Last fall, clinical teams across the Palo Alto Medical Foundation, each with the goal of improving care for our patients, vied for grants to support their forward-thinking project ideas. Launched in 2016, PAMF’s Grants and Disbursements Program awards our in-house innovators—doctors, nurses, administrators and researchers—with funding drawn from unrestricted gifts to philanthropy.
Sixteen teams were chosen from 55 applicants to pitch their ideas to the PAMF Community Board of Trustees. This year, the board opted to fund 13 projects, awarding $1 million total and bringing the program’s three-year tally to $3.5 million.
Of the initiatives awarded grants, three focused on improving mental and behavioral healthcare. “We are fortunate to have amazing donors who understand how depression, anxiety and other mental health issues can impact day-to-day life,” says Shahna Rogosin, M.D., chair of psychiatry and behavioral health at PAMF and physician leader of two of the projects granted funding. “It’s exciting to identify services that we don’t offer currently but that we believe will be impactful.”
Here is a closer look at the three new mental and behavioral health programs now becoming reality thanks to your generosity.
Transcranial Magnetic Stimulation Clinical Program
Major depressive disorder affects 17 percent of adults in the U.S., many of whom struggle to find relief. While there is an array of antidepressants available, only 33 percent of patients who take one recover, and their odds of success decrease with each successive drug trial. Plus, these medications often carry unwanted side effects that deter patients from staying on them.
“Traditionally, we’ve had very limited ways to manage treatment- resistant depression,” Dr. Rogosin says. “Complicated medication regimens and more invasive treatment modalities such as electroconvulsive therapy are not as well tolerated.”
Now, however, there is hope. Thanks to a $150,000 grant from the Grants and Disbursements Program, PAMF will pilot transcranial magnetic stimulation (TMS) at the San Carlos Center this fall. This Food and Drug Administration–approved noninvasive intervention for treatment-resistant depression and obsessive-compulsive disorder involves placing a magnetic coil over a patient’s scalp to stimulate specific brain regions linked to depression.
thought to use magnetic fields to stimulate nerve cells in the brain to improve symptoms,”
says Tam Nguyen, Ph.D., psychologist, director of behavioral health across PAMF’s
Camino, Peninsula and South Bay divisions and operations lead for this project.
Though it typically involves 36 treatments, TMS is painless, has very minimal if any side effects and is usually covered by insurance. It is also very effective. Following a six-week course, 50 percent of patients report significant improvements in depressive symptoms, while one-third recover fully—including those who’ve failed multiple medication trials.The project leaders aim to implement TMS by September, once they’ve purchased the equipment and designed the workflow and patients have been deemed eligible through insurance.
“It’s very exciting to add another treatment option, allowing for the continuation of care in-house instead of referring patients out like we had been,” Dr. Nguyen says. “We anticipate that patients will appreciate this service, and from there we’ll look at the data to see if it makes sense for other PAMF locations. Because of the high costs of purchasing the machine and setting up the infrastructure, we wouldn’t be able to do this without philanthropy.”
Acupuncture for Anxiety and Depression
A second new project will also benefit patients with depression and anxiety. Along with their TMS funding, Drs. Nguyen and Rogosin secured a $42,000 grant to offer auricular acupuncture via shared medical appointments at the Mountain View Center, part of PAMF’s Camino Division.
Strong evidence shows that auricular acupuncture, which involves inserting thin needles into particular points around the ears, is helpful for anxiety and depression.
“Many individuals, when having emotional problems, look for non-medication options first,” Dr. Nguyen says. “PAMF offers auricular acupuncture in the Alameda Division and it is very popular, with patients reporting improvements in their mental health.”
Because of its effectiveness, Drs. Nguyen and Rogosin wanted to expose more patients to this therapy without referring them outside of PAMF. About five years ago, a Fremont practitioner started an auricular acupuncture group that was very successful, but when she left PAMF, the service was not continued. “We are so excited to add back auricular acupuncture because we know it works and we know patients love it, and this will dramatically improve access to behavioral health services within PAMF,” Dr. Rogosin says.
The Grants and Disbursements funding will pay for two Mountain View physicians to take a 300-hour acupuncture training course at the Helms Medical Institute in Berkeley. Once they’ve completed training, daily groups of up to 12 patients will start this coming fall. “First, we’ll offer group appointments for depression and anxiety, then we’ll introduce additional shared medical appointments to target symptoms such as insomnia and chronic pain,” Dr. Rogosin says. “We hope to expand this service to the other divisions by sending more physicians to receive training.”
QbTest for Pediatric ADHD
Attention deficit hyperactivity disorder is the most common pediatric mental health condition in the U.S., affecting 11 percent of children and teens. Key symptoms include inattention, poor impulse control and hyperactivity, although not all kids have all three, or they may not have all at one time.
According to Brian Tang, M.D., a developmental and behavioral pediatrician at PAMF’s Fremont and Los Gatos centers, it is critical to identify and treat ADHD as early as possible, whether through behavioral intervention or medication. When the condition is overlooked or not managed appropriately, kids often struggle in school and develop anxiety and low self-esteem.“Evidence shows that when we address ADHD, children’s outcomes are better,” Dr. Tang says. “It also gives families and teachers a better understanding of the child, so they won’t mislabel them as stubborn or difficult.”
But evaluating kids for ADHD is not a perfect science, and the condition often goes undiagnosed—or it is misdiagnosed. “Unlike screening for autism and speech delays, which are done during well visits, there is not a recommended ADHD screening procedure that’s used universally,” Dr. Tang says. “Typically, when parents bring up a concern to their pediatrician, they are sent home with a validated checklist or screening tool.” These rating scales are problematic,he adds, because they are largely subjective and prone to bias, and gathering accurate family and medical history can be tricky.
Fortunately, there is now a more objective, accurate way to screen kids for ADHD, which PAMF will begin offering very soon thanks to a $26,696 grant from the Grants and Disbursements Program. QbTest, an FDA-approved, quantitative computerized assessment,rapidly measures inattention, impulsivity and hyperactivity. Patients age 6 and up sit with a laptop for 15 to 20 minutes and complete a standardized test that assesses focus while a camera captures their physical movements. Feedback from this exercise helps physicians make accurate diagnoses, rule out ADHD when appropriate and create individualized care plans.
“We are excited to have a method to screen for ADHD and also measure children’s response to medication and behavioral interventions,” Dr. Tang says. “We couldn’t have launched this project without philanthropy. If we can show that QbTest is sustainable, if parents are pleased with the service, then perhaps it can be leveraged for adults with ADHD.”