One in five children experiences a diagnosable mental health condition before turning 18. That’s about 150,000 children in Orange County alone; yet there are no inpatient mental health services for children younger than 12 in the county, and a shortage of inpatient beds for adolescents. In May 2015, CHOC Children’s announced a landmark effort to ensure children, adolescents and young adults with mental illness get the health care services and support they need. Since that time, CHOC, with the support and encouragement of other community leaders, has made tremendous progress.
Young children with serious and chronic illnesses are two to five times more likely to face mental health disorders than their healthy counterparts. In September 2015, CHOC, in conjunction with Orange County Behavioral Health Services, launched an outpatient co-occurring clinic for patients whose physical conditions, such as diabetes, cancer or epilepsy, are complicated by mental health challenges. Psychologists and psychiatrists are available to provide specialized care for these children in their medical clinics, in the hospital, or in a special outpatient mental health clinic. In the upcoming months, additional psychologists, psychiatrists and social workers will join the clinic to allow it to serve more children.
In addition, CHOC’s cystic fibrosis (CF) program recently received a grant from the Cystic Fibrosis Foundation that enables the team to expand its social worker’s availability and have a designated psychologist to help patients and caregivers. They will provide screenings, evidence-based guidelines and follow-up care for depression and anxiety, as well as develop a community referral network of mental health providers. CHOC’s CF model, if successful, could be replicated in other specialty clinics.
In the primary care setting, CHOC has rolled out mental health screenings for all 12 year olds at their well child visits. The American Academy of Pediatrics recommends that children be screened for depression during routine medical visits as many teenagers (up to 13 percent) have depression but do not receive any treatment. Children that screen positive for possible depression receive information about depression and mental health, and can receive referrals for mental health treatment if needed. CHOC is also completing a pilot in the primary care clinics where a psychologist is present to help the medical team screen for and address mental health issues, and help families address childhood obesity.
Due to the lack of inpatient mental health services, children and teens who require inpatient psychiatric services are waiting lengthy periods of time—usually days—in local emergency departments until beds become available or they are stable enough to return home. CHOC is developing strategies to begin treatment in its emergency department, to connect patients to follow-up care and other community resources, and to track outcomes. As part of this effort, CHOC has increased a social worker and psychologist’s time in the emergency department — an additional eight hours a day, seven days a week. Patients get screened to determine the need for inpatient services or access to other resources, and staff is following up with families to ensure coordinated care. Plans are to expand these services to include a specialized evidence-supported treatment that can be given in the emergency department to help families address their children’s needs in the home whenever possible. This treatment was developed at Boston Children’s Hospital.
Recruiting Mental Health Experts
Orange County has fewer psychiatrists, psychologists and licensed social workers than the state average. CHOC is working with its partners on strategies to attract experts to the region, as well as to increase specialized training of students in local counseling, psychology and nurse practitioner programs. Most recently, the hospital has hired three psychologists, one neuropsychologist and two part-time board-certified child and adolescent psychiatrists. Additional staff training and recruitment is currently underway.
CHOC’s Inpatient Mental Health Center
CHOC is proud to be building Orange County’s first inpatient program that can accommodate children younger than 12. The center will have 18 private rooms in a secured and healing environment, including an outdoor area. It will provide a safe, nurturing place for children ages 3 to 18, and specialty programming for children younger than 12. The center’s innovative floor plan was designed with guidance from national experts and incorporates elements of several exemplary programs observed by CHOC staff. Construction is expected to be completed at the end of 2017.
CHOC‘s vision for a comprehensive mental health system of care is ambitious. While there’s been tremendous progress, CHOC continues to need community support to help ensure every child and young adult in Orange County who needs behavioral health treatment receives high quality services without stigma or barriers to access. To learn more, visit www.choc.org/mentalhealth.