Getting ahead of the pediatric mental health crisis
Getting ahead of the pediatric mental health crisis
Pediatric psychologists at Children’s HealthSM designed specialized therapy programs to help combat behavioral health issues.
Each year, over one million children with mental health problems are being admitted to emergency rooms across the country.
ER visits due to mental health problems increased by more than 120 percent between 2007 and 2016. During the pandemic, that trend continued, with mental health visits to emergency departments increasing further.
While the pandemic has exacerbated the problem, experts trace its roots back to the late 2000’s.
“People point to the 2009, 2010 period as an inflection point,” says Dr. Betsy Kennard, a pediatric psychologist at Children’s Medical Center Dallas, part of the Children’s Health system in Dallas. “There was an increase in social media use, an economic crisis, and I think kids were starting to feel increased pressure academically around that time.”
More recently, pediatricians and mental health physicians have seen acute symptoms resulting from pandemic-related disruptions.
“We started to see more kids who lost their usual coping skills or outlets when they weren’t going to school,” says Dr. Sabrina Browne, a pediatric psychiatrist with Children’s Health. “When school reopened, we saw the flip side with kids who had gotten used to doing school virtually experiencing a lot of anxiety around going back.”
Today, there’s a forming consensus among mental health professionals that the pandemic acted as a catalyst for an already-growing trend, adding another layer to existing challenges and complicating stressors, symptoms, diagnoses and treatment strategies.
“There’s not one single factor,” Dr. Kennard says. “It’s very complicated.”
“People point to the 2009, 2010 period as an inflection point. There was an increase in social media use… and kids were starting to feel increased pressure academically…”
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Dr. Betsy Kennard,
Pediatric Psychologist and founder of the SPARC program
Enhanced resources for complex needs
Over her 40 years with Children’s Health, Dr. Kennard has served as co-investigator on several treatment studies for adolescent depression and suicide, co-authored cognitive behavioral therapy (CBT) treatment manuals, and developed a treatment strategy to prevent relapse in youth with depression.
A persistent struggle for patients with mental health issues, says Kennard, is access to a proper level of care.
“As a doctor, my primary goal is to reduce risk for re-attempt or attempt,” she said. “Then patients should go to outpatient care, but their access to that care can be really difficult to obtain either because of financial reasons or travel.”
Without proper outpatient care, patients can end up in the emergency room. In 2014, on a mission to interrupt that cycle, Dr. Kennard and Children’s Health – in partnership with UT Southwestern Medical Center – launched an intensive outpatient program called Suicide Prevention and Resilience at Children’s, or SPARC.
In this four- to six-week program, kids receive a balance of intensive, specialized care and an outpatient approach that allows them to continue living their lives. Instead of being admitted into the hospital, patients attend multiple group therapy sessions per week, including individual therapy, family therapy, multifamily therapy and skill-building sessions where they learn things like communication, validation and emotional processing.
This specialized treatment prevents admission to the emergency room or getting caught in between treatment centers, which is less-than-ideal for kids facing mental health challenges. The SPARC program has welcomed over 2,000 patients in the last ten years, many of which were referrals from pediatricians and other front-line physicians.
While the normal suicide re-attempt rate among teens stands at around 30 percent, kids who have been through SPARC experience a re-attempt rate closer to 10 percent, a staggering improvement.
“When we started BHIG, it was a foreign idea that pediatricians needed to talk about behavioral health.”
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Dr. Adrienne Hunnicutt,
Pediatric Psychologist at Children’s Health
“We’re very encouraged by the results,” Dr. Kennard says. “We also have high treatment satisfaction, among both parents and the teenagers so we feel like we’re doing the right thing, and we have a good program. We’re confident we can help teens and do it while keeping them in school and in their communities.”
Dr. Kristin Wolfe, a pediatric psychologist at Children’s Health and a member of the SPARC’s team of expert physicians, experienced first-hand how this specialized program improves the lives of patients.
“A few years back, we had a young girl referred to us who was having suicidal thoughts, substance abuse urges, and pretty severe depression,” Dr. Wolfe said. “Over four or five weeks, we saw a steady decline across measures of depression and suicidality. When we discharged her, she was experiencing mild symptoms of depression. She felt better and her family was happy with the care she received. Ultimately, she felt like she could get back to her life.”
Training and education for front-line physicians
In addition to offering enhanced resources for patients, the other side of this complex mental health equation involves easing the demand for behavioral health services in emergency departments by better equipping primary care providers.
That’s why Children’s Health also launched the Behavioral Health Integration and Guidance (BHIG) initiative. BHIG provides pediatricians with ongoing mental health training and education, helping them recognize and treat conditions like anxiety, ADHD, stress and depression, all at no cost.
+1 million
children with mental health problems are being admitted into emergency rooms across the country each year.
“When we started BHIG, it was a foreign idea that pediatricians needed to talk about behavioral health,” says Dr. Adrienne Hunnicutt, a pediatric psychologist with Children’s Health. “Now, pediatricians tell me, ‘This comes into my office all the time, how can I get support?’”
Given the busy schedule physicians already face, the BHIG initiative utilizes a hybrid model that combines effective training with a flexible commitment. Over six months, doctors complete online, self-paced modules and meet periodically for video calls to discuss cases and tackle questions.
“It’s hard to find time as a pediatrician to do this, so we do our best to not make it too much of a time investment all at once,” said Dr. Browne. “But putting in the time upfront can prevent a big crisis and headache for the family and the pediatrician later down the road.”
Dr. Browne says many of the pediatricians she works with speak about the increased demand for mental health care that they witness daily. “All of these behavioral health problems are going to come into their office whether or not they have the tools, so we’re trying to train them so they’re ready in the moment,” she said.
As pediatricians become better equipped to recognize and treat behavioral health issues, fewer crises should reach emergency departments.
Bringing together cross-disciplinary experts under one roof
The BHIG and SPARC programs are bright lights in the fight against the mental health crisis, but they’re not the only factors that make Children’s Health and UT Southwestern stand out. With symptoms and diagnoses that are increasingly complex and multilayered, treatment providers need an equally multilayered response. For Children’s Health, that means pairing psychologists with psychiatrists, vision with resources, and leadership that holds it all together.
“Leadership is very supportive of behavioral health initiatives, period,” says Dr. Hunnicutt. “You don’t see that everywhere, but in my tenure at Children’s, anytime we’re at capacity they hire more staff, and the program is growing exponentially.”
In terms of cross-expertise collaboration, SPARC and BHIG have access to the main hospital in addition to their own diverse staff. “I am so grateful for the multidisciplinary team here at Children’s Health,” says Dr. Wolfe. “We have psychiatrists, therapists, social workers, school services and specialized medical providers that are all easily accessible. It’s a huge bonus because I don’t know all the answers, but I work in a place where I know I can find them.”
“We have psychiatrists, therapists, social workers, school services and specialized medical providers that are all easily accessible.”
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Dr. Kristin Wolfe,
Pediatric Psychologist at Children’s Health
The issue of mental health, especially regarding children, can be a sensitive topic – one that is easy to turn away from or blame on generational divides. However, Dr. Wolfe and her colleagues at Children’s Health are on the frontlines of this crisis, helping patients, parents and pediatricians combat the ever-growing demand for essential mental health care.
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