Children who had their lives interrupted during COVID-19 will be experiencing the repercussions for years and may respond to COVID-19 as a traumatic event. Anxiety and fears related to contracting the virus, economic challenges, and deaths of family members are all traumatic events in addition to the fallout from schedule changes and social isolation.

In the short and medium-term, children may experience symptoms similar to anxiety, depression, PTSD, dissociation, depersonalization, and emotional dysregulation. In the long term, these traumas can cause physical, social, and intellectual development problems. You may see violent and risky behaviors in children resulting from COVID-19 trauma.

Remember, these factors will all contribute to PTSD symptoms in children, and multiple traumas can interact together to form more complex experiences. Your care plan should take these events into account as you build a picture of how a child’s trauma may have affected them.

PTSD can develop after one year of age

Navigating the different types of pediatric stress and trauma disorders can be confusing, so be sure to review the definitions of unique DSM-5 stress and trauma disorders to support your patients adequately. Also, remember that children can develop PTSD after only one year of age and that a PTSD diagnosis can be surprising for families who don’t realize that PTSD can develop this early.

Even when children aren’t old enough to talk and verbalize symptoms, you may notice PTSD through unusual behaviors in play, such as new aggression. Remember that adults who re-experience childhood PTSD symptoms may face additional mental health challenges as they age, so diagnosing and treating PTSD in children will help a patient throughout their entire life cycle.

There are a range of risk factors for PTSD development

You’ll see children respond to trauma differently, but factors including gender, exposure to trauma, and pre-existing anxiety disorders can make it more likely that a traumatic event will result in PTSD development. Disasters are high-stress situations, and the specific experiences a child has during a disaster can affect risk factors for PTSD; for example, feeling one’s life is in danger or delayed evacuation may act as higher risk factors.

Fortunately, there are ways to help! Protective factors can decrease the risk of children developing PTSD after traumatic exposure. These include parental support, lack of parental PTSD, and resolution of parental trauma-related symptoms. It’s important to support parents throughout the aftermath of traumatic exposure, as they can significantly affect a child’s likelihood of developing PTSD.

And remember, PTSD isn’t the only condition that can result from traumatic exposure. Other disorders and medication side effects can also create symptoms that present similarly to PTSD. You’ll act as a detective to screen for PTSD if needed, but stay open-minded and wary of differential diagnoses too.

Evaluating and screening for PTSD

I recommend screening annually for PTSD with all primary care patients using the question “has anything really scary or upsetting ever happened to you or your family” for both children and parents or guardians. This question can elicit productive responses that may suggest you formally screen for PTSD.

Many other more formal tools exist for screening for PTSD. The CATS (Child and Adolescent Trauma Screen) test is an effective tool for primary care screening. You can either provide a caregiver report or youth report for patients and families to complete depending on the child’s age. This test differentiates normal, moderate, and probable by age.

Normal scores will encourage support, empathy, and productive habits for children. For moderate CAT scores, you should monitor children and assess for co-occurring depression or anxiety and schedule follow-up visits. With a probable PTSD score, you should assess for co-occurring depression and anxiety, refer for trauma-focused, evidence-based therapy, and closely monitor for suicidal ideation or self-injurious behavior with a scheduled follow-up visit.

Treating PTSD

Psychotherapy is the first line of treatment for PTSD, and your plan for treating PTSD should help the child progress developmentally and learn positive coping strategies to regulate emotions.

While you may see many acronyms and terms for evidence-based therapy, any psychotherapy plan involves:

• Caregiver involvement
• Developing skills for coping/relaxation
• Challenging negative cognitive distortions related to the trauma
• Building a trauma narrative

Treatment will allow children to integrate the traumatic event into their experience to the extent that they can retell the event without increasing distressing feelings.

Make sure you educate children and families that PTSD symptoms can reoccur following future traumatic experiences, and ensure the family understands that they may benefit from additional mental health treatment if this occurs.

At this time, no medications are FDA approved for PTSD in children and teens. However, you may consider medication if children are diagnosed with comorbid conditions or symptoms that are causing significant distress or functional impairment despite evidence-based psychotherapy.

If you are suggesting medication for children, you should target the symptom causing the most distress or functional impairment and remember that medications are supported by published evidence but are not FDA-approved.

Your goal is to safely withdraw treatment and monitor for symptom recurrence

PTSD treatment generally consists of three phases: an 8-12 week acute treatment phase, a 6-12 month maintenance phase, and a 3-6 month treatment discontinuation phase. In the third phase, you will aim to safely withdraw treatment and monitor for symptom recurrence.

