Onboarding Doctors in Neurodiversity, with Peter S. Jensen, MD | EDB 262
The REACH Institute founder Dr. Peter Jensen discusses his work training medical professionals in neurodiversity.
(VIDEO – 28 mins) Peter S. Jensen, MD is the Board Chair and Founder of The REACH Institute. The Institute is a 501(c)3 nonprofit dedicated to ensuring that the most effective, scientifically proven mental health care reaches all children and families. They train primary care providers, therapists, and other professionals to diagnose and treat mental health issues.
While serving as the Associate Director of Child and Adolescent Research at the National Institute of Mental Health (NIMH), Dr. Jensen saw a widening gap between scientific knowledge about mental health and the application of that knowledge to help children and teens. Science has made remarkable advances in understanding mental health problems and how to treat them. But healthcare professionals were not consistently or effectively using this knowledge to diagnose and treat common disorders. After leaving NIMH, Dr. Jensen went to Columbia University to serve as the founding director of the Center for the Advancement of Children’s Mental Health. While there, he developed the core methods REACH uses today. The goal was to close the gap between science and practice. The central strategy was to bring together leading scientists, mental health experts and agencies, primary care providers, parents, and schools to identify the best scientific findings available to help children. Then Dr. Jensen led REACH to implement, disseminate, and evaluate these methods. He describes the process as “putting science to work.”
For more about REACH: https://thereachinstitute.org/
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FULL TRANSCRIPTION
HACKIE REITMAN MD (HR):
Hi, I’m Dr. Harold Reitman. Welcome to another episode of Exploring Different Brains. And today I’m excited because Peter Jensen is here. He’s the head of the Reach Institute. He’s done a million different things. I’m going to bore you with a few because Peter’s very modest. So he doesn’t want to tell you about 300 different articles, and chapters and 20 books and so many other things and all about the reach Institute, where what he’s doing is helping a few million people who needed with their mental health. And Peter Jensen, welcome to Exploring Different Brains.
PETER JENSEN MD (PJ):
Thank you, doctor, right, man. It’s pleasure to be here. Can I call you Harold?
HR:
No, you call me Hackie.
PJ:
Okay. You can call me Peter. Just don’t call me late for dinner.
HR:
Okay. Yeah, yeah. So, Peter Peter, pumpkin eater. You’ve got such a long resume, I’m not gonna read the whole thing. But it is really, really something. And you’ve dedicated most of your life to this stuff.
PJ:
I have when I was a resident, in San Francisco as a psychiatry resident, and someone nominated me to go sit on a Human Subjects Committee, which like reviews, protocols, research protocols funded by NIH. And this was a cancer, human subjects steering our committee. And I was so inspired I, I’m sitting here as the token psychiatrists still not finished my training. And I’m reading research studies that are involving 150 sites, 150, doctor’s offices for like cancer. And all of those doctors are working together to find answers. And I thought, that’s what I want to do for mental health and for kids.
HR:
Wow, great story, and your dedication has always come through. Now, according to your website, currently, one in five children experience experienced mental health issues, and only 20% of them are getting the health they need. Why is that?
PJ:
Oh, there’s a lot of reasons. You always got to remember there’s stigma. People are afraid like if a parent learns their child may have autism, it can be a devastating diagnosis, “what did I do wrong? What did I miss?” And so stigma just naturally figures in not just for the general public, but even for healthcare providers, physicians, psychologists, etc. That’s probably the big one. But the other thing is lack of training. That’s a huge one. They don’t get trained. A pediatrician doesn’t really learn much about these things. Nor does the family practice doc.
HR:
You just hit the nail on the head, because it’s not just mental health it’s all of neurodiversity. Doctors, MDs get zero training, nevermind, police, all the other teachers and everybody else. But this lack of training, which we’re trying certain individuals, like the American Academy of developmental dentists and doctors with Rick Rader and Steve Perlman, in organizations like reach, are certainly making a difference. I think what you touched on that is so important, that is up to society to change is the stigma problem, especially as you know, better than I within discrete cultural groups. I mean, you can get thrown out of a whole community by saying, I’m going for mental health problems.
PJ:
Absolutely. Yeah. We’ve seen that with our athletes recently haven’t we.
HR:
Yep, absolutely. Um, in your experience, how can anybody soften the delivery of news to a parent that your child needs some mental health help?
