Mental Health

The Partnership Access Line (PAL) has helped reduce antipsychotic prescriptions for Washington children enrolled in Medicaid by 49% since 2006.

Antipsychotic prescriptions for children enrolled in Washington state’s Medicaid program decreased by nearly half following the implementation of an innovative psychiatric consultation program affiliated with Seattle Children’s, according to a study published in the March 2017 issue of Health Services Research.

The 49% reduction in prescriptions from July 2006 to 2013 is a reversal from the steady statewide growth in the use of antipsychotics to treat children prior to the introduction of the Partnership Access Line (PAL). The number of children on Medicaid treated with antipsychotics in Washington decreased by 940 despite an increase of 186,855 enrollees in the joint Federal/state program during the study. According to the study, this counters a national trend of increased antipsychotic use with children from 2002 to 2015.

Other key findings in the study include:

• High-dose antipsychotic use fell by 57.8% in children 6 to 12 years old; and by 52.1% in teens

• 1,458 providers received a direct patient consult through PAL
• 759 providers attended at least one of PAL’s 31 general psychopharmacology education conferences

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Morgan Wood has been coming to Seattle Children’s since he was born — and as an adult, he continues to benefit from recreational and social skills classes at the Alyssa Burnett Adult Life Center.

He is known among both friends and providers for sharing his life mantras, which he developed to work through challenges related to living with Autism Spectrum Disorder.

Below, Morgan shares six of his mantras and other interesting insights from his life experience.

My name is Morgan Wood and I’m 26 years old. I was born very premature, weighing 729 grams, which is less than two pounds. Because of my weight and a bad infection I had at birth, they tell me I’m sort of a miracle. Read full post »

Eva, 14, has been suffering from OCD since she was a little girl.

Since Eva Tomassini was 4 years old, she remembers her life being controlled by rules. Not from her parents, or school, but rules she created in her head, like having to arrange things in a certain way or run away in order to prevent terrible things from happening. As Eva grew older, her compulsions and obsessions got worse. She thought if she didn’t follow the rules, someone close to her would be harmed or die.

Eva has Obsessive-Compulsive Disorder (OCD), a disorder that literally ruled her life throughout her childhood.

“It was like she was controlled by an evil puppet master,” said Earlyn Tomassini, Eva’s mother. “She had spontaneous rules she had to follow or she’d run away at night because her OCD would tell her something bad would happen to somebody if she didn’t. It was really difficult for her and for our family.” Read full post »

Researchers have identified a cost-effective way to treat depression in teens with a collaborative care approach.

Depression is one of the most common mental health issues a teenager can face. According to the National Institute of Mental Health, an estimated 2.8 million adolescents ages 12 to 17 in the U.S. had at least one major depressive episode in 2014, or 11.4% of adolescents that age.

Depression can create a huge cost burden on patients and institutions, and for teenagers that includes issues like missed school and the costs of healthcare for families. A new study in JAMA Pediatrics, led by Seattle Children’s Research Institute and Group Health Cooperative, identifies a cost-effective treatment that yields promising results for depressed teens.

“We used a collaborative care approach to treat teen depression, which included having a depression care manager who worked with the patient, family and doctors to develop a plan and support the teen in implementing that plan,” said Dr. Laura Richardson, an adolescent medicine physician and researcher at Seattle Children’s and professor of pediatrics at the University of Washington. “We were pleased to find that this collaborative approach was significantly more effective in treating depression than standard care with only a small increase in costs.” Read full post »

Dr. Eileen Klein, attending physician and co-director of Emergency Medicine Research, will speak about the challenges families and children with autism face in navigating the emergency department.

Children with autism spectrum disorder (ASD) are becoming a larger proportion of Seattle Children’s patients, challenging providers to develop new tactics to meet their unique needs.

This year’s Pediatric Bioethics Conference, “Autism Re-examined: Ethical Challenges in Care, Support, Research and Inclusion,” will focus on the challenges and special requirements of treating these patients.

Dr. Eileen Klein, attending physician and co-director of Emergency Medicine Research at Seattle Children’s Hospital, is a featured speaker at this year’s conference. She gave On the Pulse a sneak preview of her presentation plans, what she’s most looking forward to and what she hopes to learn. Read full post »

I love this picture of me and Chad on a dinner cruise in Cabo San Lucas, Mexico.

Laura Crooks, director of Rehabilitation Medicine, shares how losing her son, Chad, sent Laura and her husband on a mission to eliminate the stigma around mental illness.

My son had mental illness.

It seems so strange to write those words. Instead, I want to write that he was creative and loving and gentle. I want people to know him as a big brother and a son who lived in a large and loving family. I want him to be famous for his dream of inventing bold new means of space travel. But today, the part of Chad’s life I am compelled to share is that he had mental illness.

Chad was diagnosed with schizophrenia in April 2015. One evening, not long after telling his father and me that he had been hearing voices, he became suicidal.

I remember that night like it was yesterday. I remember taking him in the car, his dad holding him in a blanket at 21 years old, just so he wouldn’t jump out of the car as we made the trip up Interstate 5 to the University of Washington Emergency Department.

I remember coaching Chad on what to say once we got there: to tell them he wouldn’t make it through the night if they let him go. I remember how hard it was as a mom to tell my son to say these things. But I also know the truth about limited resources for mental health, and that this was the only way for him to truly get help and to keep him safe.