Make sure you communicate regularly with the family during this phase and ensure they understand the benefits and risks of withdrawing treatment. If symptoms reoccur, you’ll have to make sure the family understands that this is not a failure of treatment but instead will require a slowing of the discontinuation pace.

Your role as a communicator in this phase is key!

Resources for you

PTSD is a complex condition to treat and may involve steps forward and backward in treatment. Stay patient, as your role is essential to helping children interact in the world as they work through their PTSD. More resources we recommend include:

• American Academy of Child & Adolescent Psychiatry (AACAP) Disaster and Trauma Resource Center
• National Child Traumatic Stress Network

As always, Iris Telehealth is here as a resource for providers who need support. If your organization is feeling the weight of increased numbers of patients experiencing pediatric stress disorders, contact us today. We’d love to talk to you about the difference telepsychiatry can make in your practice!

This is our second piece in our series on pediatric behavioral health conditions. Check out our first post on diagnosing, treating, and supporting children experiencing pediatric depression here.

Over the past few years, child and adolescent anxiety has become an increasingly common and concerning trend. And, over the past year, COVID-19 and the resulting school closures have only exacerbated the situation. As a pediatrician or healthcare organization providing pediatric behavioral health services, you’re likely experiencing the impact of that trend first-hand.

Keep reading for a breakdown of the increased demand on pediatricians, the most common anxiety orders in the DSM-5 anxiety disorders, best practices for screening and assessment for anxiety in primary care, and the algorithm for treating pediatric anxiety.

Anxiety disorders are the most common mental health condition for children and adolescents

Anxiety disorders have a 30% lifetime prevalence, meaning 30% of people in a population develop anxiety disorders at some point in their lives.

According to The Journal of Pediatrics, of the 4.4 million children aged 3-17 years with diagnosed anxiety, more than one in three have a behavioral disorder, and about one in three are experiencing depression. Only six in 10 children aged 3-17 years with anxiety received treatment. The disparity between the number of children with anxiety versus the number of children in treatment is alarming, and it speaks to the role providers must play in screening and raising awareness about anxiety disorders for children and families.

The DSM-5 classifies anxiety disorders in children

If you or your healthcare organization are providing behavioral health services to children and adolescents, you should be able to differentiate between the unique DSM-5 childhood anxiety disorders as you diagnose and treat patients.

The most common DSM-5 anxiety disorders we see include:

• Generalized anxiety disorder: excessive worry about a variety of subjects such as grades, family relationships, or relationships with peers.
• Separation anxiety disorder: developmentally inappropriate and excessive anxiety concerning separation from attachment figures.
• Selective mutism: a newly added anxiety disorder in DSM-5, selective mutism is a consistent failure to speak in specific social situations in which there is an expectation for speaking despite speaking in other situations.
• Specific phobia: marked and persistent fear of a specific object or situation that causes significant distress and interferes with usual activities.
• Social anxiety disorder: also known as social phobia, social anxiety disorder is an intense fear of social and performance situations and activities (for example, being called on in class or starting a conversation with a peer). Social anxiety can significantly impact school performance and attendance as well as the ability to socialize with peers and develop friendships.
• Panic disorder: diagnosed if a child suffers at least two unexpected panic or anxiety attacks followed by at least one month of concern over having another attack.
• Agoraphobia: fear of going into certain situations where they may experience panic or be uncomfortable and without help.
• Substance/medication-induced anxiety disorder
• Anxiety disorder due to another medical condition

As a healthcare provider treating pediatric anxiety, you should be wary of differential diagnoses

Many symptoms of anxiety disorders overlap with other conditions. It can be difficult to determine whether symptoms stem from real anxiety diagnoses or other diagnoses or reactions to acute events.

Some differential diagnoses include:

• Adjustment reactions to acute stressors
• General Anxiety Disorder vs. OCD
• Bullying
• Substance Use Disorders
• Autism Spectrum Disorder
• ADHD
• Excess caffeine/energy drinks and/or nicotine use

In addition to differential diagnoses, your medical workup of conditions that can present with anxiety symptoms should include investigating other conditions and reactions to medical treatments.

Screening for pediatric anxiety is quick, free, and easy

The Pediatric Symptom Checklist-17 is generally the first step for evaluating anxiety and screens for cognitive, emotional, and behavioral problems in children ages 4-17. If you see a total score of 15+ points, you should conduct a formal assessment.

