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Avanti West Coast strikes have been called off, but more industrial action on other services is scheduled for March and April
It’s been well over two years (coming up to three) since London’s rail workers first started striking over issues like pay, working conditions and job security. And while in recent months industrial action in the capital has mellowed (ASLEF voted to approve a pay deal and then called off strikes on November), the strikes aren’t completely over.
Over the Christmas and New Year period several smaller-scale strikes took place across London’s transport network, since then more industrial action has been taking place for on Avanti West Coast services. This week the RMT reached an agreement with Avanti West Coast, ending theses strikes.
Earlier this month it was announced that nearly 500 drivers on the Elizabeth would be walking out over a pay dispute across four weeks, but those strikes were called off, too.
RECOMMENDED:
All you need to know about the train strikes across the UK.
Find out how to get to London’s airports during strikes here.
The next strikes that could potentially impact London come from Hull Trains, which runs trains to and from London King’s Cross.
The Hull Trains strikes began on March 7 and will finish on April 26, taking place every Friday and Saturday.
The Hull Trains strikes are set to last nearly two months.
No Elizabeth line strikes are currently planned.
Hull Trains workers are protesting what they say is the unfair dismissal of a colleague who raised safety concerns.
Eurostar is not expected to be affected by any strike dates. Find the latest details on the Eurostar website.
There are currently no tube strikes scheduled for London’s transport network. Tube lines may be busier during Elizabeth line strikes.
Strikes on the Overground (somewhat recently renamed and re-coloured) around this time last year were suspended. No more action is planned, though the orange line could be affected by the disruption of tube and Elizabeth line strikes.
Tubes and trains are rarely on strike at the same time, so travellers can usually get the other, non-striking one to the airport. If you plan on using the Elizabeth line to get to Heathrow, you can always use the Piccadilly line or Heathrow Express.
Coaches frequently run from central and outer London areas by the likes of National Express. All airports are also, obvs, all accessible by road – whether you’d like to drive or get a taxi. Expect higher levels of traffic during strike days.
A bill requiring striking workers to meet ‘minimum service levels’ was passed by the Conservative government in 2023. The anti-strike legislation supposedly ensures ‘minimum service levels’ on key public services, including trains, theoretically making it pretty difficult for things to grind to a complete halt.
In practice, however, the law was not effectively put into practice. The current Labour government confirmed last summer that it was rolling back the law, telling employers not to enforce it while it passes a new law to formally abolish it.
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Luigi Mangione, alleged UnitedHealthcare CEO killer's federal case pushed to April, according to court records – ABC7 New York
MANHATTAN (WABC) — The alleged UnitedHealthcare CEO killer Luigi Mangione will no longer appear in Manhattan federal court this week as previously scheduled, according to an entry on the court docket.
Instead, Mangione's federal case was pushed to April 18, according to the court docket.
The entry did not offer a reason.
A federal grand jury has yet to indict Mangione on federal charges, including one which could get him the death penalty.
Mangione has pleaded not guilty to state murder charges, including one with a terrorism enhancement.
The suspect is accused of gunning down UnitedHealthcare CEO Brian Thompson in front of the Hilton in Midtown Manhattan on Dec. 4, 2024, as the CEO headed to an investors conference, in an act that prosecutors said was premeditated, targeted and "intended to evoke terror."
He faces three separate prosecutions: the New York state murder case; another for federal charges, including terrorism; and a third in Pennsylvania on charges including possessing an unlicensed firearm, forgery and providing false identification to police. One of his federal charges, murder through use of a firearm, makes Mangione eligible for the death penalty if convicted, but he has not yet been indicted in federal court.
His lawyer in New York, Karen Friedman Agnifilo, has already presaged some of the arguments his Pennsylvania lawyer now has made with her words in a Manhattan courtroom last month, that there are "very serious issues" with how police in Pennsylvania obtained evidence from her client.
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UR home care workers vote to strike again amid negotiations for first union contract – Democrat & Chronicle
Last month, University of Rochester Medicine Home Care (URMHC) workers held a one-day strike to negotiate their first union contract.
URMHC workers provide services for patients in Monroe, Livingston, Ontario, Seneca, Wayne, Wyoming and Yates counties.
They assist patients in transitioning from hospital to home by providing nursing care, physical, occupational, and speech therapy, as well as medical and social work services.
Negotiations have been ongoing since May 2024, with disagreements centered on patient caseloads and health insurance coverage.
