Mental Health Nurse Manager Shares How Nursing is the Art of Caring for People

CHOC Children’s wants its patients and families to get to know its staff. Today, meet Lisa Schneider, nurse manager in CHOC’s new Mental Health Inpatient Center. Lisa has a degree in nursing from The Ohio State University, and is in the last semester of completing her master’s degree with a focus on Nursing Administration. She is also a board-certified psychiatric-mental health registered nurse.

mental health inpatient center nurse manager
Lisa Schneider, nurse manager in CHOC’s new Mental Health Inpatient Center

Q: What are your special clinical interests?
A: I am very passionate about pediatric mental health. I have a strong interest in trauma-related diagnoses and crisis prevention, as well as serving as an advocate to destigmatize mental health.

Q: How long have you been on staff at CHOC?
A: I am new to the organization and so excited to be here! I have been with CHOC since January 2018.

Q: What diagnoses are most common among the patients you care for?
A: As the community is beginning to recognize mental health disorders sooner, children and adolescents can present with a wide range of diagnoses such as depression, anxiety, eating disorders, psychosis, autism, PTSD, and ADHD, among others.

Q: What myths about mental health would you like to dispel?

A: Many people believe that talking to kids about suicide can put the idea into their heads. However extensive research has shown that this is not the case. Suicide is currently the second leading cause of death in children and young adults ages 10-24. Start the conversation now and talk to your kids about suicide – it could save their life.

Q: What excites you most about the Mental Health Inpatient Center?

A:  The opening of the Mental Health Inpatient Center is so exciting because we will be providing innovative care and services to children and their families. The unit will consist of private rooms, group activity rooms, an expansive outdoor play area, along with daily programming such as music therapy, art therapy, pet therapy, and classroom education. The Center is designed around aspects of nature to promote a holistic and healing environment. In addition, every child will receive a comprehensive treatment plan which will include individual and family therapy sessions while inpatient, and care continuation at discharge. I am so excited for the positive impact this Center will have on the kids in our community, especially since we will be the first to offer inpatient mental health services to children under the age of 12 in Orange County.

Q:  What inspires you most about the care being delivered here at CHOC?
A: I am inspired by the tremendous amount of dedication that CHOC Children’s has shown in our mission to provide quality healthcare to children. Specifically, we are taking a leadership role and setting a high standard through our commitment to de-stigmatizing mental health and expanding services. It is important to remember health does not solely rely on physical health, but strongly depends on mental health as well. In order to achieve overall health and well-being, mental health must be cared for with the same emphasis that is placed on physical health.

Q: Why did you decide to become a nurse?
A:  I chose to become a nurse based on the philosophy of nursing. Nursing is known not only as a science, but also as an art in caring for people. I have a passion for creating strong nurse-patient relationships, which can promote the healing process. I chose pediatrics because I’m inspired by the resiliency I see in children, and mental health specifically because I strongly believe in the concepts of prevention and early intervention.

Q: If you weren’t a nurse, what would you be and why?
A: If I wasn’t a nurse, I think I would probably be a police officer. I enjoy serving others and building strong relationships within the community.

Q: What are your hobbies/interests outside of work?
A: Outside of work, I love spending time with my husband and 4-year-old son. We are new to California so we have been spending a lot of time exploring this beautiful state!

Learn more about CHOC’s commitment to mental health

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CHOC Children’s Celebrates Completion of Mental Health Inpatient Center

CHOC Children’s leaders joined with mental health supporters today to celebrate the completion of our pediatric health care system’s Mental Health Inpatient Center, which will provide the first psychiatric inpatient beds in Orange County for children younger than 12 years old.

Set to open in April 2018, the 12,000-square foot, 18-bed facility will serve children ages 3 to 17. It is the only facility in California to offer all private rooms, as well as an option for parents to stay overnight with their children, as appropriate.

CHOC Mental Health Inpatient Center_hallway artwork
Hallway artwork in the CHOC Mental Health Inpatient Center.

One in five children experience a diagnosable mental health condition during childhood — about 150,000 children in Orange County alone. Previously, the absence of designated space to treat young patients and a shortage of beds for adolescents in Orange County meant that often children with serious mental health episodes remained in emergency departments for days at a time waiting for a bed in an outside county.

“For the first time, Orange County children younger than 12 experiencing a mental health crisis will have a place for care close to home,” CHOC President and CEO Kimberly Chavalas Cripe said. “The Center’s completion is evidence of CHOC’s commitment to ensuring that every Orange County youth receives the mental health care services they need in a safe and healing environment.”

The Center’s other unique features include two sensory rooms – one sensory-rich and the other low-stimulation to help children learn to manage strong emotions and calm themselves. In addition, the facility includes a 3,600-square-foot outdoor play area with sensory activities and a basketball court.

Mental Health Inpatient Center
The outdoor play area of the CHOC Mental Health Inpatient Center.

