Inside Pediatrics Magazine Fall/Winter 2025

DIVISION ROUNDS (cont.)

BEHAVIORAL HEALTH

Children’s expands mental health program into schools As the mental health crisis continues across the country, children and teens are in greater need of mental health services than ever before. In many cases, the first person to recognize the child’s need is a teacher. But the teacher may not always know how to help. That’s why the Children’s of Alabama behavioral health team recently expanded its PATHS program to school personnel. PATHS, or Pediatric Access to Telemental Health Services, has been around since 2019. Children’s established it—with support and funding from the Alabama Department of Mental Health (ADMH)—in response to the need for more mental health services, especially in rural areas. The initial goal was to help primary care providers understand how to help patients who present with mental health concerns. Through the program, Children’s mental health professionals offer consults or education for providers or even telehealth appointments for their patients. PATHS has since expanded into urban areas, and now, thanks to the extension of a Health Resources and Services Administration (HRSA) grant, Children’s is offering support to school systems across the state. “This is an important step for our program,” PATHS director Margo Harwell said. “Because they see students daily, school personnel play a critical role in identifying early signs of mental health concerns in students.”

ORTHOPEDICS

How dogs are transforming pediatric orthopedic procedures What goes in must come out—including the metal pins used to hold bones together while fractures heal. “It probably takes 15 seconds to remove three pins,” Children’s of Alabama pediatric orthopedist Michael Conklin, M.D., said. “But, of course, kids are very scared about that.” Enter Shelby. The 50-pound standard poodle is trained to sit on the examining table and cuddle with children while Conklin grasps the pins with a tool resembling a needle-nosed plier and pulls them out. Basically, Shelby serves as a distraction, he said. “We tell the child to pet the dog and look toward the dog and not look at me on the other side of them, not worry about what I’m doing.” For about two-thirds of patients, it works. And it even helps the ones who “freak out no matter what,” Conklin said. “It seems as if they return back to their baseline calm quicker after the procedure.” Shelby, and her brother, Foster, are part of the Pups Unleashing Patient Smiles (PUPS) program, which is one of three branches of Children’s of Alabama’s animal-assisted program, PetsRX. Another branch involves longtime Children’s partner, Hand-in-Paw, which provides therapy dogs at Children’s of Alabama’s main hospital to provide comfort and distraction. The third is a hospital based medical dog program which includes golden retrievers Wanda and Sydney to assist with scary or painful procedures. Meanwhile, suspected victims of child abuse—who are served by the Children’s Hospital Intervention and Prevention Services Center (CHIPS)—are assisted by dogs from the Help Empower Restore Overcome (HERO) Program with the Alabama Office of Prosecution Services. Soon, Shelby and Foster may be part of the scientific literature. Conklin and his team are conducting a randomized trial to evaluate the dogs’ effectiveness, comparing outcomes between patients who receive the therapy dog intervention and those who receive standard care. The goal is to, hopefully, show positive data that will pave the way for broader adoption of such programs.

Leaders began their efforts in the summer of 2024, meeting with mental health coordinators in school systems across Alabama to discuss what topics might need to be covered in their respective districts. Once those needs were identified, the PATHS team set up in-person, virtual or hybrid training sessions. PATHS leaders have offered training on various mental health topics, including anxiety, behavior management, depression, trauma and bullying. They’ve also taught educators how to identify the red flags of mental health concerns among students. The sessions are opportunities for discussion among school staff and Children’s mental health experts. Ultimately, PATHS leaders hope to help educators understand how to handle mental health issues in students as they arise.

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