After a score of 15+ points, your next steps will include a clinical interview and using the applicable symptoms rating scale.

Use SCARED (Screen for Child Anxiety Related Disorders) for ages 8-18

• 41 item inventory
• Parent and child version
• Score 25 or greater significant

Or GAD-7 (Generalized Anxiety Disorder 7) for ages 12 and up

• 7 item inventory
• 1-2 minutes to complete
• Score 10 is moderate, 15 is severe

Assessing for avoidance is the most important step, as avoidance of activities and circumstances that provoke anxiety often are the most disabling aspects of anxiety disorders for children and adolescents. Remember avoidant behaviors often become habitual and may be reinforced by family members and teachers.

In addition to avoidance, be sure to assess for acute and chronic stressors which may be contributing to presentation, current, or previous self-injurious behavior or suicidal ideation. Other common co-occurring psychiatric diagnoses include ADHD, depression, and Substance Use Disorders.

The patient and family-first approach to treating anxiety disorders

An anxiety disorder diagnosis can be scary for families new to mental health discussions. Be patient as you’re determining a treatment plan, and be sure to determine treatment based on the severity of the child’s anxiety disorder.

For subclinical to mild anxiety, you can prescribe supported self-management and follow-ups, including at-home guidance for children and families. For moderate depression or mild depression that does not respond to supported self-management, you’ll have to provide a therapy referral (Cognitive Behavioral Therapy preferred) or a medication trial. For severe anxiety, you should always refer patients for therapy (Cognitive Behavioral Therapy preferred) and medication until the child’s anxiety is stable. Be sure to establish clear goals, expectations, and communication workflows to support families through severe anxiety treatment — it can be an emotional time.

SSRIs: the gold standard

SSRIs are the gold standard of care for treating anxiety. Whenever you prescribe SSRIs, you should conduct an in-depth screening for family history of bipolar disorder or suicide, establish a plan for follow-up and emergency access to care, and educate the family about potential side effects and protocols for adequate trials. SNRIs can be used as a second option if SSRIs treatment isn’t successful.

Fluoxetine and Sertraline are the two most studied SSRIs and, consequently, are recommended the most. For both medications, you should give test doses and closely monitor the children’s response. If a child responds well to treatment, you or your providers can slowly taper them off the medication while reevaluating their reaction throughout.

Evidence from a 6-year CAMS (Child/Adolescent Anxiety Multimodal Study) indicated that a combination of Sertraline and Cognitive Behavioral Therapy showed the most benefits for patients compared to treating with just one or the other. This is an important reminder that medication is not a “cure-all” for all mental health conditions, and approaches to anxiety are often complex and multi-faceted.

Treating anxiety disorders requires a holistic regimen and candid conversations with children and families throughout the process to provide the best possible care.

Next steps: resources for providers

Treating childhood anxiety will become increasingly important as anxiety rates continue to rise. As always, Iris Telehealth is here as a resource for providers and healthcare organizations that need support. If your organization is feeling the weight of an influx of patients experiencing pediatric anxiety, contact us today. We’d love to talk to you about how we can help!

The past year has been an enormous mental health challenge for children and adolescents. Research in Child Adolescent Health indicated the global closures of schools and colleges due to the COVID-19 pandemic have negatively impacted over 91% of the world’s student population. Children found their levels of boredom increasing and motivation decreasing as schedules were upended, soccer practices were canceled, and school lunches went virtual.

With these lifestyle interruptions came an alarming increase in rates of pediatric depression.

I’ve seen the challenges pediatricians are facing firsthand and hope to provide some insight into what these new pediatric mental health challenges entail, how mental health professionals can screen for depression in primary care, and strategies for treating pediatric depression.

Research indicates pediatric depression is increasing

The percentage of children and adolescents exhibiting health risk behaviors — including suicidal ideation, making a suicide plan, attempted suicide, and suicide attempts requiring medical treatment — have increased significantly since 2011 and have accelerated with the pandemic. A survey of 1000 high school and college students indicated that almost 25% knew a peer who had developed suicidal thoughts since the onset of COVID-19. And, more than 50% of respondents in a survey of high school and college students reported they were worried about their own mental health during the pandemic.

These statistics are generally elevated for any children who identify as members of marginalized communities, with LGBTQ+ youth reporting health risk behaviors at the highest rate.

