Written by Anna Ellason, DNP, CPNP, PMHS, Certified Pediatric Nurse Practitioner (Published 11/2017)
NorthLakes Community Clinic- Ashland Downtown Clinic
At our Ashland downtown clinic location we offer general pediatric care for kids from birth through age 21. This includes well child visits, acute visits for illnesses like ear infections and strep throat and also chronic disease management for things like asthma, constipation and hormone imbalances/polycystic ovary syndrome (PCOS).
In addition to our general pediatric care, we have recently added my services as a board certified Pediatric Primary Care Mental Health Specialist (PMHS). In this role, I am able to diagnose and manage kids with various mental health conditions including behavior concerns, attention-deficit hyperactivity disorder (ADHD), impulse control disorder, depression, anxiety and many others.
Mental health conditions are an illness just like any other illness, such as cancer or diabetes. Unfortunately, as a society we discriminate against people when their illness occurs in the brain; but that stigma—and the shame and blaming that can go along with it—is unjust. When brain chemicals are missing or not working correctly, children, like adults, need medications. It is not a matter of will power, intelligence, or home-life and upbringing, it is a disease.
The PMHS role is relatively new and was developed as a direct result of the extreme shortage of medical professionals working in child psychiatry in the country. In fact, the state of Wisconsin is listed as a severe shortage state by the American Academy of Child and Adolescent Psychology, having only 1 child and adolescent psychiatrist for every 10,000 kids in the state. Here in the Chequamegon Bay Area we are in a 10-county area without any Child and Adolescent Psychiatrists. We are fortunate to have general resources: in Ashland and Iron River, NorthLakes has a family psychiatric nurse practitioner who provides some psychiatric care for children; and Memorial Medical Center also has inpatient and outpatient psychiatric services, including care for children. My new role serves as a bridge between primary care and certified psychiatric care – such as the Psych NPs in our area provide.
It’s a double whammy. At the same time resources are limited, mental health issues for kids are far more common than expected. Over half of all mental illness shows up in people by the time they are only 14 years of age, three quarters by the time people are 25. It is imperative that we work with families to help identify these kiddos and get them the help that is needed. This help may include counseling, occupational therapy, support for families and routines at home. In some cases, it also includes medications. Recent studies have shown that children with true diagnosis of ADHD actually have a lower risk of substance use the earlier that appropriate medications are started. That being said, it is important to note that my general approach is to be a low medication provider.
Diagnosing mental health concerns can be complicated and so can finding the right treatment. I often coach families that, like some medical diseases, there are not a lot of tests that help to figure out what medication would best treat a condition. This means there is a lot of trying, and trying again. Fortunately at NorthLakes we have two unique tests to help us with diagnosis and treatment.
For diagnosis assistance we have “QB test” which is the only FDA approved test for helping the diagnosis and medication management of ADHD. For treatment we have access to “GeneSight testing” which helps guide us in the choice of medication for mental health conditions. It does not tell us which medication to use but instead gives a green, yellow or red rating related to side effects, efficacy and potency based on genetic testing.
It takes a team to help children with mental illnesses: I have advanced skills and resources, the children are the experts of their bodies, the parents are the experts of their kids, and schools are the experts of their education. By recognizing everyone’s expertise and working together as a team, we can improve kids’ lives.
Meet Dr. Anna:
NorthLakes Community Clinic has clinic locations in Ashland, Balsam Lake, Hayward, Iron River, Minong, Turtle Lake, and Washburn. NorthLakes locations offer: medical, dental, behavioral health counseling, Psychiatric Medication Management, Recovery Services (substance abuse/AODA counseling/Medication Assisted Treatment), Chiropractic, Pediatric Speech Therapy, Pediatric Occupational Therapy, and prescriptions for patients.
Clinics are open Monday through Friday. NorthLakes accepts Medicaid/Badgercare, Medicare and Private Insurances such as Medica, Blue Cross/Blue Shield, HealthPartners, and more. For more information visit http://northlakesclinic.org. NorthLakes is a 501(c)3 non-profit organization.