Help For The Hurting: How a Cook Children’s Collaboration is Changing the Landscape of Mental Health Care

Eight in a series. 

Over the past few weeks, we’ve published a series of articles about the mental health crisis shaking the foundation of our youngest generation. It’s been a difficult and heart-wrenching conversation as, together, we’ve opened our eyes to this issue. This week, we want to bring you some good news.

An innovative yet practical collaboration that embeds family therapists into Cook Children’s Neighborhood Clinics (NHCs) is expanding access to mental health services for children in some of Tarrant County’s most underserved communities. It’s a silver lining, if you will, amidst a rapidly growing crisis.

The Crisis

The critical issue of mental health struggles among children isn’t a new one. It’s been lurking under the surface for years. One Centers for Disease Control statistic states that the percentage of children ages 6 to 17 who have ever been diagnosed with either anxiety or depression increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011-2012. To put skin on that, approximately 4.4 million children in the U.S. ages 3 to 17 have diagnosed anxiety, and about 1.9 million have diagnosed depression. Couple that with an inadequate supply of mental health professionals across that country and you have an undeniable gap in mental health care for hurting kids. According to the American Academy of Child and Adolescent Psychiatry, there are only 8,300 practicing child and adolescent psychiatrists in the United States—a country with 74.2 million children.

Pile a pandemic on top of all of that and you have the makings of a nationwide mental health disaster. In many ways, COVID-19 opened Pandora's box. For millions of children, each measure taken to address the virus either triggered a new mental health struggle or exacerbated an existing one. The results are devastating, evidenced by the record number of children attempting or committing suicide. Some as young as 5 years old.

“I would say that, compared to last year, I have certainly experienced and seen a significant rise in the number of patients reporting anxiety, depression and even suicidal contemplation,” said Vida Amin, M.D., Neighborhood Clinics and Population Health Advisor.

The Silver Lining

Cook Children’s Health Care System took note of the adolescent mental health situation and the gap in services years before the start of the pandemic. Concern turned to action when the system began including mental health outreach as one of its yearly strategic initiatives. Over the course of several years, these initiatives have evolved from requiring universal depression screenings for all adolescents to improving access to mental health care for patients of Cook Children’s Neighborhood Clinics in fiscal year 2021. This latest initiative steered the concept of integrating family therapists into the primary care setting.

The program launched in December 2020—perfect timing given the pandemic’s toll. Three licensed family therapists rotate through Cook Children’s seven Neighborhood Clinics each week providing services that range from mental health evaluations to outpatient counseling to education for families and clinical professionals.

In its first month, NHC physicians and nurse practitioners referred a little more than 100 patients to the therapists for evaluation. By April 2021, that number had grown to more than 380 in a single month. So far, more than 111 patients have received outpatient counseling through the program.

Breaking Barriers

This care model helps alleviate three critical barriers for families seeking mental health services—access, cost and a reluctance to trust someone new with something so sensitive.

Right now in North Texas, it can take weeks, even months in some cases, to get an appointment with a therapist. There simply aren’t enough to go around. The same is true for many parts of the country.

“The demand for behavioral health care far outweighs the number of treatment providers in the community,” said Christina Reed, LMSW, director of operations at Cook Children’s Neighborhood Clinics. “It’s just too much for nonprofits and other providers to keep up with. So for us to be able to offer this to our patients gives them that access that has been lacking in the community.”

Beyond adding much needed therapists to the landscape, bringing these services in house improves access by speeding up the referral and evaluation process. It also signals that mental health is just as important as physical health. As therapists share knowledge and integrate their care plans, physicians and nurse practitioners are increasingly looking through the lens of mental health when engaging with their patients.

“It helps to demonstrate that behavioral health care is a part of health care,” said Kelly Rand, LCSW, manager of patient and family support services at Cook Children’s Neighborhood Clinics. “You don't have to go to another office somewhere that you've never been before and that’s not familiar to get that support. It crosses that barrier to where it's not two separate services. It's all health care, and it's all here together.”

Access and cost go hand in hand. If one can be overcome, the other is often the next big hurdle. Many private practice therapists do not accept insurance, especially Medicaid, leaving families no choice but to pay out of pocket.

“We serve primarily Medicaid families,” Reed said. “If you are a child or a family on Medicaid trying to find mental health services, that is challenging and that's no secret. It’s always been challenging. Our families are left without many options because they can't pay cash for a private practice therapist.”

Counseling services at the NHCs are billed to the patient’s insurance provider, be it a private insurer or Medicaid. If a patient is not covered by insurance or Medicaid, therapists connect them to a counseling resource in the community that offers free or sliding scale fee services.  

Opening up about internal struggles can be hard. Knowing who to trust with such personal and sensitive information factors into a parent or child’s hesitancy to reach out. Embedding therapists within the primary care clinics where patients have established relationships and familiarity with providers helps build a bridge between reluctance and trust.

“There is something that our families value when it is a Cook Children’s name behind that referral or service,” Reed said. “When it's their pediatrician saying, ‘it's this person I work with right here that can help you,’ there's a lot of comfort and trust in that in a world that can be really scary. There's still a lot of stigma. There's still a lot of hurdles to jump through, even just internally, when seeking out that service.”

Comprehensive Care

For children who need emergency intervention or more intensive care than can be provided through outpatient therapy, NHC therapists work with Cook Children’s emergency department, behavioral health intake department, partial hospitalization program and inpatient psychiatry program to get patients the level of care they need.

“The NHCs are now performing 200-plus psychosocial assessments and plans of care each month,” said Robert Goodwill, senior vice president and chief operating officer of Cook Children’s Physician Network. “This is an integral part of identifying specific needs related to the level or type of care a child may need. These added resources have resulted in increased counseling sessions at the NHCs as well as the ability to connect patients and families to other services in our system and our community.”

Of the nearly 1,200 referrals NHC therapists have received since the start of the program, depression and anxiety rank as the top two issues.

“Depression and anxiety are by far the most common,” Rand said. “A third one would be ADHD or issues around attention concentration. From there, I would say, issues around some kind of trauma transition or loss. So a death loss, the loss or separation of parents, a traumatic family event, or some kind of big transition in the household. Of course, those things contribute to and cause depression, anxiety and attention difficulties in children.”

As the rising referral numbers demonstrate, this collaboration is bringing critical services to the doorsteps of underserved communities. It’s making the mental health care space easier to navigate and offering help and hope to hurting children.