Since Fall 2020, a team of six psychologists and two mental health resource specialists have been embedded in CHOC primary care locations in Garden Grove, Orange, Santa Ana, San Clemente, Irvine, Laguna Hills, and Aliso Viejo.
The Integrated Primary Care team, supervised by CHOC pediatric psychologist Dr. Christopher Min, sees patients when they come in for their primary care visits, thus filling a critical need since fewer than half of patients, studies show, follow up after receiving a referral from their primary care doctor to go see a mental health specialist.
With the youth mental health epidemic worsening amid a nationwide shortage of mental health experts, CHOC’s Integrated Primary Care team is more in demand than ever.
“For a lot of families, there’s still a stigma around mental health,” Dr. Min notes. “There are a lot of barriers, and the number of patients who follow up on mental health referrals are even lower for members of our low-resourced and non-native-English-speaking populations.”
The team is looking to expand its support in the future.
“The plan is to provide mental health support for all of CHOC’s primary care network,” Dr. Min says. “Our team is working on new, creative approaches to try and provide services to patients and also leverage other methods of treatment and education to reach as many children and adolescents as we can.”
Anxiety study underway
Dr. Min has been very involved in researching ways to better serve patients and their families.
He is co-investigator at CHOC for a large mental health-related study that includes four major pediatric healthcare systems (the principal investigator is Dr. Heather Huszti, CHOC’s chief psychologist).
The study, “Partners in Caring for Anxious Youth (PCAY),” involves treating children and teens with anxiety disorders for up to a year in the primary care setting.
Participants will be put into two groups: one where they will receive cognitive behavioral therapy (CBT), and the other where CBT will be used along with medication.
CHOC is a subsite for the federal grant-funded study that will involve 468 patients ages 7 to 17. The research project is in the recruitment phase.
Partners in Caring for Anxious Youth study details
PCAY is a follow-up study to one led by Lurie Children’s Hospital in Chicago in 2008 that showed that combining medications with CBT was the most effective treatment, followed by medication alone and, finally, CBT alone.
The new study, Dr. Min explains, will be more in depth. Unlike the previous study, it involves using community-based providers for therapy and the prescribing of medications.
Eligible participants in the PCAY study will complete questionnaires and diagnostic screening at CHOC and then be connected with local experts in anxiety treatment.
For patients receiving both types of therapy, they will see a specialist weekly for up to six months, for a total of between 16 and 20 sessions. If their anxiety disorder is in remission after that, they will receive CBT therapy monthly. Patients not in remission will get a new treatment plan and resume weekly sessions.
Parents and their children will be compensated for their time completing study-related materials.
Seeking a normal level of anxiety
Episodic anxiety is normal, Dr. Min says, but anxiety disorders aren’t.
“It controls your child’s life,” he says.
The PCAY study involves three types of anxiety disorders:
- Generalized anxiety disorder, in which a child may worry about a number of different things. They may try to be perfect and may be unable to handle uncertainty.
- Separation anxiety disorder, in which a child has a hard time being away from parents and might worry about bad things happening to them.
- Social anxiety disorder, in which a child worries about messing up in social situations and may avoid things like participating in class or going to parties.
CBT involves gradually exposing patients to anxiety-provoking situations in bite-sized pieces coupled with coping tools.
The Patient Centered Outcomes Resource Institute (PCORI) is funding the PCAY study.
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For more about CHOC’s pediatric mental health services