PJ:
Yeah. Well, you know, I love the focus of your organization. Because your focus is on you know, brains are different. And there’s just an enormous diversity in how the brain develops. There’s all kinds of things that can affect that from genes to even food additives, all that stuff may become a factor. And so I’d like to first of all emphasize, this is not your fault. Now the provider who’s bringing the bad news has to do that. This is not your fault. But they also have to remember, even for a common condition like ADHD, it’s devastating for a parent. And so you can’t underestimate the despair. A parent might hear for even a common diagnosis like ADHD, it’s like saying, your kid has cancer. What did I do wrong? Oh, my goodness, he’s never going to go to Harvard. And so that’s the first step take, you know, don’t put parents in the crosshairs for blame. Secondly, help them understand that there’s neurodiversity at work, and it happens. And brands are different. But then you have to offer hope, you have to tell him, but you know, it’s not your fault. But it is your problem we are going to work on it’s something we can’t escape, it’s probably going to have to address and we can do it together.
HR:
And here are some tools you can use. There
PJ:
There you go, the so that doctors got to be ready to offer those tools. There you go,
HR:
What do you consider the biggest roadblock to your work?
PJ:
I would have now a lot of what I’m doing now. So I’ve devoted my last 10 to 15 years on retraining doctors and therapists, teachers and others. And so I don’t directly I pretty much all along my career, I’ve still been treating children and families. But now I’m devoting 100% Time to trying to change. Doctors, say it’s a primary care, he or she sees 10,000 people, kids are adults in their career. 20% of those that’s 2000 are going to have issues that that doctor or therapist, if they’re armed with the right tools can change their lives. So I’m trying to leverage the fact that if I change one, that one can change to 1000s. So now the biggest hot obstacle is getting people on board to say, All right, I am willing to change old habits, the way I learned 30 years ago, what I always have believed, and my preconceptions about neurodiverse brains, you know, it’s bad parents, it’s this, it’s that. And so, so that’s the biggest obstacle. Now we are having great success getting doctors in. But we’ve trained 5000 doctors, wow. In a six month long change program. It’s not just a workshop. It’s six months of mentoring. I noticed on your website, you’re talking about mentoring, the importance of mentoring. So we mentor doctors and therapists, nurses, whomever, for six months, before we’re ready to launch them to Sarah, and then they can always come back to us. But it’s a six month change process. And what we’re changing is the heads, parts, preconceptions of myths and misunderstandings that those healthcare providers might have been harboring for 20 years. So that’s a big challenge. And we need we’ve done 5000. But there’s 60,000 doctors to go,
HR:
Wow. And you touch on the philosophy that here at different brains that every brain is different. So when you look at that individual patient, his brain is going to be different than the patient before. And how can we help her or him achieve their goal? We have to use different tools through How did you how did you come up with the concept of the Reach Institute?
PJ:
Oh, great question. So I had spent so after that dream I had as a resident, oh, I would like to really be involved in major multi site studies where lots of doctors are participating, not just one site, because if you do it that way, then a study can be definitive and field changing. So once I finished my training and began to lobby to go to work at the National Institutes of Health, and so after six years I got there, and they brought me in as the director for all of the child mental health research programs. So this is pretty cool. And it was a dream. And so some of the first things we did was to set up big studies Like, we hear about these cancer studies on CNN, that involve 5000 people, that’s what we did. So we started setting that up for kids, ADHD, depression, anxiety, other problem, autism, etc, those kinds of things. And I did that for 10 years. And then shortly before, I now had enough government time, I could retire. But just before I was ready to retire, I learned the Institute of Medicine, had done a big study. And it said, new research, like I’ve been doing, takes 15 to 20 years to reach doctors to eventually change doctors. And I thought, Oh, my goodness, everything I’ve been doing, won’t touch anybody until maybe I’m retired. And so a gentleman with a fair amount of money, on some mutual funds, brought me up to Columbia University. So I retired from NIH. And the goal was to now disseminate research. So it’s actually used today, not in 20 years. So we started that process. And we were doing a lot after 911 teaching therapists how to use all the new treatments to help manage after 911, then Katrina, we were doing lockdown in there. And I learned it, I was now learning how to change a doctor now. And what I learned was the way doctors do it after graduation doesn’t work. It’s like these continuing educational axes doctors go. I mean, from your own career, imagine trying to teach a surgeon how to do a new complex procedure by just a lecture. No, he’s gonna scrub in and join you and you want to see him do a three or four or five times four and say he’s good. All right, those are skills. And they take coaching, hands on coaching and practice. So I learned that the regular way we train doctors already out in the field, retrain them was totally nonsense. But I studied, I found this literature just pretty exciting to me, because it was one of the biggest discoveries of my career. I learned, there is a huge, solid bank of information, how you change behavior and people. But guess what? It was all focused on patient’s behavior? How do we get the patient that take the medicine? How do we get them to diet? How do we get them to exercise or use clean needles or condoms, all of the aids work for them substances, that science, which is actually quite remarkable deploy, it had never been used to change Doctor behavior. Why would you want to change me, I know what I’m doing. I’m a doctor. Okay. That’s our typical attitude. You know, we’re out in practice, we don’t have time to go back and really scrub in and learn a bunch of new skills. My old way is good enough. So I learned that and I begin to put it in all of what we’re doing. But then I realized it couldn’t just be Columbia University, it would, because Harvard wouldn’t want to partner with us, they wouldn’t want to seek our help. So we had to form a separate nonprofit that could partner with any university, any state, any healthcare organization, and say, we’re going to join you. And to this day, we’re still the only organization in the country that uses these quite profound methods to encourage and facilitate behavior change, and therapists and doctors, and whoever else. And so we’ve been doing that now for 15 years. That’s my story.
