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A Path Forward

Dr. Mike ScharfThe headlines were everywhere, forecasting a major problem.

“Chronic Mental Health Issues in Children Now Loom Larger Than Physical Problems,” read one such missive in the Journal of the American Medical Association in 2012.

And in parallel, another set of headlines, showing that the demand for services far outweighed the supply.

“Growing Need for Pediatric Mental Health Services,” read a 2018 report from the New York School-Based Health Alliance.

Rochester, for its part, was in better shape than most places, but still had long wait lists for certain services. Children, here and everywhere, were hurting.

But then, in fall 2017, a lifeline: Tom Golisano announced a $5 million gift to help establish the Golisano Pediatric Behavioral Health & Wellness building. The building — the remainder of the project will be funded through additional philanthropy and by URMC — is scheduled to open in January 2020, and will enable our child behavioral health leaders at URMC to create an entirely new service line while expanding two others, moves that are sure to help mitigate the need for pediatric mental health in the region.

It also represents the culmination of several decades of work by the Division of Child & Adolescent Psychiatry. While the need for pediatric mental health services has been on the rise all over the country, the Rochester region has managed to meet its demand better than many other areas.

Consider: When Michael Scharf, M.D., now the Chief of Child/Adolescent Psychiatry took over as senior medical director in 2009, the division had only five child psychiatrists on faculty.

“Today, we’ve got 16,” said Scharf. “When you look at cities our size, to have that number of child psychiatrists is extremely rare, and it may even be unique.”

Range of services

With 24 Psychiatry and Psychology faculty members — along with a variety of other care providers including nurse practitioners, mental health counselors, social workers, family and marriage therapists, creative arts therapists, and nurses — the division has been able to staff four main service lines.

The division’s Outpatient Services, called the Pediatric Behavioral Health and Wellness Service, is the largest children’s mental health ambulatory service in the region. The service is heralded for providing evidence-based assessment and treatment in a developmentally-appropriate, family-driven, strength-based approach to care for youth ranging in age from infancy to adolescence and their families.

The service provides diagnostic evaluations, individual, group and family therapies as well as medication consultation and management.  The service expects to provide nearly 40,000 appointments in the next calendar year; 20 years ago, the service provided about 12,000 visits annually.

Partial Hospital Service is for patients who require intensive services, but are able to stay at home with their families safely without 24/7 nursing observation. Patients ages 12 to 18 attend this service five days a week from 7:45 a.m. to 2 p.m., with an average length of stay for three weeks.

GCH Behavioral Health and Wellness buildingThe program combines a variety of therapies, including one-on-one sessions, group therapy, activity therapy, and schoolwork, and is housed in the Psychiatry building of the University of Rochester Medical Center (URMC). While it currently has capacity for 22 patients, it will expand by 50 percent once it is moved to the new Golisano Behavioral Health & Wellness building.

“That program is where our wait list is the most concerning, given the urgency of need for those youth and families,” said Scharf. “But with the new facility, I’m hopeful we can greatly reduce the number of children waiting for this service, hopefully all the way to zero.”

Inpatient Services, also located in the Psychiatry building of URMC, is a locked facility for children 5 to 18 with acute psychiatric issues. There are 24 licensed beds, and patients stay in this facility for an average of 10 days. A multidisciplinary team provides a variety of daily therapies, with two teachers on hand to ensure the patients stay on track with their education.

The Pediatric Behavioral Health Consultation and Liaison Service provides consultation and support to patients, families, clinical providers and staff in the Golisano Children’s Hospital.

Additionally, the division’s Crisis Intervention Service provides scheduled appointments for youth of all ages and their families. Children may be referred by the Pediatric Emergency Department, the Mobile Crisis Team, and community pediatricians and family medicine physicians. Linda Alpert-Gillis, Ph.D., Director of Pediatric Behavioral Health & Wellness Outpatient Services is excited to be able to expand this important resource for our community.

“Thanks to this generous donation we will have the space to provide needed services for youth who cannot wait for a traditional outpatient appointment yet do not need the resources of the pediatric or psychiatry emergency department,” she said. “The new building will enable the innovative outpatient crisis services to double in their capacity."

Scharf and Alpert-Gillis are also looking forward to creating new services for their current outpatients when in crisis. With the new building, that will finally be possible, as an Intensive Outpatient Service Line would allow such youth to receive a higher level of care than traditional ambulatory services during after school hours to enable them to stay at home and attend  their regular school.

Other efforts

When it comes to preventive behavioral health care, the division has been an innovator in training providers and staff who work with children in a variety of settings. This has been a particular area of emphasis, especially as a means of reducing wait lists for certain programs; if children and adolescents seek and receive help before they reach crisis, their care may not need to be so acute.

One shining example is the FairStart program in the Fairport Central School District. Fairport is one of four districts that contracts with the division for mental health programs, and URMC providers use a three-tiered system to support the district own capacity to manage the behavioral health needs of their students.

First, they provide social and emotional training to teachers and nurses to ensure they can maximize their own effectiveness when they are dealing with a student who may have a mental health concern. The second tier comes from case-specific consultation and student support workshops. Then, finally, if a child reaches the point where more intervention is needed, they provide school-based services to help them to develop ways to cope with their symptoms or situation.

“The focus of our program is building a school’s capacity to address kids’ complex social and emotional needs, and that really takes a village,” said Melissa Heatly, Ph.D., the program director. “You really need to do more than just offer clinical services in a school. You need to back it up by offering additional support and training for the other adults working within that setting.”

In addition to schools, the division is also partnering with primary care providers across the region to provide similar supports — education and training for front line providers and staff, and consultation and linkage to appointments when necessary. One program, called Project TEACH, is a state wide endeavor which the Division is a regional provider for, and has been the largest provider of Continuing Medical Education credits for pediatric mental health for primary care providers in the entire country. The outpatient service is also providing integrated collaborative care to families in GCH’s primary care pediatric practice at URMC and in the community at Panorama Pediatric Group.

The various prevention efforts have helped stem the tide somewhat. But as mental health providers throughout the region continue to grapple with increasing demand for services, there’s much work to be done.

“There’s no competition until there are no wait lists,” said Scharf. “And right now, we still have them for some services. That’s why we are so looking forward to expanding into our new building — it’s going to help a lot of children and families get the support they need."

 

3/7/2019

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