Unfortunately, the concerning increase in rates of pediatric depression will not simply go away as vaccines become available. A systemic review of 63 studies found that a surprising impact of social isolation and loneliness was prolonged risk of depression and anxiety up to nine years later. Additionally, the duration of loneliness was more strongly associated with mental health symptoms than the intensity of loneliness. Even as we climb out of the quarantine period and the COVID-19 pandemic, we should expect this prolonged trauma period to affect pediatric mental health for years to come.

Screening for pediatric depression is quick, free, and easy

The DSM-5 contains information about the full spectrum of common depressive disorders in children. But, one of the most common disorders you might run into is Major Depressive Disorder (MDD).

To screen for MDD, you can provide questionnaires specific to both parents and children at general visits and interpret their responses. You’ll find patients with MDD report depressed mood or loss of interest or pleasure in addition to five or more Major Depressive Disorder symptoms within the same two-week period.

You can use the patient’s age to determine which screening is most fitting between the Pediatric Symptom Checklist/Pediatric Symptom Checklist Youth Report (PSC and Y-PSC) and the Patient Health Questionnaire 9 (PHQ-9). Here’s how they compare:

PSC/Y-PSC

• Screens for cognitive, emotional, and behavioral problems
• For youth between 4-16
• Takes 5-10 minutes to complete
• Free

PHQ-9

• Specific to depression
• For ages 12 and up
• Takes 5-10 minutes to complete
• Free

After children take either screening questionnaire, staff will score the questionnaire responses and determine whether MDD possibility is positive or negative. Of course, you should also conduct a formal assessment — including a clinical interview and symptoms rating scales — before moving forward with MDD treatment.

The patient and family-first approach to treating Major Depressive Disorder

The severity of a patient’s MDD diagnosis will direct the treatment plan:

• Treating subclinical to mild depression includes supported self-management and follow-up conversations to help the children understand how they can make themselves feel better – including how sleep and nutrition can affect their depression.
• Treating moderate depression (and mild depression that does not respond to supported self-management) includes therapy referral and an optional medication trial.
• Treating severe depression requires a therapy referral and medication.

While some families may be hesitant about one method or the other, studies indicate that a combination of therapy and medication trials will help children with severe depression improve faster.

However, as a pediatric mental health provider, it’s important to remember how scary these conversations can be for families and set clear expectations for what families and patients can anticipate throughout the treatment process.

Steps for setting family expectations include:

• Screening for family history of Bipolar Disorder and suicide.
• Communication plans for both regular follow-up and emergency access visits.
• Family education about the length of adequate trials to reduce the risk of non-compliance.
• Emphasizing that the family should alert pediatricians about worsening depression or suicidal thoughts.
• Explanation of mania to set family expectations for this common side effect of MDD medication.
• Ongoing informed consent to continue educating families and improve treatment outcomes.

SSRIs: the gold standard

As far as medication is concerned, SSRIs (Selective Serotonin Reuptake Inhibitors) are the gold standard of care for pediatric depression. 70% of patients respond to their first SSRI, and of the patients who do not respond, 70% respond to the second SSRI.

Generally speaking, Fluoxetine, Escitalopram, and Sertraline are the most common SSRIs, with Fluoxetine being the oldest and most well-known SSRI. Whenever you’re treating a new patient or prescribing an SSRI to a child who has never taken one before, you should always conduct test doses first to understand how patients will respond to specific medications. Then, it’s important to make sure any resulting SSRI treatment plan you develop includes periodic monitoring for side effects and reassessment of patients using screening tools at recommended times throughout the treatment plan.

Next steps: resources for mental health professionals and families

Every patient and family has different needs, but, fortunately, there’s a wealth of knowledge and research around pediatric depression that can help you make the right choices for your patients.

Whether you’re looking for aacap practice parameters or pediatric depression screening tools, here are just a few of my favorite resources for providers and families:

• aacap.org and aap.org include practice parameters, with a lot of facts for families — including brief summaries explaining what to expect from pediatric mental health treatments.
• parentsmedguide.org is a collaborative effort by the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association. These sites share practical information and advice regarding pediatric depression and anxiety for parents, patients, and clinicians.
• schoolpsychiatry.org is a publication by Mass General and provides valuable screening tools.

As always, Iris Telehealth is here as a resource for providers who need support. If your organization is feeling the weight of increased numbers of patients experiencing pediatric depression, contact us today. We’d love to talk to you about the difference telepsychiatry can make in your practice!

