Addressing the Pediatric Mental Health Crisis
Mental health is one of the largest, most complicated and costly challenges in pediatric health care today. Access to appropriate behavioral and mental health resources is a growing problem nationwide—and North Texas is no exception. For adolescents, a lack of such services is even more pronounced given the extra issues that manifest as children approach adulthood. Consider that:
- 20% of children with depression and anxiety go undiagnosed and untreated
- Nearly 2 out of 5 school-aged children experience a mental health need each year
- 20% of youth have a psychiatric disorder, and half do not get treatment
- Texas is ranked as the second-worst state in the country in terms of adolescent substance abuse treatment, with only 5% of teens who need substance abuse treatment actually receiving it
- Suicide is the second-leading cause of death in adolescents; 15% have a suicidal plan every year, and 9% of these adolescents will attempt suicide
- 1 out of every 23 female adolescents and 1 out of every 19 male adolescents in Texas, aged 12-17, need treatment for drug use but are not receiving it
Thanks to caring people like you, Children's Health℠ is at the forefront of the conversation in Texas. Right now, an anonymous friend and the Hamon Charitable Foundation will triple match every dollar you give! This means your gift triples in impact for a girl coming to terms with chronic illness, a boy struggling with bullying or a teen feeling trapped by an eating disorder.
Our Mental Health Services
Children’s Health is home to one of the nation’s most comprehensive pediatric psychiatry and psychology program. We offer four different levels of care and a wide variety of programs through the following key initiatives:
- Community-Based Early Identification and Care
- Mental Health Care at Critical Moments
- Individualized Care
- Tending to Mental Health Needs for Children's Health Patients
- Improving Available Care
- Innovative Solutions
Community-Based Early Identification & Care
Children’s Health has several initiatives that expedite access to care on a broader scale, with the intent to increase access to evaluation and intervention and to provide necessary care before conditions advance to the point of crisis.
Integrated Behavioral Health
The clinic-based Integrated Behavioral Health program was launched at Children’s Health in 2015 to integrate the physical, mental and social well-being components of health in accessible and sustainable ways within our community. IBH leads to early identification, intervention, and effective referral and coordination for more complex health needs, if necessary.
Our behavioral health specialists—half of whom are bilingual in Spanish—are integrated into more than 30 primary care sites across the region. Each behavioral health specialist works with approximately 400 children to manage their behavioral health needs, from short-term interventions to long-term coordination and follow-up care.
School-Based Telebehavioral Health
Children’s Health launched telebehavioral health services at area schools in 2017. This novel initiative provides early identification and access to treatment for mental health concerns among adolescents.
When an at-risk student is identified, the school counselor contacts the family, obtains consent and refers her or him to a Children’s Health Behavioral Health Care Manager to conduct the assessment via telephone. When warranted, treatment plans can include virtual counseling sessions and external referrals to community providers, with telephonic care management follow-up.
The program, which was established with philanthropic support, provides training to school counselors, in-service trainings for school staff and parent educational presentations on behavioral health topics. It is currently available in approximately 50 schools throughout North Texas; more than 43,000 students attend these participating schools. The successes of this program also led to a significant state-funded initiative (Texas Child Health Access Through Telemedicine) through which our team provide initial support to even more students at 108 campuses across 19 school districts.
Mental Health Care at Critical Moments
Children’s Health has a network of facilities and resources in place to help children and families in times of present crisis related to mental health needs, all of which can benefit from support from philanthropic partners.
Mental Health Support in ER
Oftentimes, parents are unaware of, or do not act on, their children’s potential mental health issues until a serious episode or suicide attempt. Those children, in turn, present to emergency rooms as evidenced more and more each year by ERs nationwide.
The ER at our Dallas campus, which is the second-busiest pediatric ER in the country, is no exception. Likewise, the ER on our Plano campus is regularly experiencing high volumes of behavioral health needs.
Part of the care offered at our two ERs is from social workers and psychologists, who are the primary members of the mental health assessment team, and who protect and advocate for patients’ social and mental health needs. Social workers also help families with a wide range of social, logistical and financial aspects of their child’s medical care.
Such care is supplemental to the clinical treatment provided and, despite its value, relies on philanthropy to maintain and enhance available resources.
Emergency Room Facilities
In light of the increasing number of children and families who turn to our ERs for mental health needs in moments of stress. The ER on our Dallas campus had been at physical capacity for many years and is currently completing the final phase of a full-scale renovation and expansion to adequately meet the current and future needs of North Texas children, including with enhanced and increased space and resources for children presenting with behavioral health concerns. Enhancements to the ER on our Plano campus are currently being formalized to better accommodate the growing needs for services and resources north of Dallas, including for mental and behavioral health emergencies.
Generous donors and community members supported the critical project in Dallas and remain central to our ability to enhance the infrastructure and offerings in both of our emergency rooms.
The General Inpatient Psychiatry program at Children’s Health, housed within the Dallas hospital, provides treatment and follow-up care for patients who must remain hospitalized for a range of conditions and disorders. It is the only such program in the Dallas-Fort Worth area with the capacity to provide concentrated support for patients with comorbid medical conditions.