HR:
That’s your story. And let me tell you something, I congratulate you because getting doctors to be open minded and change their ways. No offense to my fellow MDs, and myself, is moving mountains. Because we know everything.
PJ:
We know everything. And we’re trained to know everything and to have this confidence with our patients, even though there’s a little glimmer of uncertainty in our head, but we want to make the patient feel comfortable. So we come in with great certainty. It’s a huge issue and getting knockers behind. enough to say, I don’t know how to do that, when you show me. That’s not a small issue.
HR:
You know, you touched on something earlier that I think is really holding back research. And I’m not a researcher, okay, is that in order for you to get a grant, you have to show something where a lot of work has been done. Ergo, if you think outside the box, it’s tough to get funds for it. So that’s, for instance, when I take something like Alzheimer’s, where I’ve been railing against the experts for a long time, will you stop barking up that same old tree with the amyloid and the plaques and the this — let’s take a whole different tack. Well, tried to get funding for the whole different way of looking at Alzheimer’s. And autism was similar and a lot of things are.
PJ:
Well, so one of the challenges is often people close to the ground. Like maybe a parent or maybe a doctor and solo practice, identify something that might be for real. And but it’s not mainstream. So take, for example, the discovery of what was causing ulcers, we knew for a long time knew that it was all about, you know, excess acid in the stomach. And it was an outside group that discovered a little bacterium in the lining of the stomach, H. Pylori, that, but it was an outside group. And so they found a way to get it published, but eventually, it really took over the field, but they would have been poo pooed for 20 years, you know. So it is a big problem that but the other side of the problem is clinicians, you know, like you and me, we have experiences and we think, Hmm, I wonder if it’s this or I wonder if it’s that. And so we think not like a typical scientist board, because the scientists would say, alright, could be this could be that, let’s test it by giving half the patients this and half the patients that and we have to rely on our inferences, okay? But they are great hunches, but some of them are dead ends. And so it’s always in trouble. And now the NIH has an institute for people with out of the box ideas, they still have to be research trained. But it’s called the National Institute of complementary and alternative medicine. And, yeah, and so they look for out of the box ideas, but not just by anybody. You’ve got to have good scientific credentials. And I’ll just give you a little case study ever dear friend. And when I got to NIH, I hired him. But he was mostly No, he was a very dear man, but mostly known for seeking out fringe ideas for ADHD, zinc, food, additives, that kind of stuff. But I was impressed with this character, I hired him. He came to join me. And he’s been doing so he had only been doing frame stuff before. But he got into the mainstream area. And now 30 plus years later, he just launched the definitive study, with all the right techniques of testing complementary treatments for ADHD, like zinc. And, you know, every added Deb under the sun, and it showed in this big, well designed study, it had an effect wasn’t like an effect like this. It was this big of an effect. For some kids that could be very important. didn’t replace medicines. But on the other hand, it’s like a real solid new brick in the wall of science, it added another brick, yes, sometimes this is important. But he could have been pursuing that idea in the in the hinterlands for 30 more years, but instead, he found a way to introduce it into mainstream science, but it took a lot of work.
HR:
What can Different Brains do with anything not that you need any help, but to help you achieve your terrific missions?