This past year, we have spent countless hours celebrating our healthcare heroes. We are so grateful to everyone who has worked tirelessly to fight the coronavirus pandemic and all of the challenges it has presented. However, we know gratitude alone is not enough — healthcare workers are physically and emotionally exhausted, and they need a helping hand. A recent survey done by Mental Health America showed 93% of healthcare workers were experiencing high stress levels, and 76% were feeling the symptoms of burnout. Healthcare workers are absolutely essential to keeping our society up and running, but they need support and relief from the stress of their daily work.

Read on to learn more about the mental health challenges facing healthcare workers, as well as what they (and their organizations) can do to take care of themselves.

Healthcare workers face a unique set of mental health challenges

Healthcare workers are on the front lines every single day. Whether providing physical health services in an emergency department or behavioral health services in a psychiatric unit, they are constantly face-to-face with challenging and tiring work. Behavioral health providers in particular deal with difficult, heavy subject matter so often they can become desensitized to their work — or end up taking it home with them after clocking out.

During COVID-19, these challenges only amplified. Visits to the emergency room drastically increased, particularly for children and adolescents. Rates of suicide and substance relapse have both skyrocketed. And, the already high demand for psychiatric providers grew even higher as the U.S. faced a mental health crisis. Through it all, providers started seeing more and more patients in crisis, all while trying to manage their own personal lives and health — a combination that can lead to burnout.

If healthcare providers are struggling with their mental health, they’re not going to be able to take care of others as well. Some of the most common symptoms of burnout are isolation and avoidance. Providers may start to withdraw from their teams, becoming less involved in the workplace and less enthusiastic about clocking in every day. They may also avoid seeking care, convinced they can deal with their mental health challenges all on their own — which can lead to difficulty with focusing, concentrating, and decision making.

Healthcare providers need to keep up with their own mental health to ensure they are making the best decisions for their patients.

Provider burnout affects both providers and their patients

Many providers fall into the trap of thinking they’re not as susceptible to behavioral health conditions as their patients are. After all, they’re trained mental health professionals. However, no one is immune to mental health conditions or challenges — even psychiatrists and behavioral therapists.

If you are in a leadership role within your organization, consider taking preventative measures to ensure your providers are getting the support and resources they need. Some warning signs someone may be struggling with burnout are:

• They are more irritable than normal
• They aren’t attending team meetings, and seem to be withdrawing themself
• They lose interest in activities or job tasks they used to enjoy
• They are making more mistakes on the job
• They seem to be more and more tired every day

A lot of provider burnout comes from being overworked, and some level of burnout is almost inevitable after the past year. However, it’s important to give your team the rest they need. Encourage your healthcare workers to prioritize both their physical and mental health and allow them to take time away from work when they need it.

One of the most important things you can do is have an open line of communication with your team and set realistic expectations for them. Being a healthcare professional is a challenging job, and your team should have a clear picture of what that looks like within your organization.

Resources are available to help

Fortunately, there are online resources readily available to help both providers and organizations dealing with burnout. One of the best sources is the Substance Abuse and Mental Health Services Administration (SAMHSA). Check out their comprehensive guide on dealing with stress and compassion fatigue and dive into what compassion fatigue looks like in providers.

Another resource available to your organization is telepsychiatry. Many organizations struggle with provider burnout because the few behavioral health care workers they have on staff are overworked. At Iris Telehealth, we understand the shortage of behavioral health care workers and want to work with your organization to bridge the gap. We recruit the best psychiatrists and psychiatric nurse practitioners from around the country and connect them with organizations in need.

Healthcare workers: let yourself rest

Mental Health America’s recent study on provider burnout gave us the startling statistic that 82% of healthcare workers feel more emotionally exhausted now than they did just a few months ago. Even more startling is over 40% of those participants said they didn’t feel like they had adequate emotional support. You should never feel ashamed to reach out for help, regardless of your profession. We’d like to leave you with a resource list in case you ever do feel the need to get help:

• SAMHSA’s National Helpline: 1-800-662-HELP
• The National Alliance on Mental Illness (NAMI)’s Resource Guide: Top NAMI HelpLine Resources | NAMI: National Alliance on Mental Illness
• National Suicide Prevention Hotline: 1-800-273-8255
• National Health Services Mental Health Helpline: call 111

We understand that the healthcare industry is physically and emotionally taxing, and we’re so grateful to providers everywhere for all that they do. If your organization is feeling the weight of increased numbers of patients and burnt-out providers, contact us today. We’d love to talk to you about the difference telepsychiatry can make in your practice!