The nine-bed inpatient unit is close to 100% occupied year-round. Contributions to this area can sustain and enhance the general inpatient program and its associated needs, as well as the supportive and non-clinical offerings to help patients and their families during these difficult times.
When children are in our care, our experts work with each individual family to identify the best course for treatment and recovery. Several specialized programs are offered to help children and adolescents with particular concerns to maximize their health and functioning, all with the goal of re-integrating children to home, school and social lives, and to optimize long-term recovery and well-being.
SPARC (Suicide Prevention and Resilience at Children’s)
In 2014, Children’s Health began the Suicide Prevention and Resilience at Children’s program, an evidence-based, intensive outpatient program designed to reduce teen suicide risk and increase skills and resilience for patients. It is one of only two evidence-based suicide treatment programs of its kind in the country, and the only one in the state of Texas.
SPARC is a four- to six-week program emphasizing robust safety planning and suicide-specific treatment interventions immediately following a suicide attempt or ideations. The program includes group therapy, individual therapy, family therapy, a parent support group, case management and access to a psychiatrist. Results include:
• Lower one-month suicide reattempts
• Higher rates of remaining in psychiatric and/or therapeutic treatment than for traditional outpatient care
• Teens completing the program show a decrease in depressive symptoms, suicide risk and propensity to suicide, and indicate high satisfaction with the program
SPARC fills a great need in our community, serving approximately 200 youth each year at Children’s. Our experts are also working to train other providers in the community to offer this life-saving program to their own patients.
Teen Recovery Program
The Teen Recovery Program opened in summer 2017 and is the only pediatric-specific facility in North Texas designed to help youth ages 13-18 with both behavioral health and substance use issues through a specialized outpatient treatment approach. Specifically, the evidence-based care used in this program involves:
• Medication management
• Cognitive behavioral therapy
• Motivational enhancement therapy
• Group and individual therapy
• Family engagement to help the adolescent gain valuable coping skills to end substance abuse, as well as manage emotional and psychological problems that may arise when transitioning to a sober lifestyle
Because it is an outpatient program, the child can remain at home and in school as they learn new coping strategies and ways to manage their addiction and substance misuse.
The program has helped more than 200 children and families since it began and our experts typically provide about 2,400 therapy sessions each year, providing hope for these youth and their families who may have felt like they had nowhere else to turn.
Center for Pediatric Eating Disorders
The Center for Pediatric Eating Disorders, based at Children’s Medical Center Plano, is an innovative and highly regarded program for children with eating disorders, caring for local children, as well as for children from across North Texas and beyond. The multidisciplinary team of experts care for both girls and boys, children and adolescents, who struggle with eating disorders, working with each family to develop specialized and individualized treatment plans, build skills and implement strategies for living healthy lives.
Services range from hospitalization to family therapy to art therapy to intensive outpatient sessions, all of which are delivered in a comprehensive manner that accounts for the various needs of children and families. Insurance reimbursements only cover some of the direct costs of the care provided in the Center for Pediatric Eating Disorders, so philanthropy is crucial to the program’s success.
Outpatient psychiatry services at Children’s Health are available for areas such as general psychiatry, developmental assessments and care for patients with medical-psychiatric disorders, and include a dedicated Depression Clinic and the Early Childhood Mental Health Clinic. Through evidence-based clinical care and state-of-the-art research, our high-quality clinicians provide services such as:
• Psychological testing
• Medication management
• Intensive outpatient services
• Individual, group and family psychotherapy
With external donor support, the Depression Clinic has begun to expand its offerings to improve initial and follow-up care. Additional funding is needed to maintain and further expand its offerings.
For children who need comprehensive psychiatric services, but can safely be home at night, the Day Treatment program offers all-day school alternative services to approximately 200 children each year. A multidisciplinary team of specialists helps children and families increase their levels of emotional and behavioral functioning in the home, school and community.
Through a range of clinical, recreational and artistic therapeutic techniques, health professionals emphasize family participation and encourage parents to attend several daily group sessions for therapy and education.
Like virtually all direct care in the psychiatry and psychology arena, insurance only reimburses for some of the direct costs of providing care.
Tending to Mental Health Needs for Children's Health Patients
Children receiving medical care for illness and injuries may face a range of stressors and obstacles that are above and beyond what a typical child endures. To help account for psychological concerns that may result from or be exacerbated by medical conditions, Children’s Health has experts on hand to help children and their families throughout their health care journeys.
Consultation and Liaison Service
Our psychiatrists and psychologists provide consultation and liaison services throughout our institution for medical subspecialties, inpatient and intensive care areas, and our emergency rooms at both our Dallas and Plano hospitals.
These specialists provide assessments, conduct therapy sessions with children and family members, and prepare children for procedures through nearly 120,000 patient encounters every year, a number that continues to increase. Some programs and areas throughout Children’s Health have dedicated psychological support staff to meet the unique needs of patients.
