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A Proactive Approach to the Mental Health Crisis Facing Our Youth
Key Takeaways
With the number of children seeking emergency care for mental health crises on the rise, Cincinnati Children’s has committed to long-term research efforts to achieve earlier intervention.
Experts at Cincinnati Children’s shared findings from a years-long effort to move care further “upstream” so that more children can receive help before their problems become severe.
The new report describes four pathways the collaborators have followed to transform care, including mental health training for general providers, psychologist and master’s-prepared therapist integration at pediatric clinics, programs that improve crisis management outside of the emergency department (ED), and artificial intelligence technology that identifies at-risk youth early.
As the nation grapples with a youth mental health crisis, leaders at Cincinnati Children’s share details of a years-long ongoing effort to move care further “upstream” so that more children can receive help before their problems become severe.
These efforts have involved more than $100 million in facility improvements, as well as sweeping practice changes that affect dozens of community pediatric offices, school health services and primary care clinics—plus deep investment in far-reaching research involving one of the world’s largest supercomputers to create a novel mental health early warning system.
We are moving away from a primarily reactive approach to care to a much more proactive approach.
Tina Cheng, MD, MPH
“We are moving away from a primarily reactive approach to care to a much more proactive approach,” says the study’s corresponding author, Tina Cheng MD, MPH.
Cheng, a nationally known figure in pediatric population health research and policy, is director of the Cincinnati Children’s Research Foundation, chair of Pediatrics at the University of Cincinnati College of Medicine and chief medical officer for the health system. First authors on the paper include other key leaders in a systemic transformation of mental health care at Cincinnati Children’s.
Four Major Changes
The new report describes four pathways the collaborators have followed to transform care, each addressing different levels of the mental health crisis.
Training Through the Project ECHO Program
This virtual training program was launched to enhance mental health skills for front-line general pediatricians, social workers and clinical counselors, school nurses and others working with children in primary care settings, behavioral health organizations and schools. So far, 739 learners have completed 241 course sessions through Project ECHO, touching more than 34,000 lives. Course offerings include autism, anxiety, depression, trauma, early recognition of developmental delay and more.
Embedding Behavioral Health Providers
Cincinnati Children’s has been supplying more psychologists and master’s-prepared therapists who work inside pediatric offices, where they can directly help children during a single appointment and connect families to more intensive services when needed.
To date, this effort has grown to 11 psychologists working from four hospital-run primary care clinics plus 17 master’s-prepared therapists (who receive training and consultation by a psychologist) working across 15 community practices. This model has resulted in reduced mental health-related crises, including fewer mental health-related ED visits and psychiatric inpatient admissions.
Rethinking Crisis Care
A significant number of children with new or ongoing mental health conditions can escalate into situations that cannot wait for a scheduled pediatric visit or therapy appointment. The hospital is serving these children with two programs:
The hospital’s Bridge clinic diverts patients in crisis, who are not acutely suicidal, from the ED to an outpatient clinic set up to provide immediate assessment, intervention and short-term follow-up.
Instead of a full-blown hospital stay or waiting to schedule outpatient mental health follow-up, youth can now receive care promptly from expanded partial hospitalization programs, which provide daily programming but allow the child to stay at home.
The paper explores the positive impacts of these efforts, including a gradual decrease in ED mental health assessments in the last several years. (Figure 1)
Figure 1: Mental health assessments in the ED at Cincinnati Children’s saw a steady increase as of 2011, peaked in 2017, and started to decline again with the help of diversion programs.
Focusing on Earlier Detection
The fourth major initiative seeks to sharply improve early detection of mental disorder symptoms to allow much earlier intervention than most children receive now. The health system has invested more than $10 million in its Mental Health Trajectories program, which seeks to leverage artificial intelligence technology to identify at-risk children early.
An early version of the new tool has shown that it can detect signs of clinical-level anxiety in children about 50 days sooner than these children actually receive diagnoses.
A Model for Others
Experts at Cincinnati Children’s published these findings to provide a roadmap to help other pediatric centers that also are overwhelmed by the mental health crisis.
We feel that by describing our journey, we can spark new conversations and novel collaborations across pediatric hospitals and within communities. We believe specific multi-faceted prevention approaches will need to be part of future success.
Tina Cheng, MD, MPH
“We feel that by describing our journey, we can spark new conversations and novel collaborations across pediatric hospitals and within communities,” Cheng says. “We believe specific multi-faceted prevention approaches will need to be part of future success.”
Meanwhile, building parity in access, quality and reimbursement between mental and physical health care in an integrated, whole-child approach remains a critical issue to be addressed.
Looking ahead, the co-authors agreed: “Healthcare organizations and payors must place behavioral and mental health care needs on equal footing with physical healthcare so that patients and their families receive comprehensive healthcare at every visit.”