The holidays are supposed to be a time of joy, but for many people the holiday season is a time of sadness and loneliness. With the isolation, health concerns, and financial challenges brought by COVID-19, mental health professionals expect holiday depression to be much worse this season.

COVID-Related Stress Disorder is Very Real

“There is a greater degree and intensity of anxiety, stress, and depression because of the pandemic,” says Thomas Milam, M.D., a board-certified psychiatrist and Chief Medical Officer of Iris Telehealth.

“Those who were previously struggling with depression, anxiety, and substance abuse are especially vulnerable at this time,” he says. “We don’t do well when we’re alone and suffering from depression and anxiety, so the isolation to prevent the spread of COVID-19 makes depression more difficult.”

For those who have lost jobs, the pandemic’s financial strain is also contributing to stress and anxiety. “I have admitted people to the hospital who are suicidal because they are tired of the stress of COVID, and tired of the financial pressure on their family without seeing an end in sight. They feel helpless about being able to do anything about it,” Dr. Milam says.

Chronic stress makes certain health conditions, including high blood pressure and diabetes, worse because of the inflammatory chemicals produced by the brain when we are stressed that circulate throughout the body.

How You Can Cope with Added Stress this Holiday Season

Dr. Milam has witnessed resilience on the part of patients and their families who have adapted to their situation. Many have been using video platforms, such as Zoom and FaceTime, to keep in touch. He notes that with the upcoming COVID-19 vaccines, there is reason for optimism that 2021 will be a better year.

In the meantime, Dr. Milam offers these tips for coping with the current impact of COVID-19 and holiday-related stress:

• It’s okay to “own” your stress. You don’t need to be stoic or pretend everything is fine. Expressing your feelings with family and friends is especially important during times like these.
• Make an effort to connect with people via phone or text to find out how they are doing.
• Don’t abandon healthy habits. Exercise helps. Take a walk outside. Do some stretching or find online classes such as yoga. Eat healthier foods, including fruit and vegetables.
• Take slow, deep breaths three times each day to increase your feelings of well-being. Also, listening to music, meditation and prayer can be helpful.
• Try to make someone else’s day brighter with a small act of kindness or a compliment. Doing something positive can help you feel better.
• Avoid excessive news and social media that increase your stress and worry.
• Be careful about alcohol use, substance abuse, and long-term anti-anxiety medications. Prescriptions for anti-anxiety drugs such as benzodiazepines have increased by 30 percent since the start of the pandemic. For short-term use, they are fine, but they can be habit-forming when taken long-term.
• Seek professional help if needed. Symptoms of depression include lack of energy, trouble sleeping or concentrating, and having little interest in things you normally enjoy. If those feelings persist for more than two weeks, it’s wise to seek help. The National Suicide Prevention Lifeline is open 24/7 for anyone in a suicidal crisis or emotional distress.

Tips for Helping Children

Children also may be experiencing anxiety. Symptoms include irritability, wanting to be held more than usual, or having stomach discomfort or headaches.

Dr. Milam offers these tips for reducing anxiety among children:

• Encourage children to express how they’re feeling.
• Reassure them that things will be okay.
• Maintain routines and keep to everyday schedules, such as eating and going to bed at the same time.
• Communicate frequently. Text older children throughout the day, even when they are in the same house, and ask them how they’re doing.

People who need to be cared for by a psychiatrist often face challenges accessing that care due to the nationwide shortage of psychiatrists and other mental health professionals, especially in rural areas. One bright spot from the disruption caused by COVID-19 is the dramatic rise in the use of telehealth services, which increases access to medical professionals, including psychiatrists and other mental health providers.

In data published by the Telehealth Impact Physician Survey of almost 1,600 health care professionals, more than 75 percent said that telehealth enabled them to provide quality care for patients with COVID-related mental health and other health issues.

Telepsychiatry Has Opened up a New Way of Providing Care

“With telepsychiatry, care is now patient-centric rather than clinic-centric, and studies indicate that patient satisfaction is high,” says Dr. Milam. He adds that providing patients with easier access to care also has reduced the number of emergency department visits for mental health issues.