PJ:
Well, we definitely need help. We’ve only trained 5000 Plus, and it’s taken us 15 years to get here. I’m going to be long dead if we keep going at this rate. And so we have to penetrate 50 6070 Now the the major target isn’t psychiatrist, child psychiatry. Generally they’re keeping update generally We get some, even among child psychiatry, we get quacks out there who do weird stuff, they always have to police yourself. But we need to, you know, think about the many, many people out there, whether it be children or adults, the great majority won’t get care in time, they’ll suffer and develop additional problems. Finally, when they, because of suffering or other difficulties, finally get into care, it’s probably outdated care. And that’s and only the one in 10, or one and 15 is going to get good, solid, solid scientific care. So we need more people to sign up for our training, we need funding support, so we can take our products programs across the country increasingly, right now, you think about what we do, we bring small groups of doctors that you can’t train big groups, so you can’t train 5080 100 surgeons on a new procedure they got to be scrubbing in. Okay, it’s the same way. So. So we have to have relatively small groups, usually, nothing bigger than 50 usually have five or six teachers, we spent three days solid with them, we don’t let them out of sight. Everything is assisted and monitored. It’s not hit and run lectures, we are with them the whole time. Then, we coupled them after that with one teacher like myself who’s psychiatry, and another teacher who’s like them, who maybe is a family medicine doctor, or an internist or pediatrician who can say, I’m doing this now. And you can do it too. No, no, don’t break eye contact, you can do this too. Okay, I’m going to show you how I’m doing it. And it’s going to change your practice. And so you need both types of teachers. If there’s only psychiatry teaching primary care, it would fail. And so like if you had a train a bunch of Family Physicians, and a new orthopedic, a simple orthopedic procedure, something that they could do, eventually, you’d find you would be most effective. If you have a couple family, Doc’s assisting you in the Teach. Because they can say I’m doing it, it’s, it’s been a joy. That’s what we do. So we follow up with them in small groups 10. Doc’s with two teachers, one like them, and one like me, especially, we give them six months where they actually share their cases online, where we kind of talk through him, and everybody works as a team. Kind of Okay, now, what should we do? What are we what did you learn during the original training, what’s others experience as far and so it’s a peer learning group, facilitated by two teachers. Now, that’s not cheap. So that, actually, for us to do that, and we have to pay the doctors, the teachers, at least a modest fee. For both the in person training and the follow up, we have to charge $2,000. And so a lot of doctors, they say, $2,000, that’s expensive. I can go and do an online series of hit and run lectures, that won’t change my behavior. That’ll I can just kind of zone in and out for and that’ll only cost me $600. And I can still get my state accreditation for CME, that’s a big obstacle. People don’t understand they don’t need a CME lecture, they need a behavior change process. And that, that takes more time and effort and costs. That’s our biggest obstacle.
HR:
So the incentivization is a block. “Why should I do this?” Well, because you’ll be taking better care, but that’s not enough to get them to do it.
PJ:
Yeah, because anyone who does regular continuing education to say, Oh, calm learned the greatest. And then you got a series of hit and run lectures, just like hitting, you know, slideshows on a new orthopedic procedure where you really want them scrubbing in. And so that’s, that’s really the problem, and most doctors don’t understand. When you take on mental health, you are learning new skills. And you can’t give someone a video of how to swim the butterfly and expect them to jump in the pool and swim the butterfly. They need a coach in the pool over time giving feedback on all the elements of the procedure.
HR:
What kind of reception Are you getting in the general medical community?
PJ:
Well, you know, we’ve been doing a great question. We’ve been doing this 15 years. And now a lot, a lot of states, a lot of pediatricians, a lot of organizations know about reach reaches doing something very different. And so we get a lot of positive, if you will, discussions among all the major, you know, psychiatry, child psychiatry, pediatrics, etc. So we’re hearing a lot of positive vibes. But it takes a lot more than just that, to say, Yeah, but it’s so expensive. See, that’s kind of what happens. And so what we see a lot of people doing, they try other methods, they try normal content, doing educational lectures, a one day workshop, and then they see it didn’t get where they want, or they send them off to Mass General or some other place with a three day course, that still always just a series of lectures, and they paid $100. And still, they don’t get there. And so an experienced healthcare administrator who’s really trying to tackle the problem of mental health within his or her organization, figures out CMEs not working, we got to do something different, they start talking around, and they call us up. And then they say, well, that’s expensive look, we’re gonna see if we can get the money because you know, doing a train 30 Doc’s, you’re gonna have to come up with 60 or $70,000. And so that takes time. So that’s, I think, one of the biggest obstacles. So if we had a ways to cut the costs for everybody, that would be good. Now, we do offer scholarships, for doctors who work in poor communities, or who only served kind of like Medicaid, or the indigent, we offer them scholarships. But for most other doctors, it’s still going to either they’re going to have to cough it up, or their practice is going to or their healthcare organization.
HR:
It’s also time away from their practice.
PJ:
It is yeah. We try to minimize that, you know, so we actually have the, the initial training Friday afternoon, only Friday afternoon, all day, Saturday, and then half day Sunday. And then one we follow up for the six months. We put all the follow up calls video calls, into like noon, where they have lunch break, or maybe eight in the morning or five in the afternoon, so they can work it around their busy practices.
HR:
Well, Dr. Peter Jensen of REACH, it’s been such a pleasure to have you with us. Thanks for spending the time we look forward to having you back here. And thank you so much for spending time with us here at Different Brains.
PJ:
Thank you Hackie.
