Where have all the children
(psychs) gone?

Under 18s "woefully under-serviced" says Dr Barankin.
She offers help.

By Ilina Stranberg

In 1996, when Dr Tatyana Barankin decided to address the need for continuing medical education programs in child psychiatry for family physicians, she was flooded with referrals. "The referrals would say "The child is crazy -- help me or it would be to prescribe medication, and when I did an assessment the child didnt need medication but some other form of treatment. What I realized was that the baseline knowledge of both family physicians and pediatricians suffered from a lack of proper training in medical school."

Dr Barankin trained as a pediatrician in the Soviet Union before completing her training in general and adolescent psychiatry at the University of Toronto, where shes now Assistant Professor in the Department of Psychiatry and Head of Continuing Education in the Division of Child Psychiatry.

"Everyone leaves the course with a syllabus full of information, lectures, review articles, resources, and the physicians tell me its an amazing resource."

"People under 18 are the most under-serviced segment of the population. According to the Ontario Health Study, which is an epidemiological study, child psychiatric conditions are underdiagnosed, and treatment is provided to only one in six of those diagnosed. That has to change." She was qualified, motivated and strategically positioned to take action.

OMA gives the nod
She approached the Ontario Medical Associations pediatric chapter with a needs assessment letter about a longitudinal course for pediatricians and gave them the topics she proposed to cover. "I received an overwhelming response. Doctors usually don't respond very quickly to questionnaires, but we were swamped. We had mountains of paper on our desks. So I ran my first course in 97." That first course won her an Award of Excellence in Continuing Mental Health Education from the Department of Psychiatry, and five years later her course in adolescent psychiatry was awarded the Best Continuing Education Course in Canada by the Canadian Psychiatric Association and the Council of Psychiatric Continuing Education.

"I design my programs according to the principles of adult education, and the longitudinal format allows for discussion and interactive learning. These are practitioners who have years of expertise and knowledge that are driven by the context of their practice. So theyre not just interested in learning about anxiety and depression in children, theyre interested in knowing what to do to help kid A or kid B. They need to know what would happen in case of crisis, and if they don't have enough knowledge about a particular subject, they need to know where they can tap into that particular information. They want to know where they can refer the difficult cases, and the easy cases they want to be able to treat themselves."

Dr Barankins courses are all accredited by the continuing education office of the Faculty of Medicine at the University of Toronto. Theyre attended by a mix of family physicians and pediatricians in small groups of 20 or 25 and are given over six-month period in eight two-hour sessions. At least a third of each session is devoted to case discussion, interaction, questions and answers: How do I diagnose it? How do I treat it? What do I do with difficult cases? Who could be my backup? Do I even know what resources exist?

"If you take a course, you realize what resources are available to you. Most people don't know theres an anxiety clinic, a depression clinic, a destructive behaviour clinic, a first-offender clinic and so on. They dont know there are agencies in the city that are better at anger management or managing attention deficit disorder, so the presenter is obligated to provide a list of references, city agencies and clinics. Everyone leaves the course with a syllabus full of information -- lectures, review articles, resources -- and the physicians tell me its an amazing resource."

She gave five courses between 1997 and 2003, and the positive response they generated among participants and faculty resulted in the broadening of her mandate to come up with more. She now puts together eight or nine courses every year and runs a mentorship for faculty retreat on subjects like effective interdisciplinary collaboration.

CBT course this April
"Were running a cognitive behavioural therapy course in April, and were doing a terrific new course for the first time on February 12th about sexuality in children and adolescents. I have a speaker from the Mayo Clinic and I think it will be sold out soon. All the courses sell out right away. Its because of the needs of the community and the quality of the events."

For information on Dr Barankin's courses or to be included on her mailing list, contact brian.[email protected].