Behavioral Health in a Pediatric Primary Care Office

(From the June 2018 Issue of MedStat)

Written by Brad Dickson, MD

Brad DicksonDr. Brad Dickson has been practicing pediatrics and pediatric mental health care since 1995 and since 1999 has been at Health One (formerly South West Pediatrics). He has three sons ages 22, 20 and 18. Dr. Dickson practices medicine and lives in Grove City, Ohio.

Health One (formerly South West Pediatrics) has been incorporating mental health diagnostics and treatment in earnest since I joined the practice in 1999. My interest and training in caring for patients with behaviorally pathologic diagnoses of the brain stemmed from personal experiences with children having mental illnesses and a recognition of the typically great intellect of children with mental health pathology. These patients are simply fascinating human beings to know.

To manage a large amount of children with serious mental health diagnoses in a primary care pediatric practice is an overwhelming but very rewarding endeavor. It is overwhelming work because of how complicated and time consuming their problems are to figure out and then in turn making a plan to help them attain functionality in life. It is typically an extremely emotional process for all parties involved as well. This ironically tends to be a large part of the rewarding aspect of treating these incredible children.

In concert with several groups of mental health specialists including psychologists, social workers, addiction specialists and psychiatrists, I evaluate and treat children with a wide variety of diagnoses including autism, ADHD, anxiety disorders, depression, initial illicit drug and alcohol assessments, sleep issues and academic failings. This encompasses children from elementary-school age through college years. I have become comfortable with prescribing a wide variety of psychotropic medicines including ADHD stimulants, SSRIs and SNRIs, atypical antipsychotics, mood stabilizers and benzodiazepines. One important tool we employ in the medicinal treatment of mental health diagnoses is the use of a cytochrome p-450 liver enzyme pathway genetic study performed by buccal swab (Genesight). I use this test to help us choose psychotropic medicines for individual patients using more science and less guesswork.

Since 1999, most of the mental health work in our practice has been done by me, with outside specialist help as described above. This is rapidly changing at Health One as our management is greatly expanding our mental health capabilities. We recently added a psychiatric specialized nurse practitioner and are likely bringing on another one soon. We are also in the process of recruiting licensed clinical counselors and psychologists to work in house to aid in diagnostics and treatment directions. With the increase in numbers and acuity of children with mental health diagnoses, the expansion we are having has become an absolute necessity. For example, I am regularly seeing five to ten children weekly with suicidal ideation and one to two a week who have made plans to kill themselves. And most disturbingly, over this last year, I am seeing one or two children each month who have seriously thought out homicidal plans and will explicitly map them out for me in my exam rooms. (If you have never had a discussion like that with a patient, it is absolutely chilling and not one detail will ever leave your mind)

My goal from the beginning as a pediatrician has always been to help children maintain their health and navigate through any illness as readily as possible. What I did not know as I started in private practice was the daunting journey I would take in learning what I have so far about children's and young adult's minds. It is frightening at times but incredibly enriching and humbling. It is a path I wish more pediatricians walked as I believe we will be a major factor (if not THE major factor) in turning the tide of the potential disastrous sequelae of childhood mental illnesses.

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