Seattle Children’s Reaches Beyond Its Walls to Improve Mental Health Care for Kids in the Community and Across the Region

There is a tremendous need for improved access to mental health care and resources for children and teens nationwide.

At Seattle Children’s, its commitment to helping address this need spans not only within the Seattle community, but throughout the region.

According to the U.S. Centers for Disease Control and Prevention, nearly 1 in 5 children have a mental, emotional, or behavioral disorder, such as anxiety or depression, attention-deficit/hyperactivity disorder, disruptive behavior disorder, and Tourette syndrome.

While early intervention is key in managing mental health issues, only about 20% of children with disorders receive care from a specialized mental health care provider.

That’s why Seattle Children’s is continuously working to enhance access to mental health services, promote education and research, and advocate for families affected by mental illness.

The following describes three of the many innovative programs and initiatives that Seattle Children’s offers to help improve mental health care for all children.

Innovative program bridges mental health care to primary care

In 2008, there was a strong push from mental health advocates in Washington state to increase access to child psychiatry consultations for pediatric patients being seen by primary care providers for mental health concerns.

“There was widespread recognition that primary care providers were being asked by their pediatric patients for help with mental health issues,” said Dr. Robert Hilt of Seattle Children’s Psychiatry and Behavioral Medicine team. “We realized providers did not have the support or expertise needed to deliver the most effective care, so we designed a program to help meet that need.”

Hilt led the development of the Partnership Access Line (PAL), a program that supports primary care providers such as doctors, nurse practitioners and physician assistants, with questions about mental health care such as diagnostic clarification, medication adjustment or treatment planning.

Through PAL, child and adolescent psychiatrists from Seattle Children’s and the University of Washington are available for phone consultation during business hours for any primary care provider in the state of Washington and Wyoming seeking answers about mental health care for their patient. Any provider can freely access this service when they need advice, regardless of the patient’s insurance type.

In existence for nearly a decade, PAL has seen significant improvements in children’s mental health since its implementation, including the reduction in unnecessary use of antipsychotics by children in Washington state.

“There has been nationwide concern about the unnecessary or inappropriate use of antipsychotic medications,” said Hilt, director of PAL and Community Leadership at Seattle Children’s. “Most of the calls we receive at PAL involve questions about medication, and by the end of the consultation, we often make recommendations for psychosocial intervention such as therapy rather than medication.”

A study published in the March 2017 issue of Health Services Research looked at the changes in the number of children prescribed antipsychotics, and enrolled in Washington state’s Medicaid program, during the time period that PAL was first implemented.

“The results showed that from July 2006 to December 2013, the use of antipsychotics for children dropped by about 50 percent,” said Hilt. “It’s possible that this had to do with our work at educating providers with best practice recommendations to the appropriate use of medications, allowing for less children to be on unnecessary or inappropriate antipsychotics. This can ultimately be seen as a health benefit for children, as there are many side effects with the use of these medications.”

As the prevalence of mental health issues in children continue to rise, Hilt is hopeful that PAL will continue to widen access for care, and most importantly, provide appropriate early intervention.

“We have received incredible feedback from the provider community because of the support that PAL has given them to help take care of more kids,” said Hilt. “With PAL, kids who go to their primary care doctor with a mental health issue are less often being turned away because their doctor doesn’t have the appropriate knowledge to help them — instead, we are there to help and coach providers through the process of delivering the first steps in care more effectively.”

New class breaks down barriers to talking about mental health

Youth Mental Health First Aid is a class for adults to learn skills on how to help an adolescent in crisis or who is experiencing a mental health challenge.

A recent study in Pediatrics found that from 2008 to 2015, the annual percentage of U.S. children’s hospital visits for suicide attempts or suicide ideation nearly doubled.

While many people know how to perform CPR, starting a conversation with an adolescent who is struggling with depression or addiction may feel daunting to some due to the stigma around mental illness.

