Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Thanks so much for joining us today. We're talking about pediatric access to telemental health services or the PATHS program here at Children's of Alabama. This program just received a HRSA grant of 1.5 million dollars to continue the great work that they're doing here at Children's and in the state of Alabama. Joining me now to discuss this more is Dr. Vinita Yalamanchili. Thanks so much for your time today.

Vinita Yalamanchili, MD: Thank you so much for having me.

Host: So let's talk a little bit first about the PATHS program and kind of what the specific goals are of it. What is the purpose of this program?

Vinita Yalamanchili, MD: Well, this has really been a remarkable, um, program to provide outreach and to provide treatment for many of our rural communities. That's how it started, was to increase, um, treatment for our rural communities through our primary care providers. And so, um, we started first with the rural communities. They'll call in with their questions, and then, you know, depending on, um, who they need to talk to, our social workers will kind of route them to those necessary providers.

Host: So with these rural communities, what are some of the challenges that they were facing that kind of created a need for this type of service?

Vinita Yalamanchili, MD: So unfortunately, there's just not enough child psychiatrists. There's a huge shortage of child psychiatrists. Um, and as we all know, the mental health needs of children have increased exponentially. There's just no way we can match those needs. And our pediatricians and our mid-level providers are the ones that are actually probably providing a majority of psychiatric services to children without having a whole bunch of training for this when they were, you know, in residency or through their training.

So what this has actually provided is pretty quick access to a mental health provider, um, because typically it was taking, um, patients three to six months to see a therapist or a psychiatrist. Um, and also, you know, in some of our rural communities, they are so far away from Birmingham. So they might be, you know, traveling two hours for an appointment is not feasible for some parents who have kids with disabilities or transportation, financial issues. Um, so it's great because they can come to their pediatrician's office and get those services.

Host: You talked about that three to six month waiting period. How, how difficult is that for a child who really needs a service pretty much immediately?

Vinita Yalamanchili, MD: Um, it's very difficult. It's very difficult for the child. It's very difficult for the parent, um, as well as for the pediatrician. Because the mental health needs are, you know, they will affect them in their school, their school performance, um, with their peer cohorts, like how they interact with them, um, so a lot of these children are in crisis and if you have to wait three to six months, I mean, you're losing a good part of a school year, you know, and then a lot of concerns are about safety and depression and suicidal risk, so kids can't wait three to six months to get treated for that, you know, because they could harm themselves. So it's a huge problem.

Host: So how quickly with the PATHS program can they get the assistance they need?

Vinita Yalamanchili, MD: Um, so we, um, promise them that they will get a response within 24 hours, um, and, um, typically they probably get a response within a couple of hours. Um, the providers, whether they're the mid-level providers or our pediatricians will call in and talk to our, um, social workers and give them the preliminary information, um, and um, if it's a medication question, then I'm usually the first point of contact. I'll review the information, I'll gather more information that I need, and then, um, I will tell the provider exactly, you know, how to prescribe the medicine, and give them different options.

Host: So basically, you're providing a consult for the provider, to let them know how to help this child that's in need.

Vinita Yalamanchili, MD: Yes, yes.

Host: What are some of the other components of PATHS, and the different ways that you help both the providers and the kids?

Vinita Yalamanchili, MD: So, you know we, we see children, or we hear about children from typically about 3 until 18. So sometimes the younger children don't need medications. They just need some therapy. Um, and so the providers don't always talk to a physician. They may talk to our early development specialist. Or they might talk to one of our psychologists about sleep training or behavioral management. You know, those kinds of things. So it's not always a medication question. Um, if it is a medication question and I am not able to, um, provide relief after one or two consults, then we can also provide telemedicine services.

Um, and what's also very helpful with these telemedicine services is that the patients don't have to come all the way to Birmingham to see us. They actually have to come to the pediatrician's office. Um, we have an iPad set up there. And our, um, psychiatrist will see them through the, um, iPad. And then again, we'll provide, um, recommendations for the pediatrician on how to treat those patients.

And they'll come back for follow up. So it's a really nice bridge until they can be seen by a local psychiatrist.

Host: And I know you mentioned that, um, you know, for anything related to medicine, you're the expert they'll talk to. But the program has a variety of different types of experts, right?

Vinita Yalamanchili, MD: Yes, we have social workers, we have, um, psychologists. Um, we have, um, early development specialists, um, so we have a pretty big team to kind of help. Not only do we provide, um, treatment recommendations, but we also provide resources. So, um, we have a great database of, like, who are all the therapists in different counties throughout Alabama. Um, and so that's very helpful because a lot of providers won't know what's in their area.

