Objectives
In low socioeconomic (SE) areas, with disproportionate resources for health care, the COVID-19 pandemic has exacerbated the mental health challenges among children and adolescents. The AACAP and the AAP have jointly declared the National State of Emergency in Children’s Mental Health, highlighting the need for collaborative work to reduce the risk of suicide, depression, trauma, loneliness, and anxiety among youth. A quality improvement study was designed to teach basic psychotherapy tools by psychiatry, pediatric, and family medicine residents/fellows and social workers, in an attempt to decrease utilization of higher level of care. Our second objective is to introduce this effective model of coping skills to reduce the rate of emergency room (ER) visits in low SE areas.
Methods
This fellow-run quality improvement project included kids (5-17 years old) who presented to the child and adolescent outpatient clinic from April to May 2022, and to follow up with them for 2 months. Three brief sessions comprising psychotherapy skills like paced breathing, progressive muscle relaxation, CBT skills for anxiety tools, and meditation management will be implemented. A review of clinical characteristics including diagnosis, medication, and treatment compliance will be compared. The Screen for Child Anxiety Related Emotional Disorders (SCARED) rating scale will be used to assess symptoms of anxiety at the start and end of the follow-up.
Results
The total sample (N = 164) was comprised of 40% children and 59% adolescents (male 55%, female 45%), mostly Hispanic (54%) and African American (15%), with the rest mixed. Data have shown that the most prevalent diagnoses were ADHD (56%), anxiety disorder (29%), MDD (23%), ODD (16%), DMDD (10%), and psychosis (1%). Among patients with anxiety disorder, 80% were on medications. Out of 47 patients with anxiety disorder, 22 consented for therapy skills sessions; written material was provided for practice and follow-up. All participants have rated the sessions highly and have been compliant with follow-up appointments.
Conclusions
The incorporation of a pathway model of psychotherapeutic coping skills can help children and adolescents suffering from anxiety/panic attacks, depression, and self-harming behavior, provide increased mental health care in outpatients, and decrease ER visits and inpatient admission. It is readily available, does not require specialized training, and improves compliance with future appointments.
ADOL, AD, P