Gathright Guided Work at UAMS Psychiatric Institute Child Diagnostic Unit
It takes a village of healthcare professionals to help take care of a child with profound behavioral or mental health problems, says Molly M. Gathright, MD, a child psychiatrist who is assistant dean of graduate medical education and an associate professor of psychiatry at the University of Arkansas for Medical Sciences (UAMS).
Gathright was recruited to join the faculty of the UAMS Department of Psychiatry to launch an innovative startup of a child psychiatry inpatient unit within the Psychiatric Research Institute (PRI) to address the rising concern within Arkansas regarding the number of children with severe emotional and behavioral disorders.
"There were children who were diagnostically puzzling, incurring repeated acute psychiatric hospitalizations and residential treatment, failing outpatient levels of care, and being treated with significant poly-pharmacy," Gathright said.
The job fit Gathright perfectly since she loves working in teams. She headed the team used to establish the Child Diagnostic Unit (CDU) in 2008 to serve children ages 2 to 12. The results have been a measurable success in outcomes for children.
"I was fortunate to be integral to the development of the clinical guidelines and administrative protocols that now drive the mission of the CDU to provide child and family-centered care that is collaborative, humane, and trauma sensitive," said Gathright. "The approach at the CDU utilizes an inter-professional team to produce a comprehensive individualized treatment plan. More specifically, objectives of hospitalization are to clarify psychiatric diagnoses in diagnostically challenging and puzzling children, and create a comprehensive bio-psychosocial formulation, including developmental factors that contribute to presenting psychiatric symptoms of the child and family. Another goal is establishing a rational medication regimen by reducing poly-pharmacy."
Children stay 28 days for comprehensive assessment used to develop an individually-tailored treatment plan that allows them to be integrated into the community. A key goal is to address the "revolving door" of repeated psychiatric hospitalizations.
"It's really challenging when you have tried a lot of things and they seem to be making no difference," Gathright said. "It is important then to step back and see what pieces of an assessment might be missing. Does this child have hearing impairment? Speech and language problems? Motor skills difficulties? What is the family struggling with? We need to hit the pause button, and look up and consider the other assessment pieces."
Part of process was to conduct a medication washout. Children would come in on three to eight medications. They would be slowly tapered off medications to get a baseline view and allow a very well-reasoned approach to using medicines.
"Medicines work and there is a place for that," Gathright said. "The literature supports that. But being thoughtful about how medications were being used and targeted was important. On average, children would leave on one or two medicines. We probably cut the quantity of medicines by half."
A unique inter-professional post-discharge clinical management program was developed to follow the child for 90 days.
"This post discharge management assists in integrating the inter-professional treatment plan with key collaborators, providers and support that exist within a child's returning community," Gathright said.
Prior to coming to the CDU, 80 percent of the children had some form of inpatient treatment in the previous 90 days--and sometimes more than one. Ninety days post discharge, 80 percent of the children were not being re-admitted to the hospital.
"That is really quite great," Gathright said. "A lot kids are in a revolving door, and keep being re-admitted to the hospital. Reducing that is a good outcome."
Gathright grew up in Searcy, and became interested in medicine at age 7 when her father developed multiple sclerosis. She also had an early interest in teaching. One thing she likes about her current job is she can be both a physician and a teacher.
"In that, I have found what I call my life work," Gathright said. "I am clinician first, but I get to teach not just students, but children and their families."
Gathright became assistant dean of graduate medical education a year and a half ago. UAMS has about 60 different residency and fellowship programs on campus, and about 650 residents.
"It was the next step for me to serve the greater good," said Gathright, who earned a degree in chemistry from Harding University before graduating from UAMS. "I do a lot of administrative work making sure the institution has accreditation standards. We also focus on being innovative in striving for excellence in our programs. I particularly enjoy mentoring the next generation of physicians and junior faculty members in the state."
Even with that many specialties, there are gaps in areas such as pediatric gastro-enterology, child psychiatry, neurology, and infectious diseases. And most specialists in those shortage areas are concentrated in Central Arkansas with a smaller concentration in Northwest Arkansas.
"That makes it really difficult for families who don't live in those areas," Gathright said.
In her spare time, Gathright likes to run. She has run a couple of marathons and half marathons.
"I enjoy that," she said. "I also enjoy cooking and spending times outdoors. My husband, Dr. Ken Gathright, a radiologist, and I like to travel."
For more information, visit:
University of Arkansas for Medical Sciences Psychiatric Research Institute Child Diagnostic Unit
