Washington-Area Pediatricians Start to Tackle Trauma

CFSA doctor

by Marie Morilus-Black

As part of a District-wide effort to address trauma, local pediatricians are doing their part by actively seeking opportunities to identify mental health concerns, including those that are trauma related, in their patients through the Mental Health Screening in Primary Care Learning Collaborative said Dr. Lee Beers, medical director for Municipal and Regional Affairs of the Child Health Advocacy Institute at Children’s National Health System.

Guest blogger: Dr. Lee Beers

In addition to mCFSA, traumaental health, trauma can have an impact on physical health as well.

“Many studies show that exposure to traumatic events in early childhood can increase risks for heart disease, diabetes, high blood pressure and other health conditions,” she said. “The more adverse childhood experiences you have, the greater your risks of health concerns. The impact on your physical health can also affect your ability to implement your recommended treatment.”

Pediatricians just don’t have all of the tools to address trauma and it’s something that requires community support and a community response, according to Dr. Beers. Building the necessary relationships to tackle trauma is difficult for a provider who’s seeing patients all day, but we want to help facilitate those relationships – pediatricians can be important connectors as they have regular touch points with children and families and play an important role in the system of care.

“Part of the reason that we wanted to focus on mental health in the first place is because there is this huge issue of unmet mental health needs in the city impacted by high rates of violence that complicate and aggravate mental and behavioral health issues,” said Dr. Beers. “A lot of providers were seeing that our families were struggling with mental health concerns; while the providers had some training, it was not sufficient for what they wanted.”

And even though the pediatricians haven’t formally started using Trauma Systems Therapy, the training that Washington, DC-area primary care providers have undertaken was designed to shore up their trauma-informed knowledge base.

“The primary care environment is different from some of the other environments that have longer periods of time to spend with children and families. From a time standpoint, it’s pretty important to have briefer and more efficient ways to identify concerns and connect them with the diagnostic and treatment services that they need,” said Dr. Beers.

Children’s National started hosting a nine-month learning collaborative funded by DC Behavioral Health and Health Departments in February 2014 that focused on general mental health screenings. The training ultimately expanded to 15 months in large part because the pediatricians requested even more support.  These trainings involved monthly webinar, conference calls and chart reviews.

CFSA doctor 2

“The day-to-day  work of health care is pretty different than other systems, so we’ve adopted strategies that can be integrated into our existing workflow,” Dr. Beers said of the 140 providers who have participated across the city – representing about 80 percent of the children on Medicaid. “Each practice reviewed charts to see how well they did with the mental health screenings and saw really nice improvements.”

The providers are seeing more identification and recognition of signs of trauma and are using this training as a tool to address mental health in a substantive way.

“What we’re finding is that kids are getting identified earlier by integrating mental health in a variety of ways into primary care practices,” she said. “As a result of these screenings, a lot of children are coming to the attention of behavioral health providers.”

The hope for the next stage of this work will include looking at how to pilot trauma screening over the next 12 months.

“We’re working with a lot of folks from across the city to think about how we engage in a comprehensive, citywide approach to preventing, identifying and addressing trauma,” she said. “The health care systems haven’t always been well-connected with that but are trying to become more connected so that we can all work collaboratively together.”

Dr. Lee Beers is the medical director for Municipal and Regional Affairs of the Child Health Advocacy Institute at Children’s National Health System.