The numbers about children’s mental health seem overwhelming. In North Carolina, the second leading cause of death for children aged 10 to 17 is suicide. One in five children between the ages of 14 and 18 suffers from a mental health illness. Yet more than half of the counties in the state do not have any child and adolescent psychiatrists, meaning that patients often have to travel far, join long waiting lists, or face other barriers to care.
To counter those trends, Atrium Health has a program that makes pediatric behavioral healthcare accessible and convenient. Behavioral Health Integration (BHI) brings mental healthcare to families where they already are – pediatric clinics – saving them time, reducing their costs and fighting the stigma associated with asking for mental health support. The goal is to create a proactive approach in treating the whole little person with early intervention.
“As medicine has evolved, we’re no longer just viewing psychiatry in one little space. Psychiatry is everywhere,” says Atrium Health’s Manuel Castro, MD, FAPA, medical director of Behavioral Health Integration. “The ability to provide behavioral health services while a patient is sitting in your office, while they (or their parent) have had the courage to open up about their mental state, is a golden opportunity. It’s our mission to keep that door open.”
This program recently completed its third year, and its results are creating a new set of numbers about children’s mental health – this time, much more hopeful ones.
Bringing Behavioral Healthcare to Children
BHI embeds mental healthcare into families’ existing medical care. If a patient or parent who comes to a pediatrician’s appointment with concerns about their mental health, like symptoms of anxiety and/or depression, the provider will assess the extent of the child’s mental health issues. This will begin a conversation about those challenges and their impact on daily living, and the provider may refer that patient to the program for consult.
Within minutes, that patient and parent or guardian can have a virtual consultation – via a video connection in the exam room or follow-up phone call – with a behavioral health specialist. The goal is to make the process as simple as possible for families to address their child’s mental health, whether that’s by phone or the click of a button.
That child and adolescent psychiatrist, pharmacist, licensed professional counselor, licensed clinical social worker or health coach will work with the family’s pediatrician to create treatment options. Options may include medication, different types of therapy, suggestions for a sleep routine, exercise recommendations, and more. After the appointment, the BHI team will reach out to the family with regular phone calls to learn how treatment is working and to answer questions that arise. Some families may choose to complete their child’s behavioral healthcare through the BHI program with their child’s pediatrician – while other patients may choose to use the program while they wait for an available appointment with a child and adolescent psychiatrist.
“What I hear most about from patients and their parents is the amount of support they receive during their wait – not just the medication, but getting frequent phone calls, follow-ups, health coaching,” says Michael Wenning, MD, a child and adolescent psychiatrist at Atrium Health’s Northeast Psychiatric Services. “By the time they reach us, we can hit the ground running with no delay in care.”
Convenient and Effective Care for Families
Kari Lovdal, RN, is an Atrium Health nurse and the parent of two children, Elise and Emory. Her children had always experienced a high degree of worry, and Emory also had trouble concentrating. As a new parent, Kari wondered if these were normal stages in early childhood development, but as the children grew older, she wanted to talk to a specialist to learn more about anxiety disorders.
Kari sought an appointment with a developmental pediatrician, but the waiting list was six months long. When she learned about BHI through her existing pediatrician’s office, she chose that option instead. It’s been exactly what she hoped for her children – and for her.
“I love the ease of it, the convenience of being able to have behavioral healthcare in the same practice that knows my child so well. Also, I love not having to take off multiple days from work and pull the kids out of school at different times to go to several appointments. We can do it in one place.”
Each week, the BHI team calls Kari to check on her and the children. The support they’ve gotten has made a significant difference. Emory feels more relaxed and happy; Elise is sleeping better, having better dreams and fewer tears.
Courtney Ellis, PA, the physician assistant at Atrium Health Levine Children’s Charlotte Pediatric Clinic who’s worked with Elise and Emory in their pediatric office, has found a remarkable change in the children. “Elise, who’s always been terrify afraid of dogs, sat with a service dog in our office,” Ellis says. “She was sitting on the floor with him, petting him. It was amazing to watch her ability to not instantly be afraid of new or unfamiliar things.”
Changing the Numbers on Pediatric Mental Health
Stories like Elise’s and Emory’s are just two of the hundreds of positive stories emerging from this program. Since BHI began in June 2015, 915 patients in seven pediatric clinics have enrolled in the program. Of those, 65% have shown a significant reduction in depressive scores, 68% have achieved significant reduction in anxiety, and 47% have achieved remission, no longer having depressive symptoms. Most significantly, 83% of children who entered the program with suicidal thoughts no longer had suicidal thoughts when they completed the program.
At a time when so many statistics about pediatric mental health look so daunting, these numbers offer hope.
“Pediatrics is global practice. We care for patients’ physical needs, we talk about their developmental experience and make sure they’re on track at all stages of life,” says Jeffrey Cleveland, MD, pediatrician at Atrium Health Levine Children's Charlotte Pediatric Clinic. “And, of course, we’re interested in making sure we’re also addressing their emotional health. That’s part of the whole package of general pediatric care that we seek to offer in all of our Atrium Health pediatric practices.”
If you or a loved one is in need of assistance, Atrium Health’s Behavioral Health Help Line is available 24/7 at 704-444-2400 or 800-418-2065.