At Iris Telehealth, we work to further increase behavioral health accessibility by connecting community mental health centers, community health centers, hospitals, and health systems with telepsychiatry providers. If you’re looking to speak with a psychiatrist via telemedicine, contact your primary care physician or your local health center. If you’re a health organization looking to expand your psychiatric services, reach out to us and we’ll get the conversation started.

Telepsychiatry has expanded rapidly in recent years to meet the demand for psychiatric care. As patients and providers became more familiar and comfortable with the virtual care space during the public health emergency (PHE), they encountered some unanticipated hurdles. One of these hurdles was figuring out how to safely collect patients’ vital signs when they may no longer be required to go to on-site offices and clinics to receive care.

The following five points outline opportunities providers and organizations have to adjust their operations for safely and effectively collecting patients’ vital signs and other data with telehealth and remote patient monitoring.

1. Have individuals acquire their own remote patient monitoring equipment

Patients may acquire home-based remote patient monitoring equipment, such as scales and blood pressure cuffs, for personal or shared use with their families. Like a family thermometer, remote patient monitoring equipment in the home will likely become more common and affordable over time. Increasingly, the equipment has Bluetooth capabilities. Data readings can be linked to mobile devices for personal tracking. The data can then be uploaded into secure patient portals. In these portals, patient data is shared with an individual’s healthcare team.

Many local pharmacies and large retail stores now offer on-site equipment and services for patients needing home equipment to obtain accurate routine vital signs like blood pressure, pulse, and weight. This equipment is becoming increasingly available in community spaces such as schools, workplaces, and local community and public health centers.

As smartwatches and fitness tracking devices continue to increase in popularity, many of these wearables can also be used for telehealth and remote patient monitoring devices, involving minimal restrictions or impact on a person’s lifestyle. From wristbands and armbands to chest straps, patches, and clothing-based monitors, these devices offer the potential for more regular and consistent readings of many vital signs throughout the day and night. Some devices even track heart rhythms as long as the devices are worn and powered up.

2. Purchase and send equipment to patients

While store-bought equipment like digital thermometers, blood pressure cuffs, and diabetes monitoring equipment have become more accurate, reliable, and affordable, they are generally not cheap. While patients with Healthcare Savings Accounts (HSAs) can increasingly use those funds to purchase remote patient monitoring equipment, some clinics have found grants to support purchasing and mailing remote patient monitoring equipment for patients to use at home.

This option increases the accessibility and affordability of the equipment for patients, particularly those who the pandemic and inflation have financially impacted.. Such equipment may require ongoing updates, upgrades, or servicing to maintain accurate readings, so it is important for patients and their healthcare teams to understand and comply with all the terms of use of any equipment used for remote patient monitoring purposes.

3. Extend times between patients for in-office vitals

In locations where clinic offices are open and staffed, before and after normal office hours, patients can have their vitals taken in the office on a “drop-in” or “drive-by” basis. Patients should ask their healthcare providers if these options are available at their local clinic, and discuss the frequency and type of services that would best meet their patient’s healthcare needs and goals.

4. Utilize information from other providers

Coordinating patient care with other providers at different healthcare sites can be challenging. Still, increasingly Electronic Health Records (EHRs) and EHR-based patient portals can promote effective and HIPAA-compliant sharing of important health information such as routine vital signs, glucose monitoring, and other important patient health data.

Suppose patients are seeing different providers or specialists in other locations. In that case, even if those visits are conducted remotely, the patient should ask the clinic staff how their vital signs, and other health information, can be safely shared with their other healthcare providers. Sometimes this request is as simple as signing a Release of Information to allow secure data sharing between providers.

5. Adjust requirements and expectations for vital signs

In the past, it has been reasonable to expect vital sign checks every visit for every patient, especially for patients seeking care for physical health issues. As hospitals, clinics, and healthcare providers and their staff continue to adjust their workflows to include remote patient monitoring, telehealth, and “hospital-at-home” models, expectations for patients and providers also need to evolve.

Providers should carefully consider which patients it is medically necessary to obtain vitals from and at what frequency. This consideration is critical since getting this information from every patient on every visit is much more challenging in a telehealth setting.

Empowering patients to be informed and involved in their ongoing healthcare decision-making and workflows, including vitals management, is critical to meeting the demands of patients, providers, and healthcare organizations.

If you’d like to learn more about how you can incorporate telehealth and remote patient monitoring into your behavioral health approach, contact us today. We’d love to chat through your options and help you determine the best steps forward in achieving the best patient care possible.