Mental health screenings are key to keeping kids healthy
Earlier this year, the U.S. Preventive Services Task Force recommended for the first time that physicians screen all adult patients under 65 for anxiety, acknowledging the extraordinary stress levels stemming from the global pandemic. The group said the guidance was intended to help prevent undetected mental health disorders.
The task force made a similar recommendation for children and teenagers earlier this year. Patient-feedback data reported in the NRC Health 2022 Pediatric Consumer Trends Report found that mental health hospitalizations of children have increased by 163% from 2020 to 2021. In early 2021, emergency department visits in the United States for suspected suicide attempts were 51% higher for adolescent girls and 4% higher for adolescent boys compared to the same time in early 2019.
NRC Health’s emphasis on Human Understanding is an important framework for understanding mental health needs.
“If we’re devoted to Human Understanding, we should understand the entire child as well as the family system,” says Peggy Greco, Ph.D., Chief Patient Experience Officer at Nemours Children’s Health and a pediatric psychologist. “Only asking about physical or medical symptoms is just one piece of the puzzle; that’s not true understanding. Full Human Understanding necessitates assessing or identifying emotional state or mental health for the individual child as well as for the family system. It is important, even within medical environments, to have open conversations, set a safe stage, and build a trusted relationship in order to allow for assessment of the entirety of that human being.”
Having a safe space where patients can have open conversations is critical to finding health issues—either physical or mental. In many cases, the pandemic delayed care. Because pediatric care was delayed, parents reported slightly higher rates of worsened mental health (32.4%) than did consumers without children in the household (29.9%) in Q4 2021.
Greco says that as a patient-centered health system, Nemours looks at the whole child and the whole family system when assessing a child’s needs. “And that means not excluding mental health needs,” she adds.
“There’s a dawning realization in healthcare nationwide that emotional needs or mental health needs are not separate from physical needs. They interact; emotional issues or concerns can impact physical status and vice versa.”
Greco reports that there has been a shift over the last decade toward integrating the assessment of mental health status into medical settings. She says that like many other children’s hospitals and health systems, Nemours Children’s Health has experienced a significant increase in mental health needs, spanning their whole system. This includes more parents calling in to be seen by behavioral-health services, as well as more emergency-department and clinic visits with behavioral exacerbations or emotional issues as a significant complaint.
Greco says the elephant in the room is a shortage of psychologists, psychiatrists, and other professionals who assess and treat mental health concerns. Telehealth is one way to expand availability, especially for remote patients in rural areas; Nemours also uses telehealth as a way for patients in any one practice to access mental health providers who may be at another site. Further, Nemours’ primary-care sites use an integrated-care model, with psychologists on site offering assessment and treatment in conjunction with traditional pediatric medical care. Lastly, the collaborative care model, which Greco says Nemours Children’s Health has also utilized, is another way to meet demands for mental health treatment. This approach involves psychiatrists training pediatricians to successfully diagnose basic psychiatric needs and prescribe certain essential medications, so that more patients can be managed in the primary-care office by pediatricians, with the collaborative psychiatrist remaining on call for any needs that may arise in connection with medications.
“That model results in the expansion of the availability of psychiatric services for kids and their families,” Greco says.
The strategy around collaboration and how to best manage resources to meet patient needs is also top-of-mind at Children’s Wisconsin. From 2020 to 2021, visits to the emergency department for children and adolescents with mental and behavioral health needs increased by 40 percent. In 2021, Children’s Wisconsin supported nearly 1,400 children and adolescents in the emergency department who were experiencing a mental health crisis.
To provide the best support for patients and their families, Children’s Wisconsin has increased access to mental and behavioral care in a number of ways.
“Our goal is to have therapists working alongside pediatricians in every primary-care setting, and also expand this to urgent care,” says Allison McCool, Social Work Supervisor at Children’s Wisconsin. “This has been very valuable for patients and families, because children have been able to see a therapist sometimes same-day or the next day.”
Additionally, Children’s Wisconsin opened a mental health walk-in clinic in March of 2022. The clinic is open seven days a week to support children and adolescents aged five to 18.
“We know that there are long wait lists for providers of mental health services,” McCool says. “This clinic is a direct result of families telling us what kind of care they need most and when they need it.”
Both Greco and McCool agree that identifying and coping with emotions at home are great ways to help set up kids for success as they traverse their stressful adolescent years.
“It’s the importance of parents talking with their children, really understanding how they’re doing and how school’s going—having those open discussions about where their children are and how they’re feeling,” McCool says. “Some warning signs are withdrawing from activities they’re normally involved in, loss of interest, concerns with school performance, and isolation from normal activities.”
Greco says that with adolescents, families must take time away to talk—away from the phone, the TV, and any siblings—which may occur during drives. “It’s important to have regular times when you’re asking, ‘How are you doing? How are you feeling? Are there times when you feel really, really down?’” she says. “If you don’t ask, you won’t know.”
Greco says that there are all kinds of excellent tools for identifying and helping with emotional concerns, such as mood-tracking and coping apps and easily obtainable workbooks, which can be helpful—especially for teens who may be especially private about their concerns.
She adds that modeling healthy identification and coping with emotions at home is another great way to help set up kids for success, particularly in adolescence. “Talking about emotions, identifying your own, identifying your child’s, asking about them, responding to them, and validating them are important avenues to healthy emotional development,” she says. “Sometimes parents worry that if they validate an emotion, they are somehow validating helplessness. But those are two different things. By identifying the emotion, you help your child to recognize it, and then you can problem-solve around how to respond to it or cope with it.
For ideas for parents, kids, teens, healthcare workers, and educators, KidsHealth.org, a Nemours site provides physician-reviewed information on children’s health and parenting issues, available in English and Spanish.
Success stories from Children’s Wisconsin can be found here.