Now, URMHC workers have voted to hold a strike for up to five days. According to 1199SEIU, the strike is in response to what the union describes as the university’s regressive bargaining tactics, saying it reversed its proposal for affordable health insurance without offering a counterproposal.
“There is an extreme sense that URMHC’s current negotiating team is unable to make decisions to resolve this conflict,” said Tracey Harrison, Rochester-Corning 1199SEIU vice president and lead negotiator.
“It is imperative that the senior leadership of URMHC/UR and its board of directors engage in a meaningful way to reach a resolution on a contract that will improve the overall level of care and stabilize staffing. Absent these efforts, the future of URMHC is uncertain.”
Monroe County Legislator Susan Hughes-Smith expressed her support for home care workers in late February.
“These professionals have been negotiating in good faith since May 2024 for their first union contract, seeking reasonable patient caseloads and affordable health insurance coverage—fundamental rights that are essential for both the well-being of our healthcare workers and the quality of care they provide,” Hughes-Smith said.
UR Medicine Home Care provided the following statement in response to URMHC workers voting to strike:
“UR Medicine Home Care leadership has been bargaining in good faith since May 2024 in a sincere effort to make progress toward reaching an initial contract and has reached tentative agreements with the union on many proposals. Despite our extensive efforts, employees in the bargaining unit have voted to strike for up to five days.
While URMHC recognizes and respects the right to engage in a strike, we are sincere in our desire to reach a fair agreement, as demonstrated by our agreement to many of the proposed provisions. We remain committed to treating each and every employee fairly, both those who are union-represented and those who are not.”
The next bargaining date is set for Wednesday, March 19.
—As a Rochester native, Justice Marbury entered the world of journalism to create work where voices like hers were heard—the voices of minority communities. Marbury covers small businesses, neighborhood concerns, and the interesting people who live in Rochester’s 19th Ward. As the 19th Ward reporter, she has helped implement community outreach ideas by asking what people in various communities want to read about themselves in addition to regular news. Contact her on Instagram @justice_marbury and by email at jmarbury@gannett.com.
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Medically Unneccessary: Florida holds key to better health coverage for disabled kids. Why hasn’t it helped? – Health News Florida
Florida holds the key to providing relief for Florida families struggling with mismatched public health insurance and providing disabled or chronically ill children the coverage they need.
Whether the state will use that key remains to be seen.
In 2023, legislators unanimously passed a bill that would expand the eligibility of subsidized KidCare from 200% to 300% of the federal poverty level. It was supposed to go into effect at the start of 2024. It still hasn’t.
“I have people calling me every day, ‘I need health insurance for my kids,’ ” a frustrated state Rep. Robin Bartleman, D-Fort Lauderdale, said during a House Health Care subcommittee meeting in February. She sponsored the bill for KidCare expansion.
The Florida Agency for Health Care Administration, which oversees the state’s children’s health insurance program (CHIP), has yet to enact the expansion due to an ongoing lawsuit the state filed against the federal government in January regarding rules the Centers for Medicare & Medicaid Services established in November.
PART 1: Kids with complex needs moved to state insurance that doesn’t help
PART 2: Florida Healthy Kids won’t cover drug for chronically ill child
PART 3: Why Florida Healthy Kids doesn’t work for many medically vulnerable kids
“In order to implement the expansion as passed, I believe, we need to let the litigation play out against the federal government,” AHCA Medicaid deputy secretary Brian Meyer said during a House Health Care subcommittee meeting in February.
AHCA, reached regarding the lawsuit and the delayed expansion, stated it would not comment on open litigation.
Court filings show the state has been reluctant to enact the expansion due to CMS’ rules requiring states that rely on a premium system to provide 12 months of coverage to families that miss a monthly payment
The state contends that would amount to “tens of millions of dollars” whie the federal goverment expands an entitlement “potentially at no cost.”
“Florida faces actual and imminent injury to its sovereign interest in implementing and enforcing its laws, and in the form of unrecoverable monetary loss,” according to the court filings.
Meanwhile, families waiting for the expansion are stuck in limbo with no date established as to when relief may come.
“Just make it happen,” Orlando resident Erin Booth said.
Her 9-year-old son, Landon, is a cancer survivor, but he lost Medicaid coverage just as his recovery began. As a result, he receives coverage through a CHIP program known as the Florida Healthy Kids Corp., but he’s not able to get the therapies he needs.
