One in five kids has a diagnosable mental health disorder during their childhood. And children with chronic conditions have an increased risk beyond what you see in the population—they are at two-thirds greater risk for psychiatric and social adjustment problems.
For example, roughly 50% of kids with epilepsy have a mental health disorder. "These kids are struggling, but if we don't ask, we don't know," says Heather Huszti, Ph.D., chief psychologist at CHOC Children's in Orange, California. "As providers, we're good at treating physical illness in kids, like childhood cancer. When it comes to cancer, people came together and made a change."
There are two drivers—science and health care delivery trends—that underscore the opportunity for integrating medical and psychosocial care. At the 2020 Behavioral Health Summit, presenters explored how integrating behavioral health needs of medically complex and chronic patients yields better outcomes, improved compliance and demonstrates a return on investment.
"You can't have physical health without mental health," Huszti says. "That's the foundational reason children's hospitals must be involved in kids' mental health. You can't separate the physical from the mental."
Connect with the community to provide better mental health care
In Orange County, the disconnect between physical and mental health in kids was apparent. All the kids with Medicaid had to go to county providers, so CHOC Children's could not see them on an outpatient basis. "We would see them in the hospital and then refer them in the community to someone who didn't have access to our records or training on how to manage kids with behavioral health issues," Huszti says.
CHOC Children's wanted to integrate the care and be the provider. Huszti says they got involved with the community and started to advocate by showing what the issue was—they become more visible and had more community conversations. "There was interest to develop a system of care, which allowed us to start a relationship with funders," she says. "The county behavioral health department began to see this was a special group of kids that needs unique care. Tell your story, get out there, I was shocked we had people say, ‘We'll give you money to develop something.'"
The result of that effort led CHOC Children's to create co-occurring clinics. The hospital worked with the county to develop a specialized clinic to only see children who had a medical condition and a risk for a mental health condition. "We could focus on the kids we were providing medical care to already," Huszti says. "We could read the medical record, work with physicians."
Since opening in 2015, the outpatient clinic has had more than 1,000 unique patients.
- All full-time staff members speak Spanish.
- The mean length of treatment is five months.
- Primary medical diagnosis is cancer, diabetes and "other," which includes spina bifida, obesity and eating disorders.
- 50% of patients have an anxiety-related disorder; PTSD is the top diagnosis.
The clinic is paid for with a contract with the county behavioral health department—including the cost of clinicians, rent, furnishings and overhead.
Filling a gap with wraparound services
"Once we started treating patients, we realized we had kids who struggled, especially in the community, with poverty," Huszti says. Partnering again with the county, the hospital created Project HEALTH, a full-service wraparound provider for the most acute kids who are at risk for being removed from the home or inpatient psychiatric center. "We're trying to get into the house and help them and their families," Huszti says. "Project HEALTH is counseling plus services and has a ‘do whatever it takes mentality.' We coach families through it."
Since its launch in 2018, Project HEALTH has served 211 referrals and closed 47 cases. Of these cases, 75% were stable to improved, and the organization has seen participants improve their health, school attendance or reintegrate into school.
"Our goal is to help kids and families get the treatment and services they need to be productive and lead the best quality of life they can," Huszti says.