In preparation for the 2022-23 school year, the Health Care Council of Chicago (HC3), in collaboration with HC3 member Rosecrance and community partner Communities in Schools, hosted a conversation in person at Rosecrance River North on August 11 to discuss the evolving needs of children’s behavioral health care. A panel of experts discussed the current state of children’s behavioral health care, the future of services for youth, and opportunities to better address behavioral health care needs for children and teenagers.
Jud DeLoss, CEO, Illinois Association for Behavioral Health
Adrienne Adams, MD, Medical Director of Rosecrance Griffin Williamson Campus
Judith Allen, PsyD, Chief Operating Officer, and Clinical Director, Communities in Schools
Martha Glynn, DNP, NP, Medical Director of School-Based Health Centers, Erie Family Health Centers
Aron Janssen, MD, Vice Chair, Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago
News Coverage PANELISTS WEIGH IN ON IMPROVING HEALTHCARE ACCESS FOR CHILDREN | Health News Illinois, August 16, 2022 | Link to Article Here
REACHING YOUNG PEOPLE WHERE THEY ARE | Communities in Schools, September 12, 2022 | Link to Blog Post Here
Moderator’s Remarks: Jud DeLoss, CEO, Illinois Association for Behavioral Health
The Centers for Disease Control and Prevention (CDC) estimates that as many as 1 out of 5 children experience a mental disorder in a given year. The U.S. spends an estimated $247 billion yearly on treating and managing childhood mental disorders. A recent Lurie Children’s report indicated that 18 percent of parents in Chicago said they could not get the mental or behavioral health services they wanted for their child during the height of the COVID-19 pandemic.
In his first state of the union (March 1), President Biden announced a comprehensive national strategy to address the mental health crisis; On July 29, the Biden-Harris administration announced two new actions to strengthen school-based mental health services and address the youth mental health crisis:
1) Awarding the first of nearly $300 million the president secured through the FY2022 bipartisan omnibus agreement to expand access to mental health services in schools.
2) Encouraging governors to invest more in school-based mental health services.
This discussion aims to focus on the intersectional relationships of local health systems and educators: what they have seen and experienced, how they are addressing this crisis, and what opportunities may still be on the table.
Jud DeLoss (DeLoss): Lurie has several initiatives in schools, the center for childhood resiliency, and more. What are the biggest challenges you expect to see as we begin the 2022 school year? What is the intersectionality of some of your partnerships with school-based interventions?
Dr. Aron Jansen (Jansen): There is still some uncertainty around the pandemic’s impact on children’s mental health. However, we hope there will be some return to normalcy this school year and that we can better predict these impacts in the future.
As we start the school year, the biggest challenge is the guessing game of how folks will respond. We’ve been wrong more times than we’ve been right. We all hope for a sense of “I know what to expect” going into my day-to-day life. The effects of COVID-19 have not entirely gone away, and we will still be navigating it this school year. Mental health issues persist even when the stressors of COVID-19 are gone. So, even though the pandemic has wound down, we still expect its effect on children's mental health to persist.
DeLoss: How is Communities in Schools building ‘trust’ in youth, educators, and families to be open about addressing mental health challenges for kids and teens? What are the ways in which you are seeking early intervention in your programs and offerings to help create better pathways and dialogues for more supportive help to kids?
Dr. Judith Allen (Allen): We are taking the time to make sure we are engaging families where they are and understanding their perspectives, rather than imposing our own agendas and perspectives on what we think to be true about a particular family/demographic group. We are paying close attention to the details, with boots on the ground and spending time with community members to build trust. We know these things take time, but we are committed to it.
DeLoss: Erie Family Health Centers has a strong presence in Chicago’s communities and are known for its primary care. How does addressing SDoH (Social Determinants of Health) relate to behavioral health challenges for kids and families? How are you assessing/screening and addressing these needs?
Martha Glynn (Glynn): Some children don’t have easy access to health care outside school-based health centers. They come to school and don’t have all their vaccines or maybe have never seen a doctor. By meeting children where they are [in the schools], we can identify their social needs and develop interventions that cater to them. These social needs often act as stressors contributing to mental health issues faced by children and their families.
As part of Erie’s interventions, we have supported families to create better living spaces/conditions, eliminating this stressor and its potential contribution to the mental health of our beneficiaries. For example, we will address mold in one’s home that has contributed to physical and mental health issues. Are the mom and kids stressed out? It could be lead poisoning which leads to ADHD (Attention Deficit/Hyperactivity Disorder); the criminal legal system would have a dramatic reduction in intake by addressing issues further upstream, as it is all connected.
The current health system does not adequately focus on social needs; we must figure out how to effectively build this into our clinical responses. Erie has hired full-time coordinators to address SDoH issues. It should be standardized in all clinical settings, but unfortunately, it is currently not a priority everywhere.
DeLoss: Rosecrance is well-known as an Illinois substance abuse and addiction provider. How does Rosecrance provide support services for the compounding issues that may occur for kids and youth with substance abuse disorder (SUD) problems? What are some of the programs to support kids and teens with families experiencing trauma/SUD? How do you overcome stigma, whether it’s mental health or substance-related?
Dr. Adrienne Adams (Adams): The pandemic has exacerbated the effect of SUD amongst adolescents. With the introduction of “fruity flavors,” nicotine and marijuana usage has increased, and there has been an influx of adolescents with substance use issues with these, as well as overdoses with other substances. Access to services has always been an issue in mental health and addiction. We prioritize getting services and treatment, especially to people who can’t afford them, through grants and other supplemental supports that may be available.