Since last year, Booth has seen her son deteriorate in strength. Landon has osteoporosis and muscle atrophy as a side effect of chemotherapy. He’s also experiencing mild neurocognitive issues with his memory and attention. Landon used to really love playing soccer outside. These days he can’t put on a seat belt by himself.
Regular visits to occupational, physical, and speech therapists could help. But his insurance only covered eight sessions of each. That was eight months ago.
Since then, Booth has been fighting an uphill battle trying to get Landon his therapies but she believes the state is much like a wall on his road to recovery.
“I believe he would make bigger strides if he didn’t have his therapies taken away,” Booth said.
Last year, about 500,000 children lost Medicaid as part of a national Medicaid redetermination period after the COVID-19 public emergency ended.
Florida agencies did not track what happened to the vast majority of children who lost coverage, but Florida’s program did experience an increase of about 80,000 at the time of redetermination. State data does not distinguish whether those children joined CHIP after losing Medicaid, it was a change in status, or they were new arrivals from outside the state,
What experts have been able to confirm is that during the redetermination period, thousands of disabled children who lost Medicaid or Children’s Medical Services (CMS) – a low-premium public insurance for children with special needs – were referred to Florida Healthy Kids. The program’s statutes do not cover the expensive, habilitative services many of those kids need.
That’s where the 2023 law (HB 121) comes in. The measure expanded Florida KidCare’s premium-tiered program.
Today, Florida KidCare has premiums of $15 to $20 for those with incomes between 134% and 200% of the federal poverty level. Those over the threshold are on the “full pay plan,” which isn’t subsidized and costs families about $250 a month.
Currently, there is a gap in coverage for those whose income is over 200% of the federal poverty level. KidCare requirements provide subsidized public health insurance for those making an income within 200% of the poverty level.
The law increases the eligibility threshold from 200% to 300% above the poverty level. The expansion also serves families with disabled children by making eligibility for Children’s Medical Services more accessible. The expansion would create a sliding scale of premiums that increases as families’ incomes grow, with payments of $17 to $195 for those with wages between 134% and 300% of the poverty level.
The new premiums were designed to increase as a family becomes more financially self-sufficient and prepared them for a transition to private insurance.
The idea behind the expansion was to not punish low-income families for increasing their wages, but to provide an easier transition into the private health insurance market while avoiding the gap, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
The federal government’s 12-month coverage rule is also meant to help avoid gaps in coverage, Alker said.
“A lot of these families can’t tough it out. I mean, they’ve got to have coverage. Even one week of lapsed coverage is a crisis,” Alker said.
Jasmine Smith, a Leesburg mother, almost experienced a crisis this month when the Florida Healthy Kids coverage for her 5-year-old child, Omari, became inactive.
Omari has a number of disabilities. He was born with a brain injury that left him with breathing and feeding problems. He also has spastic cerebral palsy. Omari received coverage through Children’s Medical Services until the start of this year after Smith was considered no longer eligible.
Smith was scared. Neither she nor her son can afford any gap in coverage. His 24-hour private duty nurse and feeding formula, alone, cost $20,000 a month, Smith said.
Smith was able to get Omari coverage under Florida Healthy Kids in February for his many medical needs, but there was a problem.
Smith was late on her monthly payment.
“I guess I wasn’t understanding the payments, how they were set up,” Smith said.
Believing she had to pay her $250 premium before March 1 to receive coverage for that month, Smith paid on Feb. 25. The premium for March was due Feb. 14.
The insurance became “inactive,” which means Omari was covered but Florida Healthy Kids wouldn’t pay for any services. As a result of the late payment, Omari had no coverage for the first week of March.
Smith handled the one-week lapse with financial assistance through the Florida Birth-Related Neurological Injury Compensation Association, which covered Omari’s 24/7 private duty nurse, but it didn’t cover a lot of other things.
“Like tracheostomy supplies, gastrostomy feeding tube supplies, his therapies, doctors appointments, feeding formula,” Smith said. “It’s just very frustrating when he can’t receive that because of miscommunication on insurance.”
The new law was set to take effect in January 2024, but Florida filed a lawsuit against CMS after the federal agency published an FAQ in late 2023 that listed the missed-payment requirement. A district court dismissed that case in May 2024. Florida filed an appeal, then dropped it after CMS published finalized rules regarding the 12-month provision. In January, Florida refiled a lawsuit against the new finalized rules.
Alker, with the Center for Children and Families, said what the state is doing isn’t just harmful to families in need of relief. “The critical issue right now is that they are violating the law,” he said.
