PC1151: The CALM Pilot: A Primary-care Based Coaching Curriculum to Support Children and Adolescents with Depression or Anxiety and Obesity

Background: The COVID 19 pandemic worsened rates of childhood obesity and child and adolescent mental health concerns such as anxiety and depression. Access to needed mental health services was limited for many children and adolescents while emerging evidence suggests that brief coaching sessions rooted in positive psychology practices may provide benefit to individuals with mild to moderate depression or anxiety.

Methods: C.A.L.M. (Connection, Awareness, Lifestyle, Mindfulness) by WELL Clinic is a 4-session individual coaching program for children and adolescents with obesity and co-existing behavioral health concerns such as mild to moderate anxiety, depression, stress, or anger management concerns. The visits are 20-minute, individual, telemedicine sessions. The session topics include (1) Overview & Wheel of Health, (2) Savoring activity and S.T.O.P., (3) 3 Good Things and Positive Affirmations, and (4) Guided Mindfulness Practice and Next Steps. The program is rooted in the best evidence from positive psychology which focus on strengths to support well being and behavior change. Patients are identified and referred to the C.A.L.M. pilot by the by their primary pediatrician from sites across Children’s Primary Care Medical Group, a large multi-site pediatrics single-specialty group. The coaching sessions are delivered by a certified pediatric nurse practitioner with training in mindfulness and meditation practices. Each session used patient-centered coaching techniques to help patients explore existing behaviors and identify a goal for behavioral change. The visits are coded as obesity and dietary counseling and/or exercise counseling, and by mental health related comorbidity.

Results: In the first 5 months of the pilot, 28 patients were seen in the CALM by WELL Clinic pilot; 93% of them have completed the 4-session program to date. A patient experience survey was sent to each patient following the sessions. The response rate was low. Those who completed the survey reported improvement in their social and emotional wellness, more confident in managing their mental health, and that they would recommend the program to a friend. The nurse practitioner clinician rated the sessions as feasible, enjoyable, and effective. All visits were covered by insurance.

Conclusion: A primary-care based brief coaching program rooted in positive psychology is an innovative and practical way to help children and their families with mild to moderate anxiety, depression, stress or anger management concerns and obesity to receive mental health supports for patients who otherwise do not otherwise or currently have access to a therapist.