Rosecrance has expanded our services/programs. For example, we have programs within schools that provide onsite assessments within different school systems, onsite estimates with counselors providing drug screening, assessments, counseling, Student Admission Programs (SAP), individual and group training therapy, and parent education. We also have outpatient services and virtual psychiatry. Intervention is also a top priority for us. Overall, we are actively collaborating with our partners to meet the growing demand as best we can.
DeLoss: What are the ways in which you are seeking early intervention within your target audience?
Allen: We focus on building trust and developing ways to ensure we’re speaking the same language regarding outreach. Our team is using a framework to help focus these with the three Rs model: Rigor, Relevance, and Relationship.
Rigor focuses on the structure needed to build relationships.
Relevance pertains to how we talk to students, teachers, and parents about things that are relevant to them.
A relationship is about building solid relationships with students by learning from our precious interactions and using those lessons to strengthen our relationships. For example, Children love the sound of their own name, and we need to ensure that staff knows the children they are speaking with.
DeLoss: Anything you can share about Lurie’s Interventions?
Janssen: We are approaching the intervention design and implementation with a sense of humility. At the same time, we are prioritizing collaborations, working with community partners, and encouraging community involvement. At Lurie, we continue to prioritize cultural fit but, more importantly, the structural fit of our programs and interventions.
DeLoss: What role does trauma play – how are each of your organizations cultivating and understanding early-childhood trauma intervention, as well as post-support? E.g., many communities in Chicago experience high levels of trauma, especially related to violence. How are we working to heal? But also prevent?
Allen: Our staff is trained in trauma-informed practices. We also help our students and families to understand what trauma means to them. We know language is important when addressing trauma, so ensuring that we use appropriate language is key. And we educate the partners we work with to build their capacity on how to address trauma, talk about it and build equity in it.
Glynn: We are offering secondary support to the trauma faced by clinicians. The cases that come in are beyond what we can physically deal with, which can be overwhelming. As such, we are open to exploring ways to help providers cope with associated stress.
Janssen: We do a lot of work in trauma-informed care. It is about listening to and understanding their feeling about events they have experienced. Kids have no control over the exposure to the things that happen to them, and that’s the biggest challenge for providers. It affects them.
We don’t have the same responses to children who act out as we do to children who express their trauma differently, although they may have the same type of trauma. When I worked in New York, there were several misdiagnoses of bipolar, when in reality, they just needed someone to care and say, I hear you, tell me more. It goes a long way to heal a broken, fractured society.
Adams: In our practice, we treat mental and SUD issues. If we take the time to notice what’s going on, we can also treat their underlying trauma. You can’t isolate them, but they often occur hand in hand. Ultimately, we also need to introduce preventive measures in solving trauma-related issues as underlying structural issues may contribute.
DeLoss: How do you overcome stigma, whether it’s mental health or substance-related? How are your organizations cultivating best practices for cultural humility and competencies to address the unique needs of different populations? What considerations are being made to embrace equity in the behavioral health space as it is in the primary care space?
Janssen: We approach it with a sense of humility and collaboration. Any intervention without community input does not work. When developing programs, we consider structural and cultural competencies to be practical. Asking, are community members informed? Is the community responsive? That is how we become successful. We also need to learn to tolerate failure. We will fail more than we succeed because that’s the nature of the work.
Allen: There are many stigmas, especially in the African American community. Letting people know it’s OK to not be OK. We all need to engage with the communities and recognize the signs and symptoms of depression and anxiety. We are letting people know more about psychiatry and providing information and resources. Psychiatrists are of all shapes and sizes. We are trying to get the message out there that’s it OK to take care of yourself—cycle education or continuous education – eg. the way primary and secondary education is implemented – and reduce the stigma of mental health services.
Adams: We are focused on fighting the stigma associated with trauma and mental health. We provide information and resources to the community reminding them that we are here to help and that it's okay to take care of yourself mentally.
DeLoss: What considerations are being made to address and embrace equity in the behavioral space as it is in the primary areas?
Glynn: We offer everyone opportunities for training and advancement. We recruit for our patients, aiming to hire people who speak the same language and have a similar cultural experience as our patient populations. We want to ensure patients feel welcomed and heard.
Allen: We make sure to educate our staff on the importance of equity and aim to make behavioral health on par with physical health. We provide training in the community, including CPR and mental health first aid. Equity to us is getting everyone that impacts a child’s life at the table to talk about what’s going on with our kids and charting the solution from there.
Audience Question: How do we change the DCFS's current approach to intervening systemically? Janssen: Some policy challenges make equal access to evidence-based child care impossible. We advocate for changes with philanthropy and research to change the system. There is also a current sense of a difference between mental and physical health. One out of five kids will have a mental health diagnosis. And right now, we are training pediatricians to do screening as there is currently a human resource shortage within child psychiatry. We must embrace and address our pediatricians' needs so that they can incorporate mental health interventions into their practice.
Adams: Structural public policy needs to be changed. In residential facilities, transgender kids can’t be in gender-affirming units. We should work with DCFS (Illinois Department of Children and Family Services) to update the procedure to be current with the times. Reimbursements from insurance companies are also challenging. There are only 323 children and child psychologists in Illinois, and the median age has decreased to 54 years of age. We need more practitioners, and we need to work with pediatricians to help with diagnoses.
Audience Question: What would one or two wishes be to increase the ability of primary care practitioners for screening?
Janssen: Incentives, financial or otherwise, and training help. Having any skills gaps scare practitioners. And there is also a misconception about human resource availability. We need to all accept that there are not enough of us, and we all need to help.
Adams: Collaborative care is essential within this space as there is an immense shortage of trained personnel. Also, having more sensible policies will help.