Stemming the Tide: Investments in Pediatric Behavioral Health Make a Difference
Across the United States, the pediatric mental health crisis is overwhelming communities like a tidal wave: Compared to 2016, children's hospitals in 2021 saw a 31 percent increase in mental health inpatient visits for children and teens ages 3-18. Four in 10 teens in 2021 reported feeling sad or hopeless and 1 in 5 has contemplated suicide.
Even before the COVID pandemic, demand for pediatric behavioral health services had been stressing communities nationwide. For many families, this has meant long waiting lists for outpatient care and visits to the emergency room when children and teens reach a crisis.
Over the last few years, Golisano Children’s Hospital has launched new initiatives to help address these needs in the Rochester region. It has grown the Mobile Crisis Team, opened the Golisano Behavioral Health and Wellness Center, and developed school partnerships that have significantly increased the ability of caregivers to provide early interventions and help children before they reach a point of severe emergency.
“The emergency room is not a good place for kids in crisis,” said Michael Scharf, M.D., Chief of Clinical Service in the Department of Adolescent and Child Psychiatry at University of Rochester Medicine, in a recent interview with Pro Publica. “Providers focus on treating the most urgent symptoms, not on addressing long-term behavioral problems. Most kids who end up emergency care could’ve benefitted from earlier intervention from outpatient services.”
As a result, while most the rest of the country is getting overwhelmed with increasingly long waitlists for outpatient services and emergency departments, GCH is shortening their waitlists and treating more kids in the outpatient setting than ever, and there’s potential to make even more gains.
Bringing Services Directly to Families
One of the most vital new GCH pediatric behavioral health services is located in a nondescript office in Henrietta. Within these walls are the headquarters of the Mobile Crisis Team, a multi-disciplinary unitt that provides rapid-response services to children in both home and school environments. Utilizing psychiatric mental health nurse practitioners, social workers, mental health counselors and other specialists, the Mobile Crisis Unit team provides assessment, stabilization, and rapid-linkage to treatment providers.
Established in 1994, the Mobile Crisis Team (MCT) has grown its capacity rapidly, including the addition of two dedicated child and adolescent teams, to serve the increasing the number of pediatric patients. This need has escalated significantly in recent years, as the team has gone from treating 60 patients in January of 2020 to 160 in January of 2022.
“With the development and coordination of our crisis call line and dispatchers, we’re able to get out into the field much quicker and coordinate assessment, and mobilize our team from one patient to another. We’re seeing more and more patients each day, and there’s minimal carry over from one day to the next,” said Carrie Meeks, Clinical Director of the MCT.
The benefits of the MCT are clear: They are able to provide immediate, coordinated care in a safe environment for children and adolescents undergoing a mental health crisis. Only 1.9 percent of patients initially seen by the MCT end up visiting the emergency room later on, and thanks to these services, pediatric emergency room visits for psychiatric care have remained relatively stable in Rochester since 2018 despite significant increases in emergency department visits across the country.
As the demand for MCT services increase, the teams have gotten more efficient and effective in treating patients. Each case – which comes through the crisis call line staffed by a Masters-level therapist – is triaged by the members at the headquarters and the dispatch team.
The first priority is determining whether the case is appropriate for the MCT. Issues like medical concerns or patients at immediate risk of harm to self or others are encouraged to utilize emergency services or go to CPEP, URMC’s Comprehensive Psychiatric Emergency Program. All other cases are handled by the MCT team, where members in the field meet with patients and coordinate care via phone or Zoom with doctors at the headquarters.
“Every patient and family gets tailored treatment,” said Yilmaz Yildirim, M.D., Medical Director of MCT, “Our motto with mental health is ‘each patient is different from one other.’”
The MCT utilizes company-issued vehicles that are unmarked, and staff have no uniforms or indicators that would even reveal that they are a behavioral health team. The goal is to be discreet and treat the patient (literally and figuratively) where they are at.
“We’ll get creative with folks to meet their needs,” said Meeks.
When meeting patients in the field, the MCT provides crisis intervention, mental health assessment, medication management when indicated, and connection to the appropriate level of care. If there’s an extended waitlist for treatment, the MCT is available for interim support along with the crisis call line.
“The addition of medication management was critical,” said Yildirim. “We are able to see patients who are not on medication and we help connect them to services.”
As the team has grown in capacity, their community partnerships have expanded due to positive feedback from patient families about the MCT’s ability to provide quality outpatient services in a family-friendly setting while helping to keep emergency visits to CPEP down.
In the past few years, the MCT has been invited to give presentations to schools, police, libraries, and community associations. “The program has become better known in the community,” said Meeks. “In three years, we’ve expanded the number of community organizations we work with.”
More families are coming forward about their positive experiences with the MCT. Lynda Backus is a social worker in the community for both child and adult protective services. Early in 2022, her 5-year-old son started having a behavioral health crisis on a school night.
“He was emotionally disturbed and upset, asking to talk to somebody. It was scary being in that situation and not knowing how to handle it,” she said.
Backus turned to the crisis call line and was immediately connected to the operator. The operator talked to her son to help calm him down, arranged for a team to come visit the next morning, and continued to check in via phone through the course of the night to see if he was ok. The next day, a group of three specialists from the MCT came out to their home.
“Their engagement with him was amazing. From the minute they got out of the car, I was blown away with how comfortable and engaging they were with him,” said Backus. They sat out our couch, played with our dog, and had a conversation. They made us feel so at ease.”