Um, and so, um, we also help with finding, we have a partial program here, so we can also help them make recommendations to our partial hospitalization program, or if they need hospitalizations, which hospitals are close. So, it's not just therapeutic services, but we also give a lot of information about mental health resources in their communities.

Host: It's a great way, I guess, of connecting these patients with the resources they need, even if they're in an area that may not necessarily have those resources.

Vinita Yalamanchili, MD: Absolutely. Absolutely.

Host: And I know you talked about rural areas and some of the challenges they face, and that's how this program started, but it's really expanded beyond that, right?

Vinita Yalamanchili, MD: Absolutely. Um, so we first started off with our rural communities, but now we have actually, um, expanded to our urban communities, and we have quite a few practices here in Birmingham that have taken on this opportunity because even though they are closer to us and they're closer to Children's, um, they also have the same waiting time, three to six months. And so they have a lot of kids in need, and we're able to provide the services for them as well.

Host: Has there been any way of measuring the progress that you've been able to make and the way that you've been able to make a difference in kids lives through this program?

Vinita Yalamanchili, MD: So I don't have, like, hard numbers, but just in my experience, you know, um, our director will send every week, she'll talk about how she's adding more and more practices, and I'll think, how will I have time to answer all these questions?

But what's really interesting is that, you know, um, a physician will call in a few times; and when I do the consultation, I also provide education. Um, and I explain. You know, these are the situations in which I prescribe this medication, and, um, if this doesn't work, you can try this. We discussed dosing, side effects.

So actually, after, like, a couple of times, and for the most part, the initial intervention that we make is very helpful and they don't call me back. But I also think because we provide that education, after a couple of calls, that same pediatrician might not call me for a while because they'll say, well, you've taught me enough, like now I feel comfortable doing this on my own for many patients.

Um, so like I said, I don't have an actual number, but it's interesting to see that like even though as we add more and more practices, it's, you know, our volumes, we have a good volume, but it's not like we can't manage it because I think the educational part helps them help other patients who they're not calling me about.

Host: That's incredible, and I guess that's got to be rewarding for you to see the progress that they're able to make and the way that they're able to help the patients.

Vinita Yalamanchili, MD: It's, um, it's, it's actually probably one of my most favorite jobs that I do, um, because you know, I am providing care very quickly to children and, um, the pediatricians are just so grateful for these services because, you know, I mean, I don't want to treat an ear infection. I don't know what antibiotics to give, you know what I mean? And so it's the same way as like they feel much more comfortable, you know, and supported and that they can prescribe these medications. Um, what's also very helpful is not only do they help; not only are we helping them, but they help me too. So, um, just this last week I was in the emergency room and we had a patient who is, um, part of, um, his physician is part of the PATHS program.

So I was able to tell that physician, like, hey, I saw him. I don't think he needs admission. I started this medication. I told him to come back to you in a week. These are what you're looking for. This is what you'll do next. So like, you know, I didn't have to worry that I started a medication out of the emergency room and he won't be followed.

Um, or that he's going to wait three to six months to get that medication adjusted because I can do that with his pediatrician, you know, through this program. So it kind of works actually both ways.

Host: Excellent. Well, uh, thanks for all the work that you're doing, and I know it's very rewarding work, like you said. Um, let's talk a little bit about the, the HRSA grant, 1.5 million dollars, more than 1.5 million, actually. What does that mean to this program and for the future of this program?

Vinita Yalamanchili, MD: Well, um, the HRSA grant, um, helps, you know, um, fund all of our, um, employees, so all of our therapists and our physicians, um, and our psychologists who provide the services in the PATHS program. Um, it also, um, provides, um, money for the trainings that we do. So we have something called Project ECHO where we, um meet with the pediatricians every two weeks. It's a, it's a lunch meeting. Um, one group of pediatricians brings in a case that we discuss. And then in addition to the case that we discuss, there's also a learning piece to that, um, to that particular case.

And so that provides the educational resources for that. Um, we have also trained, um, 20 therapists and social workers in the rural communities in certain types of therapies so that they can provide that. Um, so that everybody doesn't have to come into, you know, the larger city. So we're providing more training.

Um, and as I talked to you about previously, uh, when patients come in to do telemed services, um, that funding also pays for the iPads that we give to the pediatricians so that they can, um, you know, obtain the telemedicine services with our, um, psychiatrists. Um, and so, you know, it's going to really help fund the entire program.

Host: So y'all have made a lot of progress, done a lot of good work in the past, and have a lot of good things coming up in the future as well.

Vinita Yalamanchili, MD: Absolutely, absolutely.

Host: All right, once again, Dr. Vinita Yalamanchili with Children's of Alabama and the PATHS program. Thanks so much for your time.

Vinita Yalamanchili, MD: Thank you.

Host: For more podcasts like this one, go to childrensal.org or wherever you find podcasts.