In January, outgoing CMS administrator Chiquita Brooks-LaSure sent a letter to AHCA informing the state agency that it had yet to demonstrate compliance with the new rules, thus terminating coverage of Floridians who were otherwise eligible for 12 months of coverage.
“States that are not in compliance with federal regulations are subject to further compliance action, including potential withholding of federal funds,” Brooks-LaSure wrote.
Florida Healthy Kids, the most prominent public insurance entity under the state’s CHIP umbrella, operates in a cost-share system. The federal government pays for 70 cents of every dollar spent on health care. The remaining 30 cents is paid through a combination of state funds and monthly premiums.
Any funds withheld by CMS would hurt Florida greatly, said Lynn Hearn, the director of advocacy at the Florida Health Justice Project.
“We’re talking about the very significant contributions that the feds make to the CHIP program,” Hearn said. “It’s a very high-match rate, and it would be a hit, a significant hit to Florida’s budget for that program.”
The 12-month stipulation was put in place to protect children from sudden gaps in coverage.
“Continuous care is critical to a child’s success, especially the kids we’re talking about, with complex medical needs,” Hearn said. “Even if we’re talking about those with diabetes or asthma, if their family is in a car accident and they miss a month premium, those kids can’t miss a month, and you don’t want them to miss access to medicine.”
Yet, Florida remains steadfast in its argument against the stipulation.
Steve Freedman, the creator of Florida Healthy Kids, is now a professor of public health policy at the University of South Florida and serves as an ad hoc member of the board of directors on Florida KidCare. He agrees with Florida’s position.
“The very DNA of Healthy Kids Corp. was family participation. So the whole idea of families saying they’re going to participate and then not participating is it’s fundamentally antithetical to why it was founded to begin with,” Freedman said.
Alker disagrees with the state.
“It’s a pretty disingenuous argument,” she said.
Alker points to Florida’s 2024-25 state budget and Florida KidCare’s predicted expenditures of $744 million. During a February budget agenda meeting, AHCA reported Florida KidCare had a projected overall surplus of $43 million.
During the meeting, AHCA budget analyst Bobby Jernigan was asked why there was such a large surplus.
According to AHCA, the discrepancy comes from enrollment estimation versus real-time enrollment. Estimating conferences take place multiple times a year to help AHCA realign its budget with its current enrollment list.
“We find that those estimates are slightly off; either environment or economic changes that take place will impact those enrollment numbers,” Jernigan said.
Part of the reason there was an overestimate was due to AHCA preparing for the KidCare expansion, but that wasn’t the main reason, Alker said.
“It was more the redetermination process,” she said. “It was the expectation that as children became ineligible for Medicaid, they would roll on to CHIP. But instead, we had 500,000 children come off of Medicaid, and (80,000) go onto CHIP.”
In the state’s argument against CMS and the continuous coverage stipulation, AHCA reported in court filings that the 12-month stipulation would cost the state $1 million a month to put in place.
Florida’s 2024-25 fiscal budget was $118.6 billion. Gov. Ron DeSantis’ proposed budget for the upcoming fiscal year is $115 billion.
“When you have a budget like the size of the state of Florida’s and the federal government is paying the vast majority, that this loss of 0.01% of their budget is going to cause them not to be able to balance their budget, that just doesn’t make sense,” Alker said.
It also doesn’t make sense to those waiting on the delay.
After DeSantis signed HB 121 in June 2023, AHCA submitted a waiver to CMS seeking the necessary federal funds that would enable the expansion. In December 2024, CMS approved the waiver with the expansion to be effective immediately. In a letter, CMS wrote that Florida would need to respond with a plan to demonstrate compliance with the continuous eligibility requirement. CMS sent a reminder Jan. 2 that funds would be withheld without compliance.
On Feb. 4, a member of the state House of Representatives asked Brian Meyer, the AHCA Medicaid deputy secretary, if AHCA was aware of the January letter and if communications with AHCA had occurred.
“We have not responded to that communication yet but we do anticipate responding in the near future,” Meyer said.
At the time of the January CMS letter, the Biden administration was still in power. It was thought that with the Trump administration, a friendlier ally to Florida leaders, communication between AHCA and CMS would begin, Hearn said, but that seemingly hasn’t happened.
“The litigation that Florida has filed has had the result of stopping communications between Florida and CMS,” Hearn said. “The agency that it has sued presumably would have a friendlier reception under the current administration. It’s a little bit of a mystery as to why Florida would want to continue with this litigation.”