The MCT connected Lynda and her son to family crisis referral center, and arranged for a case worker from Hillside Family of Agencies to visit within 48 hours. He is now seeing an individual therapist and is in a much better place than several months ago.
“Because we connected with Mobile Crisis Team, we were able to be linked to these services sooner,” said Backus.
As the MCT continues to grow its reputation and capacity, Yildirim imagines the team operating similar to a 911, 24/7 type service — an idea that was far-fetched several years ago but is now within reach.
“When we started, we had three to four teams with limited coverage in the daytime. We now have seven to eight teams, with multiple teams helping throughout the day and two teams serving at night until 10 p.m. We hope to expand these hours to meet the needs of the community,” said Yildirim.
In June of 2020, the Golisano Pediatric Behavioral Health and Wellness Center opened on South Avenue. Established with a generous gift from Tom Golisano, the Center was intended to address the growing pediatric behavioral health crisis in the region.
The Golisano Pediatric Behavioral Health and Wellness Center has delivered on that promise, helping to significantly ease the burden of long waitlists in Monroe County. When the center was constructed, the waitlist for services was nearly 400. Now, the average for the region is 150, and in combination with the Mobile Crisis Team, the center has helped prevent severe outcomes and emergency department visits for children.
Linda Alpert-Gillis, Ph.D., director of Pediatric Behavioral Health & Wellness Outpatient Services, shared that when she began at UR Medicine, the service saw 3,000 patient visits a year. Now, they are able to provide over 60,000. “Outpatient access is critical to supporting the needs of children and their families,” said Alpert-Gillis, “partnering with parents and caregivers is essential to make sure that the services developed, and provided, are in line with the complex needs of diverse families.”
With this initial success, the behavioral health team and GCH supporters are not resting on their laurels. Thanks to $1 million in initial funding from the Brighter Days Foundation, GCH plans to start building the area’s first-ever walk-in mental health crisis clinic for young people up to age 18, who can show up with no prior appointment to get immediate care.
“There’s currently no crisis clinics like this from the city of Rochester to Batavia," said Scharf in a recent interview with 13WHAM News. “So, this is geographically strategic, as well as quantitatively strategic.”
Scharf estimates the walk-in crisis center will see up to 3,000 patients per year. Many of these patients will need follow-up care, so GCH is exploring options to open an additional, smaller pediatric behavioral health and wellness center on the west side of Rochester.
The cumulative effect of these services would be to provide immediate and safe care outside the emergency setting. "The idea is that the space will be calming and comforting. All the services we offer will be family-centered,” said Scharf.
Brighter Days Foundation director Annette Weld said her organization came forward to help fund this project in order to address the urgency of the behavioral health crisis.
“This gift will address the national crisis in child and adolescent mental health on a local level,” said Weld. “We don’t have time to sit around and discuss the problem without action. It is exciting to see the changes coming. There is still a lot of work to be done and more funds to raise but we are seeing movement in a positive way and that is great!"
Regional School Partnerships
While new facilities and programs have helped the Monroe County region, providing services in rural areas is still a challenge. Although these communities have the same demands for care, they also have fewer primary care offices and logistical obstacles that make them more difficult to serve, according to Melissa Heatly, Ph.D., clinical child psychologist at GCH.
“Rates of mental health challenges are similar across the board, and the risk is elevated when you’re in the context of poverty or an economically suppressed area, where there’s greater chance of adverse child events,” said Heatly. “Rural areas, with lack of employment or child care opportunities for families, put a lot of stress on people.”
To navigate around these infrastructural barriers, UR Medicine – with grant support from the Substance Abuse and Mental Health Services Administration (SAMSHA) – is implementing a new initiative called UR Supporting our Students (SOS). UR-SOS focuses on enhancing the capacity of middle and high school educators in the Finger Lakes region to support adolescents with behavioral health needs, including those with serious emotional disturbances.
Part of UR-SOS is implementing a Project ECHO (Extension for Community Healthcare Outcomes) model in rural schools. ECHO utilizes a virtual “train the trainers” approach to prepare school staff to identify, approach, refer, and effectively support teens with behavioral health needs and their families, before they escalate.
“We currently offer mental health training for a number of districts in-person in Monroe County, but we want to look at ways to expand our capacity and conduct outreach to communities where there may be fewer resources,” said Heatly. “ECHO pairs a hub of experts with content knowledge with community educators who offer collaborative case studies for discussion and problem-solving. In turn, participants are learning from each other, and experts are learning from participants. We’re building expertise in these participating districts to help identify and support kids with mental health challenges, and they can then turn key in their own community to make a difference.”
UR-SOS also trains school mental health staff as trainers in Youth Mental Health First Aid, an effective and engaging public health course that teaches community members how to respond to teens experiencing mental health emergencies.
After a year, UR-SOS has made progress building capacity of school teams to reach kids before they need an acute intervention such as CPEP. “Schools are the most common point of entry for kids with mental health issues, and schools are under-resourced in mental health services,” said Heatly.
Thanks to the program, 184 educators and school mental health staff have been taught crisis intervention and de-escalation, who are now able to refer children to various forms of treatment closer to home. Similar to the Mobile Crisis Team and the new outpatient facilities, it’s yet another form of intervention that provides quality care to children in a safe environment.
“It truly takes a village to support our kids’ mental health needs - it should really be a shared responsibility of everyone, including mental health providers, educators, families, and even youth. They want to help each other – and we’re proud that UR-SOS helps them do that.