Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And we're here today to highlight the Pediatric Mental Health Integration Program with Dr. Corinne Catarozoli. She's the Co-Director of Behavioral Health Integration and Innovation at New York-Presbyterian Hospital-Weill Cornell Medical Center, and an Assistant Professor of Psychology and Clinical Psychiatry at Weill Cornell Medicine.

Dr. Catarozoli, it's a pleasure to have you join us again. I'd like you to start by telling us about the crisis we're seeing with mental health in our youth today. Have you seen this increase in anxiety, depression, eating disorders, and other disorders in our children and teens over the course of the last few years? Because I feel like we're in a mental health epidemic with our kids, and I've seen it with my friends. I've seen it all around, yeah?

Corinne Catarozoli, PhD: Yes. And thank you so much for having me. And you're right, the youth mental health crisis, which started alongside the COVID-19 pandemic back in 2020 is ongoing. We see continued rise in rates of anxiety, depression, suicidality, and other mental health concerns among children and teens. And we've had some really unprecedented statements administered by a variety of different organizations really underscoring the concern about these trends.

So in 2021, the U.S. Surgeon General issued an advisory on youth mental health. And around the same time, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children's Hospital Association jointly declared a national state of emergency in children's mental health.

So, we have seen this concerning trend continue now, you know, several years later. We have various CDC data showing there's an ongoing risk for youth and teenagers, and these trends are alarming. We're really concerned about this worsening rate and what goes along with that, which is a really high demand for care.

Melanie Cole, MS: So, let's expand on that, doctor. How has the mental health crisis impacted access to care for children and adolescents? I personally know a few of my friends who are having trouble finding mental health professionals for their children and their teens and their 20 somethings. And I myself was looking, and there's online access and such, but there is such a lack of providers in this epidemic that we're in.

Corinne Catarozoli, PhD: Yes. It's a really tough climate to find providers who have availability, because we have this huge increase in demand for care. So, more youth than ever have been looking to find a mental health specialist. And this was really layered on top of a longstanding workforce shortage. So, dating back even many years, even prior to the pandemic, there's been a national shortage of child and adolescent psychiatrists and psychologists. So, when you put these two things together, you get really a perfect storm of these huge, weightless, really a lack of availability. So, kids can't get care in a timely manner. They can't access care at the time that they need it. So, what happens is that problems get worse when they're untreated. And that is contributing to this escalation in severity and acuity that we're seeing over time.

Melanie Cole, MS: I agree. And it is definitely a concerning time and it's a challenging time for mental health. I'd like you to tell us about your program. How did it come about? Discuss the Behavioral Health Integration and Innovation Program at Weill Cornell Medicine and how it's positioned to address pediatric mental health concerns.

Corinne Catarozoli, PhD: Sure. Given this unprecedented need that we're seeing here at Cornell and across the country, we have realized that we really need to innovate to meet this demand, and we need new models of care. The traditional mental health care delivery system that we used for youth just isn't sufficient to meet the capacity of the youth accessing or needing care today. So, we've come up with kind of a new model. It's based on what's called integrated care. And this has been identified as a potential solution to the mental health crisis and just improving mental health care access across the board.

So, integrated care is when mental health providers are embedded into medical settings, like pediatrician's offices or specialist offices like neurologists or GI doctors. So, children can receive their mental health care right alongside their physical care. We have put these two concepts on par, and this is a way to make mental health treatment, mental health assessment, and screening really available to the settings where children present the most frequently.

Melanie Cole, MS: Wow. What a comprehensive program. That's awesome and so needed. Talk about the medical settings that your providers are embedded in, because that goes along with the multidisciplinary approach and need for these children.

Corinne Catarozoli, PhD: Yes. First and foremost, we focus on primary care. We know that kids present to their pediatricians many, many, times a year for their annual well visits, for many sick visits, to get school forms, and camp forms signed. So, I feel like I'm at the pediatrician's office with my own kids all the time. So, this is a really great place to catch mental health symptoms and to be kind of on the front line of first identifying any concerns. So, we've put a big emphasis on primary care.

And then, next, we moved into specialty care. So, at Cornell for a long time, we've had psychologists integrated into several of our subspecialist divisions in Neurology, GI, Endocrinology, and Sleep Medicine. But just last year, we were able to open up to all of our other pediatric specialties. So, everything from Cardiology, Pulmonology, Allergy, Genetics, Hem-Onc. If your child is coming in to one of these divisions for care, you simultaneously have access to psychological service alongside your medical care. So, this has been a really big broadening of the audience that we are able to offer these services to.