Scott Darius is the executive director of the Florida Voices for Health. The organization is an advocate for families who lost Medicaid. Darius said Voices for Health hears from frustrated families wondering why the state hasn’t enacted the expansion yet.
“I think they’ve kind of been holding it hostage,” Darius said. “So now you have a whole host of families who would otherwise qualify for this for Florida KidCare under the 300% expansion, but, yeah, that option is not available to them until we take that step.”
Hearn pointed out that a reason for the ongoing litigation could be the national implications of a Florida victory. Should courts side with Florida regarding its stance on the 12-month eligibility protection, that would strike down the rule for all states that charge a monthly premium. According to KFF, 16 other states have monthly premiums.
“It appears that Florida won’t be satisfied with waiving the rule for its own purposes, and it’s trying to bring it down in totality,” Hearn said.
In February, the U.S. House of Representatives passed a budget resolution targeting cuts to Medicaid, as much as $880 billion or more over a decade, according to KFF. Both House Speaker Mike Johnson and President Donald Trump have expressed sentiments they don’t want to see Medicaid cut. But the hasty changes in Washington, D.C., have experts like Hearn worried about what could happen to Florida’s CHIP.
“CHIP is one of the programs that the committee tasked with these cuts is responsible for overseeing, and so CHIP is definitely vulnerable,” she said.
And while federal and state leaders figure out what happens next, children like Landon are stuck waiting.
Booth, his mom, is a generational Floridian. She was a believer in the DeSantis administration, too, but she can’t reconcile with everything that’s happened over the past year and the current state of CHIP in Florida.
“I never dreamed this would be happening. I always thought Florida was good for taking care of the people. But I guess not,” Booth said. “It’s not like these kids are asked to be disabled. They just want to be a kid. So why are you denying them the care to be a kid?”
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School of Data Science faculty improve AI reliability in medical field – UTSA Today
MARCH 17, 2025 — Researchers at the UTSA School of Data Science are making artificial intelligence (AI) more reliably answer medical questions. Their project, Reducing Hallucination of LLMs for Causality-Integrated Personal Medical History Question Answering, received a $35,000 grant in 2024 through the Collaborative Seed Funding Grant program, sponsored by the School of Data Science (SDS) and the Open Cloud Institute.
The research team is led by Ke Yang, an assistant professor of computer science, along with Anthony Rios, an assistant professor of information systems and cybersecurity, and Yuexia Zhang, an assistant professor of management science and statistics. All three are SDS Core Faculty members.
Their work focuses on reducing AI hallucinations, a term used to describe when AI confidently provides false or misleading information. Large language models (LLMs), such as ChatGPT, generate responses based on patterns in data, but they do not have real-world understanding. This means they can sometimes sound convincing while being completely wrong. The issue is made worse when AI learns from flawed, outdated or biased information.
Some AI mistakes are harmless — such as misidentifying Toronto as Canada’s capital — but others, particularly in health care, can be much more serious. A recent Harvard study found that many people preferred ChatGPT’s medical advice over responses from doctors, highlighting the need for more reliable AI in medicine.
Incorrect AI-generated medical advice could lead to misdiagnosed conditions or incorrect treatment recommendations. This makes it essential to improve accuracy.
“We found that there’s not much work targeting AI hallucinations in specialized fields, especially those with high risks such as health care, finance and employment,” Yang said.
Ke Yang discussed her research on AI hallucinations and large language models at the 2024 Los Datos Conference.
To improve AI accuracy, UTSA researchers are working on ways to give AI better context before it generates a response.
“We observed that AI sometimes gives incorrect answers because it doesn’t have enough background information on medical questions,” Yang said. “To address this, we proposed to extract previously known knowledge about diagnoses and practices to help AI think more logically. We then structured this information in a way that allows AI to process it more effectively using another AI system.”
The team is developing an AI model that can fact-check itself. To achieve this, they created a Causal Knowledge Graph (CKG) — a well-known format that organizes information from trusted medical sources. This structure helps AI recognize connections between medical concepts, allowing it to provide more accurate and reliable answers.
By integrating this external data with the user’s original question, the model gains a better understanding of the context of the user’s question, making its answers more. If successful, the team expects its model to generate hallucination-free answers, even in areas where the AI has received little to no prior training.
