How a Children's Hospital Is Identifying Mental Illness Early

At a growing number of pediatric clinics in Nebraska, an annual wellness check sometimes feels more like a visit to the therapist than to a primary care provider.

There’s as much talk of screen time and suicide prevention as growth charts and lab results. Kids who suffer from persistent sadness or ADHD discuss symptoms just as they would a sore throat or a sprained arm.

“We know that mental health and physical health are two sides of the same coin and shouldn’t be separated in a patient’s care,” said Jennifer McWilliams, MD, division chief of pediatric psychiatry at Children’s Nebraska. “A lot of at-risk kids hesitate to seek mental health services, but they see their pediatricians, and they trust them.”

After participating in the hospital's grant-funded Children’s Outreach and Provider Education (COPE) program, primary care providers can turn a well child visit into a mental health touch point. Early signs — mood fluctuations, slipping grades, social withdrawal — are flagged and addressed before they spiral.

“Primary care is uniquely positioned to focus on prevention and well-being,” McWilliams said. “If we equip those doctors to screen and intervene early, we prevent problems before they become crises.”

Equipping primary care providers

Historically, pediatricians received scant training in mental health.

“When I was a fellow, I was asked to teach two hours of psychiatry to residents and told, ‘Cover everything,’” McWilliams recalled. “That was our entire curriculum.”

In the past few years, there’s been growing recognition of the importance of integrating mental and physical health. The Accreditation Council for Graduate Medical Education now mandates a month of mental health training for pediatric residents, which McWilliams calls “a start.”

COPE builds on that foundation with three core components: education, real-time consultation, and referral support.

Primary care providers attend intensive workshops or webinars on topics like ADHD, anxiety, depression, and behavior issues, learning how to treat and manage the mild-to-moderate conditions during routine visits and bridge gaps in access to behavioral health professionals. By the visit’s end, the patient will have a treatment plan, like new coping strategies or an appropriate medication, all without leaving the pediatrician’s office.

When a primary care provider encounters a patient in distress — say, a 13-year-old describing suicidal ideation — they can pick up the phone and consult a Children’s Nebraska psychiatrist immediately. They’ll talk through safety planning, medication options, and whether an emergency referral is needed.

For less urgent questions, providers can submit secure emails to psychiatrists after appointments. Within a day or two, they receive tailored guidance: dosage adjustments, behavioral strategies, or red flags that warrant specialist care.

Since 2023, the program has trained 508 primary care providers and offered 2,700 continuing education credits.

And since 2019, Children’s Nebraska child and adolescent psychiatrists have provided nearly 1,000 consultations to primary care providers who have undergone the training

Ideally, primary care teams would feel equipped to handle about 75% of mental health needs without needing consultation or referral, McWilliams said. “The biggest success story for me is when they stop calling.”

One provider in a rural area used to call McWilliams once a week for consultation. After a few months, McWilliams stopped hearing from her. She wondered if she’d been seeing fewer patients in need of mental health care.

“I’m still seeing them,” the provider told McWilliams. “But I’ve got it now. I’m saving you for the most challenging ones.”

Later this year, Children’s Nebraska will open a behavioral health and wellness center that consolidates pediatric primary care, outpatient psychiatry, crisis assessment, partial hospitalization, and inpatient units under one roof. McWilliams expects that hub to reinforce COPE’s mission, extending support to patients at every stage of acuity.

“The only way we’re going to be able to address the mental health component is if we work at it together as a team, being able to help providers feel comfortable and confident to help take care of these kids,” McWilliams said. “Every time we do that, we’re helping take care of more kids and making sure they’re getting treatment.”

In response to the Make America Healthy Again (MAHA) Commission’s report on child health, the Children’s Hospital Association highlights the ways children’s hospitals are helping children live longer and healthier lives by confronting the root causes of chronic illnesses.