And then, even more recently, we've expanded into the pediatric surgical service. So, we have providers supporting children pre-op before their surgeries, during their actual medical admission, while they're inpatient in the hospital, and then along with post-op recovery, helping them kind of adjust following surgery. So, that's a new initiative that we've launched just this spring.

And then, lastly, we've also recently expanded to critical care where we are seeing children in a pediatric ICU followup clinic, so any child who has been admitted to our PICU in the hospital. Once they're discharged, they can be seen by our psychologists to continue to support them following that really stressful situation.

So, we're excited about the expansion that we've had recently for these services. Because now, really at any point of care that a child is coming to Cornell for any sort of medical concern or just regular routine pediatric care, they can also be seen for mental health services.

Melanie Cole, MS: What about on the inpatient side, Dr. Catarozoli? If a child has a violent outburst or a mental health crisis, or God forbid, you know, any of these things that we hear about with our kids, what is the inpatient situation like?

Corinne Catarozoli, PhD: Yeah. So, we have inpatient Psychiatry services for children who have acute mental health needs. We have child units, adolescent units, and some specialty units like eating disorder treatment. And we also, on our medical side for children who are hospitalized for a medical reason, anything from a broken bone to inpatient care for cancer diagnosis, we've had a long time established consultation liaison team that for many years has provided services to our children hospitalized in those units made up of both Psychiatry and Psychology. And in recent years, we've been able to expand our psychology services, in particular, offered in this setting. So, we even have a psychologist round with the inpatient medical team now. And this is a way of truly embedding mental health considerations into care and to have this as part of the conversation when we're making a plan of care for a child in our hospital.

Melanie Cole, MS: Tell us a little bit about the benefits that are associated with providing care in pediatrician's offices and other medical settings, because the medical home seems to be an overarching theme of where we first, as you said, you're at your pediatrician all the time. I remember when mine were little. Oh, my goodness. You know, I think our pediatricians are the gold standard. And boy, are they amazing. So, that is the first place. That's the starting point. Tell us a little bit about how that all ties together.

Corinne Catarozoli, PhD: Exactly. Our pediatricians are, for families, some of our most trusted providers. We've often had longstanding relationships with them. Maybe you've been going to that office since your child was an infant. So, parents are comfortable there. Children are comfortable there. Just like you said, it's your medical home. So, we like to say there's no place like your medical home as a place to get care.

So, because of this trusting relationship, that can really improve the uptake of a referral. Imagine the difference in a referral where a pediatrician says, you know, I have some concerns that your child's anxiety is becoming disruptive. Here's a referral to go to a mental health clinic in some other location in some other place you've never been or heard of. And then, you call that clinic and there's a waitlist and oftentimes what happens is there's no followthrough. That referral is sort of lost. Whereas if they can say, "You know what, we have a provider. They're just down the hall. I'm going to grab them." They're going to come in and say hi and talk to you quickly and then you can schedule another visit to follow up with them right here in our clinic where you've been coming all of these years. So, there's many, many advantages to having this care located in the same place where a child is getting their pediatric care, their well care.

There's also this idea of early intervention that with pediatricians having these regular contacts with children, they can catch things earlier. They can catch symptoms before they worsen, and there's almost always an improved prognosis with early identification. So, that's a real advantage as well. And ultimately, this model improves access. So, we are able to get kids in quickly, they can get care right away at the time when their symptoms are most interfering. And then, it also reserves our specialty slots. So, in our Psychiatry clinics where we have highly specialized providers, we reserve those spots for more complex clinical cases that really need it the most. And some more mild or mild to moderate symptoms can really be managed without taking up one of those spots. So, it kind of improves the utilization of all of our services overall.

Melanie Cole, MS: What an amazing program you've helped to create, Dr. Catarozoli. As we wrap up, what's your vision for the program? How do you feel that this care model improves the way that our youth, these patients, and the mental health epidemic that we're seeing receive their care and why this continuum of care is really so important for success?

Corinne Catarozoli, PhD: Our vision is to put mental health on par with physical health, so whether it's your pediatrician, your subspecialist, or a hospitalist who are making these considerations right alongside our physical health treatment. And for families, embedding this into their understanding of their child's overall well being is critically important. So, our overall vision of improving access is critical for treating all the mental health concerns that we're seeing with the youth mental health crisis right now and for providing really holistic, comprehensive care for our children.

Melanie Cole, MS: Thank you so much, Dr. Catarozoli, for joining us today, sharing your incredible expertise and for all the great work that you're doing. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts, Spotify, iHeart, and Pandora. And for more health tips, go to weillcornell.org and search podcasts. And don't forget to check out Back to Health. We have so many great podcasts there as well. I'm Melanie Cole. Thanks so much for joining us today.

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