One challenge with using external data sources is ensuring AI pulls only the most relevant context for each question. To solve this, the team is also developing a system that filters information more effectively using subgraphs — smaller, targeted sections of data. These act like an index, helping the AI focus only on the most useful information instead of searching through everything it has learned.
Beyond improving AI-generated medical answers, the team wants to create a benchmark database — a collection of hallucination-free question-and-answer pairs that could serve as a standard for other AI researchers. This resource would serve as a testing tool, allowing developers to evaluate AI models against verified data and improve overall performance across various applications.
“Our project helps create open-source tools for researchers and develop new AI solutions that improve reliability in high-risk fields like health care,” Yang said.
Yang believes this research could extend beyond health care, improving AI accuracy in various fields.
“This work has the potential to bolster trust in AI and encourage people to use it for a variety of important applications,” she said.
By reducing hallucinations and improving reliability, UTSA researchers are making AI a safer and more trustworthy tool, particularly in areas where accuracy is critical.
— Christopher Reichert
UTSA Today is produced by University Communications and Marketing, the official news source of The University of Texas at San Antonio. Send your feedback to news@utsa.edu. Keep up-to-date on UTSA news by visiting UTSA Today. Connect with UTSA online at Facebook, Twitter, Youtube and Instagram.
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Incorporating mental health care into primary visits – Contemporary Pediatrics
Pediatricians face rising demands in specialty care and mental health, with programs such as REACH helping them manage these challenges.
Incorporating mental health care into primary visitsLatest revision
| Image Credit: © chathuporn – © chathuporn – stock.adobe.com.
General pediatric providers and pediatric specialists across multiple areas of medicine have told Contemporary Pediatrics that general providers are taking on more and more responsibilities. Longer wait times for pediatric specialty care, exacerbated by the COVID-19 pandemic, are still lingering and contributing to these added responsibilities.1
In addition, 1 in 10 children in the United States do not have a primary care doctor, a trend that is increasing. According to a 2024 study published in Frontiers, part of the reason for this struggle to find care is that medical practices have reached their maximum capacity of child patients who are covered by Medicaid, citing paperwork, low payment, and capitation as the primary drivers of low Medicaid participation.2
Even for children who are commercially insured, there has been an approximately 15% drop in the number of primary care visits in the past decade, further demonstrating the strain that the pediatric health care system is navigating.2
On top of these challenges, pediatric patients still face a mental health crisis, officially declared a national emergency in children and adolescents by the American Academy of Pediatrics (AAP) in October 2021.3
The AAP states that approximately 16% of children under 6 years of age have clinically significant mental health problems that require early-life clinical care. Whether patients present with dysregulated emotional or behavioral problems such as anger, aggression, or anxiety, or the inability to participate in family and community events, these issues rarely resolve without some capacity of specific intervention.4
These challenges often land first on the family’s pediatrician, who must not only manage a multitude of responsibilities but also must navigate an area in which they may not have a wealth of experience. A 2017 article published in Pediatrics noted that despite Accreditation Council for Graduate Medical Education requirements that ensure pediatric trainees complete a month each of developmental-behavioral pediatrics and adolescent medicine, an adequate depth of experience could be lacking. This doesn’t mean pediatric residents aren’t eager for additional opportunities to deliver mental health care in practice, even with the present challenges.5
The REACH Institute, a 501(c)(3) nonprofit organization, aims to deliver effective, scientifically proven mental health care to children and families by providing thousands of primary care physicians with training in evidence-based therapies to better diagnose, treat, and manage child mental health issues.6
The institute’s founder and board chair Peter S. Jensen, MD—a child and adolescent psychiatrist—acknowledged the challenges pediatricians may face when handling mental health issues in the primary care setting.
“At REACH, we've trained over 8000 pediatricians and family practitioners over the [past] 15 years, and what we've heard again and again is that the biggest challenge is finding the time and space in a busy practice to introduce and follow up on the topic,” Jensen told Contemporary Pediatrics in an interview.
“That's the first obstacle,” said Jensen. “The second is that primary care doctors and others in primary care don't get much training during residency. They've never had real practice in treating depression or maybe an anxiety disorder. They get a little exposure to [attention-deficit/hyperactivity disorder], but there is often so much more they need to learn how to do. So, the issues are time and space, background support and training, and then, of course, making sure they get paid for that work, which is so critical.”
Jensen stated there is a group of effective, free tools that function like checklists that are easily accessible online. Some are filled out by the parent, some by the child, but these tools can help the provider determine what a problem might be, even before a referral.
