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New child psychiatry fellowship program will help address shortage crisis of mental health providers

The training of fellows in child and adolescent psychiatry in Wichita will leverage that pipeline effect to attract and/or produce more child mental health experts.

counselor speaks with three siblings
Susanna Ciccolari Micaldi, M.D., child psychiatrist and clinical assistant professor at KU School of Medicine-Wichita, talks to three siblings. (File photo)

The statistics are staggering: About one in seven youths in the U.S. has a mental health condition and half of those kids go untreated, according to a 2019 article in JAMA Pediatrics.

The numbers for Sedgwick County and rural Kansas are just as dire. A severe shortage of psychiatrists trained to treat children and adolescents is compounding those figures.

Kansas probably needs more than 400 child psychiatrists to meet the demand of diagnosing and treating the state's kids and teens, according to officials with the KU School of Medicine-Wichita Department of Psychiatry & Behavioral Sciences. In reality, there are fewer than 100 in Kansas and fewer than a dozen serving Wichita and rural Kansas.

That's why KU School of Medicine-Wichita is setting the groundwork for creating a fellowship training program in child and adolescent psychiatry by adding a new faculty member experienced in running such a program and starting a fundraising campaign to support the training.

Dr. Brown talks to a young patient

Above, right: Dr. Rachel Brown begins her conversation with an adolescent by asking about his day.

"We know that if we train them here, they'll often stay here," said Rachel Brown, MBBS, the department's chair who is among the area's few fellowship-trained child and adolescent psychiatrists.

Brian Pate, M.D., chair of the Department of Pediatrics at KU School of Medicine-Wichita, calls the phenomenon of the school's ability to train medical students and residents who become physicians who practice in Wichita and Kansas a "pipeline effect."

"Access to specialized mental health experts for our youth is truly a crisis situation in our community and region, and at a time when the mental health needs of our youth are skyrocketing," Pate said. "I have no doubt that training fellows in child and adolescent psychiatry in Wichita will leverage that pipeline effect to attract and/or produce more child mental health experts for our children, and it may be one of the most important and sustaining strategies we can employ."

The two-year fellowship program would be able to train four fellows each year and help provide care to more than 500 children and adolescents annually, or about one-quarter of those who are going untreated in Sedgwick County, Brown said.

This fall, Cassie Karlsson, M.D., who has been in charge of a similar fellowship program at the Indiana University School of Medicine, will join the KU School of Medicine-Wichita faculty. While Karlsson wasn't trained in Kansas, she does have another tie to the state that helped lure her to Wichita. She grew up in Harper, about an hour's drive from Wichita.

"There's something really rewarding to me to think about coming home and making a difference," said Karlsson, who will start Nov. 1 in her new position. "Child psychiatry is the most underserved specialty in all of medicine. ... The fact that (KU School of Medicine-Wichita) is invested in working with the community and state to establish a child and adolescent psychiatry fellowship training program really speaks volumes to their commitment to children and families in Kansas.

"We know how difficult it can be to recruit physicians to rural states so the opportunity to have state-of-the-art training, right there in Wichita, really increases the likelihood that we will find great physicians who want to both train and stay in the community, which is really a long-term investment for the state of Kansas."

The school already has an outstanding record in training and keeping adult psychiatrists through its residency program. About 90% of the psychiatrists currently practicing in Wichita and the surrounding area are graduates of the program.

"As a longstanding educator of psychiatrists for the region and the state, the school has a great opportunity to build in an area the state sorely needs and it's a great way to invest in the future of care," said Brad Rukes, the KU Endowment development director for KU School of Medicine-Wichita who will oversee the fundraising campaign for the program.

KU School of Medicine-Wichita faculty member Susanna Ciccolari Micaldi, M.D., known to colleagues, students and patients as Dr. C-M, received her psychiatry residency training at the Wichita medical school and completed her fellowship in child and adolescent psychiatry at KU Medical Center in Kansas City, the only other such fellowship program in the state.

In her clinical practice, Ciccolari Micaldi sees firsthand the crises of rising mental health conditions for youth and the lack of trained health care professionals. She provides care to inpatients in the 14-bed adolescent behavioral unit at Ascension Via Christi St. Joseph and consults with psychiatry residents when young patients come to the St. Joseph emergency room with possible mental health issues.

"In the last year since COVID, we have had so many more (emergency department) visits by children and adolescents coming through (Ascension Via Christi) St. Joseph's," said Ciccolari Micaldi. Many of the young patients are experiencing worsening symptoms of mental illness and feelings of isolation, she said.

"We don't have enough psychiatrists, so we often send them back to their primary care doctors," Ciccolari Micaldi said. Those who need hospitalization can end up waiting days in the ED for a bed in the unit to open, she said.

While some adult psychiatrists in the area are "stepping up" to see younger patients, Brown and Ciccolari Micaldi noted that there are distinct differences in addressing mental health conditions in children and adolescents.

"Children are still developing and the ways in how they think and act are so fundamentally different than adults," Brown said.

"What a person gets during a child psychiatry fellowship program is two years of working exclusively with children and adolescents in all kinds of settings - inpatient settings, acute-care settings, emergency settings - and understanding what's normal and what's not normal. Not every child who has a mental illness needs to see a child psychiatrist, but if they do, we want to make that kind of care accessible."

How to help

If you want to make a contribution to the new fellowship training program in child and adolescent psychiatry, go to the Psychiatry & Behavioral Sciences giving page.

KU School of Medicine-Wichita