The Center’s innovative floor plan was designed with guidance from national experts and incorporates elements of several exemplary programs observed by CHOC staff. It was built with two primary goals in mind: patient safety and creating an optimal healing environment. The facility incorporates safety features such as shatterproof glass, special high-density materials, doors that open one at a time, and many other measures. The design includes elements of nature, curved features and a soothing color palette to promote healing and relaxation.

With pediatric psychiatrist Dr. Hoang “Wayne” D. Nguyen as its medical director, the Center will offer specialty programming to children 12 and younger. Patients will participate in therapeutic programming seven days per week, which is unique among inpatient facilities. During their stay, typically five to seven days, patients will also have access to medical specialists if assessments suggest a relationship between the mental health condition and an underlying health issue.

CHOC Mental Health Inpatient Center_activity room
One of several activity rooms in the CHOC Mental Health Inpatient Center.

CHOC broke ground on the Center in September 2016. The Center was announced in May 2015 as the centerpiece of a pediatric system of mental health care that would be scalable and replicable by other health systems nationwide.

“CHOC is committed to the truth that mental health is as important as physical health,” Cripe said. “Put simply, health is health. We want to create a system that others can replicate and help empower health systems across the country to support children’s mental health.”

CHOC’s broad and robust pediatric system of mental health care has been built to facilitate early diagnosis, intervention and treatment of pediatric mental health problems.

The system’s components include the ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s, designed to prevent psychiatric hospitalization and re-admission; mental health screenings in primary and specialty care settings; pediatric mental health training for community health care providers, school personnel and therapists; and a co-occurring clinic for patients with mental health challenges complicated by physical illnesses.

Other aspects include mental health triage at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital; an early childhood mental health initiative set to begin in spring 2018 that is aimed at reducing behavior-related suspensions from child care and preschool settings; and faith community partnerships.

“While the Mental Health Inpatient Center at CHOC Children’s will support children and families while in crisis, we cannot meet all the needs for pediatric mental health care alone,” Cripe said. “By joining with our community partners, we are working together to ensure that children get the help they need when they need it and where they need it.”

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Meet Dr. Micaela Thordarson

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Micaela Thordarson, lead psychologist, ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s.

dr-micaela-thordarson
Dr. Micaela Thordarson, lead psychologist, ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s.

Q: What is your education and training?

A: I earned my bachelor’s degree in psychobiology from UCLA with a minor in Spanish. I earned my PhD and master’s degree in clinical psychology from Palo Alto University with a specialization in children, adolescents and families. I completed my pre-doctoral internship with Nationwide Children’s Hospital in Columbus, Ohio, and my post-doctoral fellowship with Geisinger Health Systems in Pennsylvania.

Q: What are your special clinical interests?

A: I am particularly passionate about working with high-risk pediatric patients. I have done a great deal of work with suicidal and self-harming youth and their families. As a bilingual clinician in Spanish and English, I am also very interested in the interactions between mental health and cultural identities, for example, race/ethnicity, gender, religion and age.

Q: How long have you been on staff at CHOC?

A: I joined CHOC in October 2017.

Q: What are your most common diagnoses?

A:  Depression, anxiety, and major life stressors are the most common difficulties our patients face.

Q: What would you most like community/referring providers to know about the ASPIRE® Intensive Outpatient Program at CHOC Children’s?

A:  Our eight-week intensive outpatient mental health treatment program – the only pediatric-dedicated one of its kind in Orange County — is designed to serve a broad range of emotional and behavioral difficulties for high-school aged teens 13-18. It includes individual and family sessions, and crisis support as needed. If the teens and families you serve could possibly benefit from an intensive program, please don’t hesitate to reach out to me. Additionally, we aim to collaborate closely with all the important stakeholders in our patients’ lives. This includes primary care physicians, psychiatrists, therapists, educators and coaches.

Q: What would you most like patients and families to know about ASPIRE®?

A:  While our program is hard work, it’s pretty fun to be a part of! The daily after-school programming for teens and their families is all interactive, including art and other expressive therapies, and designed to teach and practice new skills in fun ways.

Q: What excites you most about the program?

A: I am so excited to be able to offer a very important service to teens and families who are in crisis and need extra support. The program we offer is guided by research and has been carefully constructed to generate the best outcomes possible.

Q: What inspires you most about the care being delivered at CHOC?

A:  I have worked with a number of different organizations and teams since I began my career in the mental health field. The team at CHOC is unparalleled in its enthusiastic dedication to innovation and excellence in the care of children.

Q: Why did you decide to become a psychologist?

A:  I fell in love with the field of psychology immediately after taking my first job at a crisis shelter for teens. Getting to witness, and even participate in, the incredible changes these youths made in their lives in a few short weeks was inspirational. I knew that was work I wanted to be a part of for the rest of my career.

Q: If you weren’t a psychologist, what would you be and why?

A:  Either a zookeeper, so I could spend time with cool animals every day, or a Disney princess at one of the theme parks so I could wear awesome costumes and play with kids all day.

Q: What are your hobbies/interests outside of work?