“For example,” said Jensen, “one of the older measures a lot of primary care providers have used is called the Pediatric Symptom Checklist (PSC-17).” Previously, a 35-item list, “researchers found they could reduce it to 17 items, which you can type into a web browser and download right away. This tool lets you separate a child who might have more attention problems from one who might have anxiety, depression, or other behavioral difficulties. It is easy to use, free, and can be integrated into the electronic health record. There are both parent and teen versions, and they can be transformative.”7
Jensen stated that physicians can get paid for using these tools, as most insurance companies and Medicaid allow billing codes for their use. On top of that, Jensen noted assessments taken are quick to complete but can offer strong indications of a potential mental health issue.
“These assessments take just a few minutes, provide valuable insights, and help point pediatricians in the right direction.”
He noted many providers are likely familiar with the Patient Health Questionnaire-9 (PHQ-9) tool, used to screen for depression. Other tools such as the Screen for Child Anxiety Related Emotional Disorders (SCARED) and Vanderbilt Diagnostic Rating Scale may also be familiar to general providers.7
“However, it's one thing to know about these tools and another thing to actually implement them—distribute them, review the results, and interpret them,” Jensen added.
“Imagine a child comes in with significant school-related stress, worrying about falling behind, agonizing over tests at night, and having trouble falling asleep. You administer the SCARED or General Anxiety Disorder-7—both anxiety self-report scales—and confirm that 'this kid is high in anxiety,’” Jensen explained.7
“Then, in your practice, you say, 'I'm going to teach you how to do deep breathing. We're going to spend 3 minutes on this, and now I'm assigning it as homework. I want to see you back in 3 weeks. Mom, I want you involved in this too. Your daughter has to work on this; it's a skill,'” Jensen said as an in-office example.
“This simple intervention—teaching deep breathing and incorporating it into a protocol—could benefit many anxious children who need that kind of support. If every primary care provider learned how to use these exercises, it would make a significant impact,” Jensen concluded.
References:
1. O'Dwyer B, Macaulay K, Murray J, Jaana M. Improving access to specialty pediatric care: innovative referral and econsult technology in a specialized acute care hospital. Telemed J E Health. 2024;30(5):1306-1316. doi:10.1089/tmj.2023.0444
2. Wells J, Shah A, Gillis H, et al. Tiny patients, huge impact: a call to action. Front Public Health. 2024;12:1423736. doi:10.3389/fpubh.2024.1423736
3. AAP-AACAP-CHA declaration of a national emergency in child and adolescent mental health. American Academy of Pediatrics. October 19, 2021. Accessed February 6, 2025. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/?srsltid=AfmBOoqgj3jdeCTzPdMP1X_SocPRGux5HWTag1bkUPhC7D93TUf4MJHm
4. Mental health in infants and young children: pediatric mental health minute series. American Academy of Pediatrics. Accessed February 6, 2025. https://www.aap.org/en/patient-care/mental-health-minute/mental-health-in-infants-and-young-children/?srsltid=AfmBOopzADBa2UacJuNtBEIXsMX6IE9WTaluk5Gmr2k9y484Cz0rSTo9
5. Raval GR, Doupnik SK, Closing the gap: improving access to mental health care through enhanced training in residency. Pediatrics. 2017;139(1):e20163181. doi:10.1542/peds.2016-3181
6. The resource for advancing children’s mental health. The REACH Institute. Accessed February 6, 2025. https://thereachinstitute.org/
7. Rating scales. The REACH Institute. Accessed February 6, 2025. https://thereachinstitute.org/training-old/rating-scales/
Recommendations for anxiety screening in pediatric primary care
Early anxiety screening in pediatric primary care improves detection, outcomes, and access to mental health support starting at age 8.
Addressing atypical anorexia: Part 3
The final episode in our podcast series on atypical anorexia discusses fat bias in health care and its impact on diagnosis and when pushback against diagnosis happens.
Cingulate reports phase 3 safety data for CTx-1301 to treat ADHD in children, adolescents
Results will be included an a final analysis of safety and efficacy data for CTx-1301, which will be included in a NDA submission with the FDA, stated Cingulate Inc.
Addressing atypical anorexia: Part 2
Dr. Erin Harrop discusses the necessity of understanding that eating disorders do not all look the same in every patient and how a multidisciplinary approach could be an effective way to diagnose and manage anorexia nervosa that is atypical.
