Dartmouth Project Aims to Boost Child Psychiatry Skills in State

National reports show that one in four children will experience some form of trauma by the time they reach 18.

The trauma can range from witnessing a car accident or hurricane to being a victim of sexual abuse.

And studies say that about 40% of those children will likely develop Post Traumatic Stress Disorder - or PTSD.

The good news is that the latest treatment methods for PTSD in children have proven to be very successful.

The bad news is that there are only about 20 child psychiatrists in New Hampshire.

Craig Donnelly, a child psychiatrist at Dartmouth Medical School, says that the state needs at least twice that many.

Donnelly: “That number even nationally represents a shortage. The council on graduate medical education recommends there be about 15 per 100,000 population so we're significantly below where we need to be.”

To help address the shortage, Donnelly and his colleagues are piloting a project that uses web and video technologies to share their expertise with mental health clinicians in the state.

AMBI: Tele-session ….Good Morning Genesis……how's everybody doing….

You're hearing Donnelly mentoring a group of clinicians from Genesis Behavioral Health in Laconia.

Donnelly's sitting in a conference room at Dartmouth in Hanover.
And the clinicians are in Laconia.

They see each other on video screens.

AMBI: more chatter from session….

In this session, Donnelly helps them understand how to use a new treatment for PTSD called “trauma-focused cognitive behavioral therapy.”

Clinicians at Genesis have been through Dartmouth’s Web training – and they are now using the therapy with their child patients.

Dartmouth’s Donnelly says they plan to train clinicians in as many as 10 health centers in the state.

DONNELLY: “We can take advantage of the focal points of expertise we have in the state and be able to link up with distant places where patients actually live, and we can provide training and services for cutting edge evidence based efficacious treatments.”

Laura Deshene, one of the trainees, is a social worker at Genesis.

She says that since taking the training she finds it easier to identify and treat children who have PTSD.

Deshene described a 10-year-old girl who went through the treatment after she had been sexually abused for years.

Deshene: “She came in didn't want to talk about it. She was having multiple symptoms not sleeping nightmares that kind of thing. And as she went through this therapy she felt so much better and she is happier.”

Mary Brunette is the medical director at the state's Department of Behavioral Health.

She says that pediatricians have been taking up the slack left by the shortage in child psychiatrists.

Brunette: “I just spoke to pediatrician the other day and he said how can we get better mental health treatment into our office complexes. We had a conversation about this very problem …He said I see a ton of kids and I’m happy to see them but a lot of times their problems are bigger than I can handle and I'd like to be able to refer them to somebody like you. But there's nobody to refer to.”

Brunette applauds the tele-medicine project – but points out that it doesn’t solve all the issues.

She said that in addition to a shortage of child psychiatrists - turnover rates among mental health clinicians is about 50% per year.

Brunette: “Not sure why turnover is happening but one factor may be what we pay these clinicians. We know that reimbursement for publicly funded mental health is lower so it's hard to pay these folks a reasonable wage.”

So even if Congress does pass legislation requiring insurers to adequately cover mental illnesses - children who are uninsured or on Medicaid may still face obstacles to treatment.

For NHPR News, I'm Dianne Finch