A:  I love spending time with my family, hiking with my dog, and eating delicious food. I have a huge family and we have a lot of fun together!

Learn more about ASPIRE

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CHOC Launches Mental Health Intensive Outpatient Program

CHOC Children’s is offering teenagers experiencing symptoms of a mental health condition a new source of hope in a validating, supportive environment staffed by experts in adolescent mental health. The ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s will bring solutions to teens and their families who show moderate to severe symptoms of anxiety, depression or other mental health problems.

Participants ages 13 to 18 attend after-school programming for three hours a day, four days a week in sessions that span eight weeks total.

Run by experienced, licensed clinicians who specialize in working with teens, ASPIRE incorporates therapy, mindfulness exercises, coping and problem-solving skills, art therapy and other expressive therapies to help teens develop and practice healthy behaviors and learn how to manage their feelings, emotions and personal interactions.

Parents or guardians also participate in family counseling and skills groups two days a week in the late afternoon and early evening.

A board-certified adolescent psychiatrist is also available for consultations and medication management, as is case coordination with other medical providers and the teen’s school, and crisis support.

Teens who could benefit from the program may exhibit a range of behaviors:

  • Moderate to severe symptoms of anxiety and depression
  • Extreme emotional outbursts
  • Significant conflict with family or friends
  • Suicidal thoughts
  • Decreases in functioning at home or school
  • Self-harming behaviors

The program’s primary goal is to promote emotional wellness of young people. While in the program, youth will be provided a validating, supportive environment where they can focus on improving their emotional heath:

  • Improvement in symptoms of anxiety, depression and anxiety
  • Improved functioning at home, in school and with friends
  • New skills to cope with stress
  • Decrease in unsafe thoughts and behaviors

ASPIRE® is a component of CHOC’s landmark pediatric mental health system of care launched in spring 2015 to ensure children, adolescents and young adults with mental illness get the health care services and support they need.

The system of care also includes outpatient support for patients whose physical conditions are complicated by mental health challenges; mental health screenings for all 12-year-olds at their well child visits with CHOC pediatricians; and an increased presence of psychologists and social workers in the Julia & George Argyros Emergency Department at CHOC Children’s Hospital.

The cornerstone of the wide-ranging effort is the CHOC Children’s Mental Health Inpatient Center.  With 18 beds, it will be the first unit in Orange County to accommodate children younger than 12.

Learn more about ASPIRE

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How to Help Your Child Navigate the Emotional Aftermath of a Traumatic Event

By Dr. Sheila Modir, pediatric psychology post-doctoral fellow at CHOC Children’s

It’s difficult for adults to make sense of a tragedy, so consider how difficult it can be for children. To help parents support their children as they navigate trauma either in their own lives or process a tragic event they see on the news, consider the five E’s of helping a child navigate the emotional aftermath of a traumatic event: 

  • Explore what your child already knows in a gentle and calm manner. You can start with a neutral question inquiring about how their school day was or if anything happened while they were at school.
  • Explain what has happened in a way that your child can understand based on his/her age.
    • This is the time to address any misinformation your child might have picked up at school and help them understand that a scary thing did happen, but also reassure their sense of safety as schools and adults work hard to keep their children safe on daily basis.
    • Limit information that you provide to your child to the questions that they ask you, so that you avoid overwhelming them with information that they may not already have been exposed to.
    • You can provide examples of ways you and others in your community keep your child safe every day (i.e., how when you drop them off at school in the morning and you look both ways before crossing the road, how doctors are working hard to help the children that have been hurt).
  • Express to your child that feelings are normal and it is okay to feel sad, mad or angry when a tragic event occurs. Remember to reduce media exposure after a traumatic event, as repeated exposure to the event has been associated with psychological distress and intensifying already heightened emotions.
  • Emotionally model for your child healthy expression of feelings as children take their cues from their parents. Describe how you cope with your distressing emotions to your child (i.e., When I feel scared when something bad happens to me, I talk about it with someone who makes me feel safe or I take three deep breaths).
  • Ensure stability by continuing to adhere to your child’s daily routine. This will provide them with a sense of reassurance and safety during a chaotic time. Engaging in a daily routine is not meant to ignore what has happened, rather to continue to provide the child with structure, stability, and predictability.

If you are struggling to help your child process a traumatic event, or if you feel your child could benefit from additional support, ask your pediatrician for a referral to a pediatric psychologist or psychiatrist.

Below are a few additional resources on coping with trauma that I often share with my patients and their families:

Helping Children Survive the Aftermath– Florida International University

Mobile App: PTSD Family Coach– U.S. Department of Veterans Affairs

Responding to a School Crisis– The National Child Traumatic Stress Network

Resources for Parents and Caregivers– The National Child Traumatic Stress Network

Helping Traumatized Children: A Brief Overview for Caregivers– Child Trauma Academy

Tragic Events: Parent Resources – The Fred Rogers Company

Learn more about mental health services at CHOC

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