More screen time linked to higher stress, depressive symptoms in adolescence
Higher physical activity and lower screen time in childhood were linked to reduced stress and depression in adolescence, according to a Finnish cohort study.
ADHD with ASD and without it: Should they be treated differently?
"My takeaway is that if medicine is needed, stimulants will be my first choice in this age group, regardless of whether the ADHD coexists with ASD."
Recommendations for anxiety screening in pediatric primary care
Early anxiety screening in pediatric primary care improves detection, outcomes, and access to mental health support starting at age 8.
Addressing atypical anorexia: Part 3
The final episode in our podcast series on atypical anorexia discusses fat bias in health care and its impact on diagnosis and when pushback against diagnosis happens.
Cingulate reports phase 3 safety data for CTx-1301 to treat ADHD in children, adolescents
Results will be included an a final analysis of safety and efficacy data for CTx-1301, which will be included in a NDA submission with the FDA, stated Cingulate Inc.
Addressing atypical anorexia: Part 2
Dr. Erin Harrop discusses the necessity of understanding that eating disorders do not all look the same in every patient and how a multidisciplinary approach could be an effective way to diagnose and manage anorexia nervosa that is atypical.
More screen time linked to higher stress, depressive symptoms in adolescence
Higher physical activity and lower screen time in childhood were linked to reduced stress and depression in adolescence, according to a Finnish cohort study.
ADHD with ASD and without it: Should they be treated differently?
"My takeaway is that if medicine is needed, stimulants will be my first choice in this age group, regardless of whether the ADHD coexists with ASD."
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Loans: NELFund to deploy software for Students with disabilities – Voice of Nigeria
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The Nigerian Education Loan Fund (NELFUND) says plans are underway to introduce specialized software aimed at ensuring that students with disabilities in higher institutions can fully take advantage of its loan scheme.
The Managing Director/Chief Executive of NELFUND, Akintunde Sawyerr, disclosed this during a stakeholders’ engagement on student loan in Benin City, Edo State.
He emphasized that the Act establishing the loan scheme guarantees equal opportunity for all, adding that NELFUND will collaborate with the National Commission for Persons with Disabilities (NCPWD) to ensure more inclusivity.
“We want to see how we can make it easier for those visually impaired, so that they can actually apply for the loan. We are looking at a specific software we are going to use,” he said.
During the event, which brought together religious leaders, parents, persons with disabilities, government officials, teachers, and community representatives, Sawyerr described the initiative under President Bola Tinubu’s administration as a transformative step for education in Nigeria.
Addressing concerns about loan repayment in the event of a beneficiary’s death, he said: “The law says that, if the very person dies, that loan is not transferred to the family or anyone else. The loan is wiped out.”
Sawyerr reiterated the government’s commitment to making tertiary education accessible to all Nigerians, stating that “President Bola Ahmed Tinubu came up with this initiative that no Nigerian student anywhere in Nigeria should be deprived of the opportunity to gain tertiary education because of lack of money.
“In order to actualize this vision, he set up this agency, Nigeria Education Loan Fund. He has funded it, he has put political will behind it, having created a structure through an Act of Parliament that effectively says that we are to go and look for these students, those who are about to drop out, those who are considering not furthering after secondary level, that we should look for them and if money is their issue, we should try to solve it. We’ve been doing that,” he said
On his part, Edo State Deputy Governor, Dennis Idahosa, commended the Federal Government for making the student loan scheme a reality.
“Let me also use this opportunity to thank the President of our dear country, President Bola Tinubu, for this initiative. Because before now, many families go through a lot of challenges to be able to pay school fees for students across the country.
“The thanks also go to my former boss, the then Speaker of the House of Representatives, Femi Gbajabiamila. In the 9th Assembly, this bill was sponsored by him and was assented by the President, and that is what gave this opportunity to Nigerian students to be able to pay school fees.
“We as a state government, by the grace of God, we are going to collaborate with you for very aggressive sensitization to ensure that almost all the students in Edo State benefit from the student loan initiative,” he said.
Edo State Commissioner for Education, Dr. Paddy Iyamu, described the scheme as nearly free due to its zero-interest nature, explaining that repayment would only begin two years after completing the National Youth Service Corps (NYSC) and when beneficiaries are employed, with deductions set at 10% of their salary.
The commissioner, who commented the NELFUND Managing Director, for passionately championing the loan scheme initiative across the three senatorial districts in Edo State and across the country, said Governor Monday Okpebholo-led government would leave no stone unturned to ensure its success.
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