Model & Strategy
The U.S. has a long-standing children’s mental health crisis. In 2013, research began to surface citing the now routinely-circulated statistic that one in five American children lives with a mental health disorder, in most cases: ADHD, anxiety, behavior problems, or depression. COVID-19 exacerbated this crisis. For example, the percentage of high school students who reported experiencing persistent feelings of sadness or hopelessness grew by 50% from 2011 to 2021 and jumped an additional 15% from 2019 to 2021. Additionally, from March 2020 to October 2020, mental health-related emergency department visits increased 24% for children ages five to 11 and 31% for ages 12 to 17, compared to 2019 emergency department visits. Unfortunately, most frontline health care workers do not receive adequate mental health training during their formal education.
While the need for clinicians who can provide children with appropriate and effective mental healthcare has risen, the health provider population has been overwhelmed by the demand for assistance. Even prior to the pandemic, CDC data indicated that only 20% of children with mental health disorders received care from a mental health provider. Many children and families who actively seek out care must wait for months before receiving care due to the shortage of providers; lack of access to mental health treatment is especially prevalent in high-need and marginalized communities. On average, it takes eight to 10 years for a child to receive treatment after symptoms first appear.
Intensive and sustained training is the cornerstone of REACH’s response to the children’s mental health crisis. REACH’s Patient-Centered Mental Health in Pediatric Primary Care (PPP) program integrates interdisciplinary research to increase practitioners’ awareness of and facility with best practices in mental health. REACH draws from evidence-based research in medicine and mental health to highlight high-leverage best practices that PCPs should prioritize in serving their child and adolescent patient population. REACH Institute’s PPP program includes: 1) a dynamic three-day, 17.75-hour interactive course focused on building skills and confidence in diagnosing and treating pediatric behavioral health problems; and 2) a six-month case-based follow-up program through which participants join 12 bimonthly, one-hour group conference calls with national primary care and child/adolescent psychiatry experts to solidify their learning. Through the PPP program, a wide range of PCPs, including pediatricians, nurse practitioners, and physician’s assistants, build their skills and confidence with the diagnosis and treatment of high-incidence child mental health disorders like anxiety, depression, and ADHD. The program trains clinicians to diagnose and treat mental health conditions they see every day in practice, allowing them to manage the most common issues themselves and saving referrals to mental health specialists for complex cases.
Over the next five years, REACH plans to scale their model to train 16,000 PCPs to support 5M children and families through expanded trainings and by growing the number of sites licensed to provide REACH training through their train-the-trainer program.
Lisa Hunter Romanelli, PhD is a practicing clinical child psychologist with expertise in cognitive behavioral therapy. She came to REACH from Columbia University College of Physicians and Surgeons, where she was an Assistant Professor of Clinical Psychology in Psychiatry and Director of School-Based Mental Health Programs at the Center for the Advancement of Children’s Mental Health. Dr. Hunter Romanelli completed an internship and post-doctoral fellowship at the Yale Child Study Center. She earned her PhD degree from Rutgers University and her BA from Harvard University.
To date, REACH has trained 6,000 PCPs. Every REACH-trained PCP has the capacity to support approximately 250 children with mental health concerns per year.
Approximately 1.5 million children receive mental health care from REACH-trained PCPs annually.
Over the next 5 years, REACH plans to scale their model to train 16,000 primary care providers to support 5 million children and families.