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Bedolla (left), 18, has been seeing therapist Julia Petersen from time to time since she was 8 years old.

Yajaira Bedolla was 11 months old when her parents learned she was deaf.

Living in Uruapan, Mexico, Bedolla’s parents searched their town for resources to help with the unknowns of raising a deaf child. The limited resources they found focused on teaching deaf children just to speak, rather than also learn sign language.

They expanded their search and, in doing so, briefly moved to California and back to Mexico before landing in Seattle when Bedolla was 8. Here, they found Seattle Children’s and Petersen, a mental health therapist who provides outpatient therapy and support for deaf patients and their families. Read full post »

The holidays can be a particularly blue time of the year for people, including children and teenagers. The darker days of winter can bring about a gloomy mood and the hype of the holidays can set unrealistic expectations for children. There are many reasons children may feel sad or anxious around the holidays, including added stress around having to be with one or the other parent (not both), in cases of divorced families, or coping with the loss of a loved one who recently passed away.

To help kids cope with sadness around the holidays, Dr. Elizabeth McCauley, associate director of Seattle Children’s Child and Adolescent Psychiatry, offers some advice on how to keep those blues at bay.

“People have high expectations around the holidays,” said McCauley. “And sometimes those expectations are too high for what the holidays will bring. You get a mental image that things are supposed to be perfect, like in a storybook. But the reality can be more down to earth.”

Set realistic expectations

McCauley advises parents to incorporate kids in holiday planning to help set realistic expectations for holiday events. Kids can become disappointed when things don’t live up to what they’ve imagined, which can trigger sadness.

“Establish expectations that fit in with your family’s interests and budgetary constraints,” said McCauley. “Have open conversations about the hype of the holidays versus reality. Acknowledge if you are not able to plan a special trip or purchase as many gifts this year. Get kids involved in planning activities so they have something to look forward to while they’re out of school for the holidays.”

Make a plan for the holidays

McCauley also recommends incorporating some structure into the holiday break.

“Transitioning from school to the holiday break can be difficult for children who are used to their normal routine,” said McCauley. “Structure is great for many children and can reduce worry. Knowing what events are coming up gives children and adolescents a useful heads-up so they know what is expected. They should also be encouraged to let parents know about things they want to do with their free time.”

Incorporating structure into the holidays doesn’t mean children can’t have fun during their break. Bake cookies or play board games, says McCauley. The simplest of activities can be the most fun. Also, try to incorporate activities that focus on giving rather than receiving.

“Plan an activity that will give a child a sense of joy from giving,” said McCauley. “It’s great to involve kids in activities that allow them to make a donation, or volunteer their time, as opposed to focusing on what gifts they will receive.”

When it’s something more than feeling blue: Signs and symptoms of depression

Holiday blues are normal, according to McCauley. There is, however, a difference between holiday blues and depression.

Depression is a problem that many children and teens face. Depression is the most common mental health problem in the U.S. Each year, depression affects 17 million people of all ages, races and economic backgrounds. As many as one in every 33 children may have depression; in teens, that number may be as high as one in eight. Depression can affect children of all ages.

Depression can occur for many reasons – family conflict, school pressures or problems with peers. There is no single cause of depression. For parents, it’s important to differentiate when a child is feeling a little blue versus experiencing depression.

When feeling sad or withdrawn for more than two weeks gets in the way of a child’s or teen’s ability to function in school, at home or in social settings, McCauley recommends talking to a healthcare provider. She said it’s also critical to talk to a healthcare provider immediately if a child or teen has thoughts of self-harm. Other signs and symptoms of depression in children and teens include:

• Sadness or feeling irritable
• Loss of interest or pleasure in usual activities
• Eating too much or too little
• Weight changes
• Sleeping too much or too little
• Feeling tired a lot
• Feeling guilty
• Trouble thinking or paying attention
• Suicidal thoughts or behavior

The holidays can be a very fun and exciting time of the year. It’s normal to experience an occasional sense of sadness, but learning to talk through those feelings and setting realistic expectations for the holidays can help make this season the happiest time of the year.

Resources:

• Understanding Depression
• Seattle Children’s Psychiatry and Behavioral Medicine
• Parents Guide to Teen Depression

Dr. Bryan King

The prevalence of autism spectrum disorders (ASD) is on the rise, but researchers are still searching for explanations as to why. A new study out today in JAMA Pediatrics , linking the use of antidepressants during pregnancy to an increased risk of autism in children, is just another brick in a path toward understanding risk factors associated with autism in general, said Dr. Bryan King, program director of Seattle Children’s Autism Center and Professor of psychiatry and behavioral sciences at the University of Washington, but it’s not the answer.

King sat down with On the Pulse to answer questions about the study. Read full post »

When I was 16, I spent 10 days at Seattle Children’s in the Inpatient Psychiatric Unit (now called the Psychiatry and Behavioral Medicine Unit, or PBMU).

I fought it. I hated it. I couldn’t get out of there fast enough.

Looking back three years later, I can tell you that those were the most important 10 days of my life. If not for my time at Seattle Children’s, I’d probably be in jail now, or dead.

Everyone on the unit met my resistance with compassion – and somehow, they got through to me. Even though I fought being in their care, they cared for me. They cared about me.

I left Seattle Children’s with medications that helped me and coping skills I still use today. Read full post »