In order to help address the increasing mental health needs of today’s youth, Seattle Children’s is offering a new class, Youth Mental Health First Aid, which aims to give adults who regularly interact with young people, such as parents, family members, caregivers, teachers and coaches, the tools they need in order to help an adolescent in crisis or who is experiencing a mental health challenge.

Participants practice asking difficult questions, such as “Are you at risk for harming yourself?” The class also clears up misconceptions like asking someone if they’re at risk for suicide will not put the idea in their head. Instead, the question lets you know whether an individual is at risk for self-harm, making intervention possible.

“We’d like to see Youth Mental Health First Aid as prevalent as CPR,” said Laura Crooks, senior director, patient and family experience at Seattle Children’s, who was instrumental in bringing the class to the hospital. “Everyone should take it.”

After devastatingly losing their son to suicide, Crooks and her husband, Todd, became advocates of Mental Health First Aid, a program that teaches students how to identify, understand and respond to signs of mental illnesses and substance abuse disorders.

The class aims to empower adults with tools and education so they can help adolescents age 12 to 18 who are experiencing mental health or substance abuse challenges. Students learn about common youth mental health issues, adolescent development and how to support young people in both crisis and non-crisis situations. Topics covered include anxiety, depression, substance use, disorders in which psychosis may occur, disruptive behavior disorders, eating disorders and treatment options.

After losing her son to suicide, Crooks has worked to improve the mental health system in Washington state by bringing Youth Mental Health First Aid to Seattle Children’s and creating Chad’s Legacy Project.

“After we lost our son two years ago, we started asking questions like how did he fall through the cracks, and what could we have done differently as parents?” said Crooks, who has shared her family’s story. “We didn’t know what to do when he got diagnosed with a mental illness. My husband said if we had taken a Mental Health First Aid class, there is a chance that our son could be still here. We try not to live in that space, but it was very profound.”

Youth Mental Health First Aid offers practical instructions about how to talk to adolescents about mental health and when to intervene in a crisis, Crooks said. One key part of the class is practicing the ALGEE algorithm, which stands for “Assess for risk of suicide or harm, Listen nonjudgmentally, Give reassurance and information, Encourage appropriate professional help, and Encourage self-help and other support strategies.”

After taking the class, Crooks and her husband have intervened in mental health crises. Using the skills she learned, Crooks was able to diffuse a situation in her neighborhood by calming an individual who then agreed to get help.

Seattle Children’s is the first children’s hospital that offers the course on a regular basis, Crooks said. She hopes the course will become a recommendation for anyone who comes to the Emergency Department with a child having a mental health issue.

“Young people face numerous issues and stresses,” Crooks said. “The Youth Mental Health First Aid class helps you understand when there’s really a problem.” For example, the class helps participants identify the difference between teenage moodiness and depression.

The class is $15 and free with a scholarship. Next year it will be available online. Eventually, the hospital will offer a course in Spanish. Crooks said the hospital intends to provide the class for as long as people want and need it.

“We were trying to focus our efforts on how to make the system better for people in Washington,” said Crooks, who created Chad’s Legacy Project — which is involved in advancing mental health education and innovations in the evaluation and treatment of mental illness — with her husband. “We were hearing from all these families, ‘What do we do?’ This course is something they could do that could actually make a difference.”

School-based services meet children where they are

Odessa Brown Children’s Clinic (OBCC) provides health care services, including mental health, to five central Seattle elementary schools and runs the Garfield Teen Health Center (GTHC) at Garfield High School. The school-based program helps to address mental health care needs in the community and increases accessibility by meeting children where they are, in the schools. It is a program that Mark Fadool, clinical director of mental health services at OBCC, says is making a difference.

“It’s vital to provide services upstream, which means meeting with families before a crisis occurs,” said Fadool. “We are focused on families who come through our clinic doors, but we are equally committed and concerned about families who can’t make it through our doors. We know it’s challenging to make it to our clinic. Many of our families live so far away because of the lack of affordable housing in Seattle. We must continue to ask ourselves, ‘How can we make it to where our kids and families are, and reach children outside our clinic walls?’”

