Dr. Seth Kaplan: A Warrior for Children’s Mental Healthcare in Texas and Beyond
TLC Pediatrics of FriscoFrisco, TX
Dr. Seth Kaplan: A Warrior for Children’s Mental Healthcare in Texas and Beyond
TLC Pediatrics of FriscoFrisco, TX
In the face of a declared national mental health emergency for children, Dr. Seth Kaplan outlines what independent pediatricians can do to support the fight for better mental health care.
A National Emergency
Even before the COVID-19 pandemic, mental health concerns and suicidal ideation in children had been on the rise since 2012, nearly a decade. As the physical toll of COVID-19 rises with hospitalizations, deaths, and the prevalence of “long haul” COVID, the secondary effects are still being understood. These secondary effects include a disturbingly sharp rise in mental health issues for all people, but especially the youngest and most vulnerable among us. The social isolation experienced in the face of school shutdowns and the loss of other social networks provided by activities such as sports and other extra-curriculars, combined with stressed parents and nationwide political unrest have proven heavy burdens on American children.
On October 19, 2021, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP) and Children’s Hospital Association went so far as to declare a state of national emergency in children’s mental health. One of the places where this troubling trend is being particularly felt? The state of Texas.
“Sometimes it seems that at-risk populations are actually under attack in the state of Texas.”Dr. Seth Kaplan
All Eyes on Texas
While Texas ranks third in mental illness prevalence, it also ranks last for access to care, according to a study conducted by the Meadows Mental Health Policy Institute in conjunction with the Rees-Jones foundation. Onto this trouble-laden stage steps Dr. Seth Kaplan of TLC Pediatrics in Frisco, TX, and immediate Past-President of The Texas Pediatric Society (TPS), the Texas chapter of the American Academy of Pediatrics. Explains Dr. Kaplan, “The rising children’s health crisis is of particular concern in a state like Texas, which ranks very low in many of the criteria that determine the overall health of our children such as rates of childhood obesity, activity levels, and screen time.”
Over the recent months, Dr. Kaplan has been tapped by his local media to advise the community regarding the safety and efficacy of COVID-19 vaccination for eligible youth populations. Appearing on local news affiliates for ABC, CBS, and other news outlets such as the Texas Tribune, Kaplan has been outspoken on the importance of vaccinating young children for COVID as it becomes recommended by the CDC and approved by the FDA.
“I was doing about a story a month, but the cadence has increased to almost weekly,” stated Kaplan. “What I have learned from the media attention I have received is how pediatricians can harness the power of traditional and social media to amplify important messages and create awareness around issues that may not be receiving the attention they deserve. That’s why I am using this opportunity to speak out regarding the current pediatric mental health crisis.”
Kaplan also expressed frustration at what he views as counter-productive legislative policy in Texas as it applies to LGBTQ+ youth, undocumented migrants, and unaccompanied minors who are entering Texas from other countries. “Sometimes it seems that at-risk populations are actually under attack in the state of Texas,” lamented Kaplan. “Even before the pandemic, we struggled with limited access to mental health care for these populations who have been targeted unfairly by state policy for at least 5-7 years.”
The additional pressures of COVID-19, lack of traditional support and reporting systems in schools, the strained mental health resources nationwide, and the politicization of medicine have created a perfect storm in which the most vulnerable children are not receiving the mental health treatment they need so desperately.
Even with laws passed by Texas lawmakers in 2019 requiring schools to train teachers and other school staff to address trauma, substance abuse, and confront suicidal ideation, there is still a long road ahead to truly support the children of Texas from a mental health standpoint. Compounding the problem is a woeful lack of child psychiatry access. The Department of State Health Services found that there is only one psychiatrist per 12,122 children in Texas, while The Kaiser Family Foundation estimates that only 34.5 percent of mental health needs are being met in the Lone Star State.
Although the state of Texas is still struggling its way forward in terms of better physical and mental health for its children, the strides made in 2020 with Dr. Kaplan at the helm of TPS have been promising. Two major initiatives have been enacted in the past 18 months that not only have the power to turn things around in Texas, but also to serve as models for other states hoping to address the national state of emergency for children’s mental illness.
Promising Developments
According to Kaplan, “One of our top accomplishments in 2020 is the development of our Child Psychiatry Access Network (CPAN) which supports collaboration between behavioral health and primary care practitioners.” CPAN was officially launched May 18, 2020. Through CPAN, pediatricians in Texas can access a network of child psychiatry help centers throughout Texas. Enrolled physicians can call CPAN to get real-time access to resources such as urgent assistance for patients, referrals to local mental health experts, and ongoing educational materials on mental and behavioral health disorders. “Physicians who call CPAN for assistance can expect a 30 minute or less response time, which has made an enormous difference for those who are seeing young patients exhibiting concerning symptoms,” explains Kaplan. “Most pediatricians are not really trained to recognize and treat mental illness in children. It’s important to address this unmet need in the field.”
The second advancement in mental health care for Texas Kaplan mentions is the funding of mental health training courses for Texas pediatricians through The REACH Institute, a 501(c)(3) non-profit organization “dedicated to ensuring that the most effective scientifically-proven mental health care reaches all children and families.” The REACH training was funded in part by a donation through Ascension Seton Medical Center in Austin, TX. The training was delivered via three-day workshops offered on an ongoing basis over six months and took the form of case presentations. It was also offered online due to COVID restrictions, enabling a greater swath of pediatricians to take part across the state. “The evidence-based training provided by REACH is invaluable as we look to empower primary care providers to join the fight against pediatric mental illness,” explained Kaplan. “In addition, this normally expensive training was paid for by an outside source, which encouraged pediatricians to partake who otherwise may not have been able to due to cost concerns.”