Neuropsychology at Children’s Health focuses on the study and assessment of brain function problems caused by injuries and brain disorders. Our pediatric clinical neuropsychologists conduct comprehensive evaluations for children with more complex medical histories involving autism and other developmental disabilities in order to assist with treatment interventions.
Evaluations include standardized assessments and clinical observations of a child for a range of factors, including neuropsychological strengths and weaknesses, cognitive and social-emotional abilities, and sensory abilities and motor skills.
The discipline takes the whole child—as well as his or her multiple environments, like school, home and social settings—into account in order to maximize potential and health outcomes.
Philanthropic needs in this area span patient care, provider training through fellowships and research.
Rees-Jones Center for Foster Care Excellence
Our experts work closely with the Rees-Jones Center for Foster Care Excellence at Children’s Health in order to meet the urgent behavioral and mental health needs of children entering the foster care system, and to maintain care as these children progress.
A team of child psychiatrists, psychologists and early childhood specialists is integrated into the Rees-Jones Center; this integration serves as a standard of care for foster children nationwide. Some of the behavioral health services offered to patients and caregivers include:
• Child psychiatry services and developmental assessments
• Parenting support and education
• Trauma-focused cognitive behavioral therapy
• Parent-child interaction therapy, a system of coaching in which a specialist uses earbuds to relay helpful techniques to a foster parent as the parent interacts with the child in a playroom
Services are now also offered virtually to increase access and convenience to mental health care for children in foster care.
Improving Available Care
Children’s Health is committed to improving the availability and quality of mental health care for all children—in Dallas, across Texas and beyond. By strengthening the skills and expertise of current providers, and by training the next generation of providers, we are helping to ensure children can access specialized care when they need it.
Center for Pediatric Psychiatry – Training and Education
In order to offer the latest and most effective therapies to better meet the needs of the youth we serve, Children’s Health needs to ensure our staff receives continuing training and education. Our experts can continue to be at the forefront of the latest, most effective treatment for our patients through:
• Attending conferences to present findings and learn from peers
• Participating in continuing education forums
• Bringing in visiting specialists and experts to share knowledge with the psychiatry and psychology teams at Children’s Health
Investing in the career development and continual training of these caring professionals is key to ensuring current and future generations of children have access to the best mental health care. It also keeps our staff at the leading edge of research and treatment, and helps ensure that Children’s Health can continue to attract and retain the best talent to care for children in North Texas.
Mental Health Research
Children’s Health is a leader in clinical research, paving the way for new discoveries, cures and management for pediatric illness and injury. The fields of pediatric psychology and psychiatry are always evolving as new trends are continually analyzed and new approaches are continually evaluated.
Funding restricted to research on mental health and well-being can help advance studies to improve the lives of countless children and families affected by these conditions. Types of research in this area can focus on:
• New treatments for specific conditions
• Understanding population-wide trends in pediatric mental health
• Psychological impact on children and families dealing with chronic conditions
• Much more
Such donations would be used to support studies with the greatest promise in this area.
Any sustained improvements to the pediatric mental health care landscape will require changes to the broader environment and structure that impact laws, guidelines, public funding and related insurance reimbursements.
Children’s Health is active at the local, state and national levels, advocating for important programs and providing expert information to lawmakers regarding legislation on issues related to the health, safety and security of children in North Texas, including matters that affect availability and sustainability of mental health care.
Such efforts are solely funded by institutional operations and philanthropy, but are crucial to the long-term health and well-being of Texas children.
What's Coming: Innovative Solutions
Children’s Health and the Meadows Mental Health Policy Institute have collaborated during recent years to create an ambitious plan to address the pediatric mental health crisis in North Texas. Rather than caring for kids’ needs at the breaking point, our approach will empower primary care providers across the community, allowing for earlier identification and treatment of kids’ mental health conditions—before they escalate.
The proposed solution will be the first of its kind, offering a fresh approach to a historically elusive problem by integrating a mental health assessment component into the standard pediatric care routine in the following three, straightforward ways:
- Develop and train pediatricians to assess, address, monitor and manage a child’s mental health conditions, such as mild-to-moderate anxiety, depression and suicidal ideation. Training revolves around online training modules and other educational support developed for community partners.
Additionally, a new primary care clinic for pediatric patients with behavioral health issues is planned for the southern part of Dallas—home to many traditionally underserved and high-risk communities—and will provide hands-on training for clinicians while demonstrating effective ways to integrate mental health into primary care practices.
- Analyze patient-level, provider-level and community-level information to continually inform evidence-based practices that improve the consistency and quality of the integrated mental health model.
- Promote and advocate for systemic sustainability and scalability of the integrated mental health care model by changing the way all stakeholders, including legislators and insurance carriers, fundamentally view and address the ever-evolving mental health paradigm.
By reconceptualizing where most children receive care for mental health needs, we are redirecting a focal point of tackling the pediatric mental health epidemic. The scope of this effort has the potential to change the landscape of pediatric mental health today and long into the future.
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