The need for mental health services is on the rise. Waitlists for mental health services are longer now more than ever. It’s a problem that Fadool says keeps him up at night.

“We’re bursting at the seams,” he said. “And more kids are in need.”

The school-based program is one innovative way OBCC provides convenient access to mental health services to a population who is historically underserved. During the 2016-2017 school year, 669 students received medical, dental or mental health services through the school-based health centers. Fadool said the program has helped to reduce the number of absences, increase staff moral at the schools they serve and decrease disciplinary action.

“What we’ve found is that the medical services we provide are important, but the need is more with social and emotional needs,” said Fadool. “We’ve seen a significant increase in children suffering from anxiety and depression. We know that many children in the community have adverse childhood experience (ACE) scores, which are stressful or traumatic events including physical abuse, sexual abuse or neglect. What we’re finding is that schools are inadvertently triggering children who have gone through, or are going through, some kind of trauma. What we need is a change in the culture, to look at kids and not say they are bad, but instead look at why a child may be acting a certain way. We need to set up a culture where children are accountable, but where we’re also are able to help them cope with high anxiety and stress.”

Fadool says many of the students the school-based program serves are from low-income communities, many of whom are ethnically diverse and children of immigrants.

At Beacon Hill International School, mental health therapist, Gina Gutmann, says the care she provides is tailored to the needs of the school and the families in the community. For instance, about 60% of her clients are Spanish speaking. She runs support groups for Latino parents as well as providing resources in Spanish to better meet their needs.

She also says many of the services she provides aren’t only offered to children and their parents, but also teachers and administrators. Gutmann, who has worked in the schools for more than 25 years, says her work is very collaborative, and driven through trust and engagement within the schools.

“Our care happens outside the clinic walls,” said Gutmann. “I’m embedded in the school community, serving people who would not be able to get therapy anywhere else. Together, we’re creating a positive and rewarding environment. When I walk into the classroom, kids are excited to see me. The services we provide are helping to destigmatize therapy. It’s becoming part of the school culture.”

Gutmann says the change she sees has been exciting and incredibly rewarding.

“There are some things you can’t measure,” said Gutmann. “When I look around and I see change, I know I’m in the right place. I know I’m making a difference.”

Gutmann offers individual therapy, cognitive behavioral therapy, mindfulness, trauma resolution, as well as group therapy, parent support groups and teacher consultation.

There are many success stories Gutmann can call upon as examples of how the school-based program is building a healthier community. She recalled a little boy who once had violent outbursts two or three times during the school day. He was very disruptive in class, would throw things and use obscenities to threaten teachers. Teachers believed he needed to be put into a special education class, but Gutmann saw something more. The little boy needed structure, help expressing his emotions and more positive feedback. Gutmann said after working with him and developing strategies with his teachers, his behavior improved dramatically. He’s no longer threatening and disruptive, he’s able to talk through his feelings and extinguish his behavior before it gets out of control.

Another little girl suffered from selective mutism. She wouldn’t talk in class or interact with her peers. After only about four months of working with Gutmann, she blossomed. Today, she has less anxiety, is speaking and participating more in class, and even recently danced with her classmates.

According to Fadool the school-based program isn’t the only way OBCC is finding innovative ways to address mental health needs in the community. They partner with groups outside the clinic to go beyond just medical care. In their Birth to Five Program, Fadool says families coming for primary care from birth to age 5 are offered a host of services, from helping families with eviction notices, to providing parenting resources and more. So much of health and wellbeing goes beyond medical care, and so providers at OBCC are finding ways to help address the social, economic and environmental factors many families face like food insecurity, housing insecurity, safety, nutrition and more.

Fadool says they also worked with the Rainier Vista Boys and Girls Club to create a soccer club for youth ages 7 to 13. The club uses the sport as a foundation to teach skills like social-emotional regulation, decision-making, healthy eating and meeting educational goals.

“We’re trying to knock down silos,” said Fadool. “The safety net that has held the community we’ve served for years is frayed now more than ever. Together, we can help support the amazing families who live in our community.”