A Background in Treating the Whole Child
“While many pediatricians view mental health in children as an interest, there is not really much training provided to accurately diagnose and treat mental illness in children,” said Kaplan. By training primary care physicians, school staff, and other professionals to provide mental and emotional support to patients, it is possible to lessen the burden on the strained and understaffed mental healthcare system.
Dr. Kaplan first became interested in the mental health side of pediatrics 20 years ago in school-based health clinics when in residency at Boston Children’s Hospital and Boston Medical Center. There, Kaplan trained with pediatric behavioral health pioneers such as T. Berry Brazleton and Stephen J. Parker. “The training I received instilled in me a desire to treat the whole patient from primary care to mental, behavioral, and developmental care.”
Upon marrying and moving to Texas, Kaplan saw an unmet need. “In my experience, meeting the mental and behavioral health needs of patients was not much of a focus in the Dallas pediatric community.” Kaplan started his own independent practice in December of 2003 with a foundation built on his experiences addressing mental and behavioral health as part of primary care.
“Pediatricians are often faced with behavioral health concerns such as attention deficit hyperactivity disorder (ADHD). Addressing common issues such as ADHD allows pediatricians to dip their toes into the behavioral/mental health pool and get more comfortable assessing and treating the whole child.”
Five Action Items for Pediatricians
When asked what steps pediatricians can take right now to join the fight for better pediatric mental health, Dr. Kaplan offered five key takeaways which lead directly to actionable steps.
#1: Don’t be intimidated
“Many pediatricians shy away from diagnosing and treating mental illness in children, simply because they were never trained to do so,” states Kaplan. In these times when mental health care is so needed and yet so scarce, pediatricians should feel empowered to seek out resources and apply this knowledge to help their underserved patients. According to Kaplan, “Even offering simple, brief interventions in the form of short cognitive behavioral therapy (CBT) or mindfulness techniques can be doable in the primary care setting when practitioners seek out just a little additional training.
#2: Gather helpful resources
According to Kaplan, “It’s easy to put together lists of local mental healthcare providers for referrals and to gather and administer screening tools for common issues such as developmental delays, ADHD, and depression. Just having a resource list is a great first step towards feeling empowered to help patients in new ways.”
#3: Educate yourself on common medications
“There are limited medications for the treatment of mental illness with pediatric applications,” explains Kaplan. He recommends that physicians familiarize themselves with the medications, use cases, side effects, and more in order to address the most common issues in primary care settings whenever possible.”
#4: Make good use of screening tools
Kaplan encouraged all pediatricians, especially those in states like Texas that do not require regular screenings for developmental, behavioral, and mental health issues, to seek out the right screening tools for the identification of problems in patients as they arise. Kaplan recommends the Comprehensive Health and Decision Information System (CHADIS), which is a web-based platform developed by Total Child Health, Inc. that delivers dozens of screening tools for use by pediatricians to assess the developmental, behavioral, and mental health of their patients in primary care settings. “Sometimes you feel shackled by what you can do in the context of a small, independent practice,” explains Kaplan. “The screening tools provided by CHADIS allow you to identify when something you suspect is actually there, which is a huge relief to both physicians and caregivers.”
With proper screening and improved access to mental health resources, Kaplan believes that pediatricians can address and treat 75-80 percent of the most common mental, behavioral, and development health concerns in the primary care setting. According to Kaplan, “These tools, when used properly, can especially empower smaller independent pediatric practices to act as the first line of defense in this current mental health crisis.”
#5: Utilize telemedicine
Even with better training, screening tools, and access to mental health resources, the services pediatricians are able to provide may be limited simply by lack of physical access to and from a provider’s office. That’s why Kaplan recommends adopting and utilizing telemedicine tools. While telemedicine has existed since the 90s, the rate of adoption was fairly flat until COVID restrictions made it necessary for patients to seek treatment outside of the traditional office visit. According to a July 2021 McKinsey article, telehealth usage stabilized at a level 38 times higher than before the pandemic. Encouragingly, Beckers Hosptial Review reported that behavioral health visits were virtual 46.1 percent of the time as compared to 22.1 percent of medical visits, a development that indicates that patients are embracing telemedicine specifically for this purpose. Kaplan encourages to capitalize on this trend to drive mental health treatment accessibility.
“We must remember to be nice to each other, raise kind children, and truly see each other. Every little thing helps, and every person can be a part of the solution. If strides can be made in Texas towards better mental health for our children, they can be made anywhere.”Dr. Seth Kaplan
Final Thoughts
As the entire nation attempts to get back on its feet even as COVID continues to ravage the globe, it is essential to address the needs of our struggling children. “We have to remember that advocating for our children should be our number one priority,” states Kaplan. “All of our actions should be informed by this fact. We must remember to be nice to each other, raise kind children, and truly see each other. Every little thing helps, and every person can be a part of the solution. For example, the improvements we have made to mental healthcare access and treatment have been made possible through the partnership of independent pediatricians, affiliated pediatricians, subspecialists, and organized medicine, including the incredible support of the TPS staff, which allows us to accomplish so much more than one pediatrician could do alone. If strides can be made in Texas towards better mental health for our children, they can be made anywhere.”
Allyson Howard is a firm believer that well-crafted stories can redefine brands and organizations, reinvigorate internal and external business communications, and engage and inform consumers in groundbreaking ways. Her BA in English and Education from the University of Iowa, as well as her MS in Professional Writing from NYU, have positioned her to create a wide range of content tailored to communicate unique brand voices and messages. She lives outside Chicago with her family and enjoys cooking for loved ones and reading.
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