Dr. Raulerson working to help children

Brewton pediatrician says $2 million grant a step in the right direction; more funds needed

In an effort to better serve the underserved areas of rural Alabama, the Alabama Department of Mental Health and Children's of Alabama has received a grant of $2,009,323 that will help establish a pediatric telemedicine health network.

Modeled after a framework established 15 years ago by Brewton pediatrician, Dr. Marsha Raulerson, the network will consist of providers called the Alabama Pediatric Telemental Health Network and will use evidence-based telehealth methods to train, educate and equip rural primary care providers to support early identification, diagnosis, treatment and referral of children and adolescents with behavioral conditions.

The five-year grant will utilize the Alabama Department of Mental Health as the lead agency and Children's Hospital in Birmingham as the primary implementation partner.

Plans are that by the second year of the grant project, an Infant and Early Childhood Mental Health Consultant will be implemented to help professionals address social, emotional and behavioral issues in children under the age of 5.

Dr. Raulerson said she and Dr. Tom Vaughan, a child and adolescent psychiatrist at Children's hospital in Birmingham, worked together on the Medicaid Advisory Board when the American Academy of Pediatrics gave small grants to plan a telepsychiatric program.

“We have almost no services for children and young families from birth to 3, and the serious behavior issues that develop in children in mental illness, really start when their brain is developing in the first few years of life,” said Dr. Raulerson. “We are dealing with the fallout that we have almost no funding whatsoever in our state for well-trained childcare for young children. I think the K-4 program which now serves 25 percent of children in our state is a good step in the right direction, but they are 4 years old, and 90 percent of their brain is already developed. We just don't have the resources.”

Raulerson said that many people who work with children do not understand normal early childhood development and what is normal behavior. As a result, children may be exposed to abuse or worse at the hands of adults who are not trained to care for them, especially children who may exhibit behavioral issues or problems that could benefit from early intervention by professionals.

“When we decided to start this system, every child was supposed to have a case manager, every child was supposed to have a trained master's level mental health counselor to help follow the recommendations from the UAB psychiatrist,” she said. “We haven't had those things consistently. You have to have someone to connect with the school, to keep up with parents' appointments, help with transportation if needed. You need a psychologist, a master level person who is trained to help the children with behavioral management so they can be successful every day. We can't solve the problems day-to-day for these kids without a team.”

Dr. Raulerson said that case managers would get overwhelmed and transfer or change jobs, so a new case manager came onboard every few months.

“Mental health has had a lot of problems with staffing, with a high turnover of case managers,” she said. “If there's no case manager consistently, it creates a lot of problems with having kids seen in schools and follow-ups become difficult.”

Dr. Raulerson said Dr. Vaughan started seeing patients in her office through Skype in early January this year.

“Dr. Vaughan sees children with a mental health diagnosis once a month and I write prescriptions, I take calls from parents when there are problems, I send emails and I have constant contact with him,” she said. “The program is so successful, we have a 90 percent show rate, almost unheard of in mental health. It's particularly difficult in rural areas, where there is sometimes no access to transportation, and kids who need the services can't get to Mobile or Birmingham or Dothan where the closest child psychiatrists are. Being able to use telemedicine has been a way to connect children with the best-trained pediatric mental health specialists.”

Dr. Raulerson said the program has turned out lots of graduates who have gotten on with their lives and are doing well, but that there are also miserable failures, noting that some who have aged out are now having difficulty accessing mental health services as adults.

“The biggest problem is a lack of taxpayer money to fund mental health,” said Dr. Raulerson. “Mental health workers are poorly paid and don't stay in their job. It's really sad that children in rural Alabama have such limited access. We have such limited programs in Alabama.”

Dr. Raulerson said she talks to the Department of Human Resources, families who are having problems with the children, schools, and named a list of entities or people she had recently spoken with to try to help children who need help get it.

“Dr. Vaughn and I are really putting a bandaid on the situation, but without case managers, and master's level counselors who know how to work with children who are mentally ill, its been really difficult for us to help some children who have severe behavioral issues.”

Dr. Raulerson said the goal at the end of the grant's five years is to set up a system of care that works. If that system of care works, the funding has to be increased to the state department and mental health.

“I'm very excited about this grant,” she said. “I think it can help to build a system of care that will work for children with mental health needs. We can try to develop a team with this funding.”

 
 
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