FAMILY

Physicians and Counselors Expand Mental Health Services for Columbus Children and Teens
As pediatric mental health diagnoses continue to climb, medical professionals at Nationwide Children’s Hospital and elsewhere are boosting programs and increasing outreach to help combat the crisis.
Kathy Lynn Gray
Columbus Parent
Sarah and Aaron Silverman know that growing up can be stressful. And they know they can’t completely protect their young son and daughter from a very worrisome world. So, the Worthington couple is doing their best to give Ethan, 8, and Madelyn, 5, the tools to manage stress and anxiety whenever it crops up.
“I’ve struggled with depression and anxiety, so it’s something we’re always worried about,” says Sarah Silverman. “I say, ‘Let me arm them with the best emotional intelligence and tools that I can.’ ”
Their concerns are shared by parents, health care workers, teachers and government officials nationwide and are borne out by concerning statistics. According to the National Institutes of Health, one in five children has a “significantly impairing mental disorder.”
A survey of 500 parents conducted in March by the Kids Mental Health Foundation at Nationwide Children’s Hospital found 70 percent of parents and caregivers are concerned about their children’s mental health and wellness. A 2023 national survey by the Harris Poll found that half of parents with children younger than 18 felt that social media had negatively impacted their children’s mental health in the last year.
While the pandemic exacerbated pediatric mental health issues, there was a treatment crisis long before kids had to isolate in their homes because of COVID-19, says Dr. David Axelson, chief of psychiatry and behavioral health at Nationwide Children’s Hospital. “COVID made things worse, especially with anxiety and depression, and we are trying to catch up with the need,” he says.
In 2019, the year before the pandemic hit, Nationwide Children’s opened the Big Lots Behavioral Health Pavilion, the hospital’s first freestanding facility dedicated to treating mental health. The nine-story building consolidated and expanded services that had been scattered around the hospital complex and includes a psychiatric crisis center, a 16-bed crisis stabilization unit, 38 inpatient beds and intensive outpatient programs.
The need for care, Axelson says, is reflected in the ongoing increase in calls to the hospital’s service line: In 2023, 44,000 calls came in for mental health concerns, compared with 19,000 a decade earlier. Patient counts are rising, too, as measured by the number of total inpatient days spent at the hospital. The pavilion recorded 9,000 patient days in 2019, more than 13,000 in 2023 and is projected to reach 14,500 this year.
Axelson says he has noticed an increase in children suffering from behavioral dysregulation with aggression, which can cause people to react disproportionately to everyday stress. Unfortunately, these feelings sometimes are directed at those trying to help. “Patient aggression towards staff is a significant problem that has gotten worse in the last five years,” he says.
The problem has had serious ramifications. The U.S. Department of Labor cited the hospital in May 2023 stating it had failed to protect pavilion employees from patients and levying $18,080 in penalties after investigating a November 2022 complaint filed with the Occupational Safety and Health Administration. “Employees, including nurses and mental health specialists, were exposed to workplace violence in the form of repeated and consistent exposure to violent attacks from patients which resulted in serious injuries,” the DOL stated.
Nationwide Children’s contested the penalties and the case is ongoing, according to Scott Allen, regional director for public affairs and media relations for the DOL. Spokesperson Audrey Hasson says via email that the hospital continues to work with OSHA but cannot comment on specifics. “The safety of our staff and that of the children and families we serve is our highest priority,” she writes.
Reaching More Children
Since opening in 2019, the pavilion has expanded its offerings, increasing intermediate levels of care and intensive outpatient services, and embedding mental health services into the hospital’s community care clinics. It has reduced the wait time for inpatient beds, but the facility does sometimes reach capacity.
Axelson says the goal is to help children and young adults in the early stages of mental health issues to prevent the need for more intensive care. “Being able to provide services that can get kids back home and back in the community is really important and is something we’ve been able to do,” he says.
One newer service is OhioRISE, for children and young adults up to age 20 who have significant behavioral health treatment needs. Operated through the Ohio Department of Medicaid with several partners, including Nationwide Children’s, the $1 billion program was rolled out in 2022. Its goal is to provide better access to mental health care at home and in the community so participants can stay with their families. The program, which originally served 5,500 young people, now has nearly 38,000 enrolled around the state.
“Resources are out there, although often not enough and with barriers,” says Maggie Dangler, site manager of the Hilliard-area office of Syntero, a nonprofit Central Ohio counseling services provider. “But don’t wait to get services until your child is at that higher level of need.”
In addition to individual counseling, Syntero provides on-site services for 11 school districts in Franklin, Delaware and Morrow counties. In Delaware and Morrow, the organization recently launched same-day access so any child can get an immediate mental health assessment.
Anxiety and depression are the most prevalent issues Syntero counselors see, Dangler says, pointing to the “constant onslaught of access to peer pressure through social media” as one cause. “Bullies can always get through to you through Snapchat or Instagram,” she says. “But we need a lot more research to find out why [more mental health issues] are happening.”
Dr. James Duffee, who has been both a pediatrician and a child psychiatrist for 45 years in Dayton and Springfield, attributes the increase to a wide range of causes: social media, electronics, obesity, alcohol and marijuana use, and community violence, particularly at schools. “Kids have to have active shooter drills, and they feel like there’s no place that’s safe,” he says. “But I think the largest issue is the disintegration of social safety nets like churches and scouting, where children learned a sense of virtue and value. And the polarization of people—kids pick up on that and feel like this is not a safe time.”
Duffee, who retired from clinical care and is now a consultant for the Ohio Department of Health, reminds parents that children pick up on adults’ anxieties. “They need to make sure they’re not sharing that anxiety with their kids,” he says. “Kids need a stable, secure base that they can go back and touch, so they can feel secure when they go out into the world.”
Enlisting Primary Care Providers
Duffee has been helping the health department develop the Ohio Pediatric Mental Health Care Access program.
ODH Director Dr. Bruce Vanderhoff says the program, funded with a federal grant, will provide education, psychiatric consultations and a referral network to help doctors, nurse practitioners and physician’s assistants who treat children. “We need to do a better job of supporting mental health care delivery through primary care,” he says. “A lot of behavioral health care is sought for children through their primary providers, because it’s a safe environment without stigma.”
Vanderhoff says the program will roll out in 2025 and offer peer-to-peer consultations with psychiatrists; training so that primary care providers can better assist children with their mental health; and a community referral network with a broad array of behavioral health providers.
Duffee says similar programs are offered in most states, based on a model that began in Massachusetts 15 years ago. “Part of the idea of these programs is to do a risk assessment and tide the child over with adequate care until appropriate care can be given,” he says. “Another is to build competency among community practices so children will be cared for close to home and away from high-cost facilities.”
Dr. Jordee Wells, an assistant professor of pediatrics in the emergency medicine division at Nationwide Children’s and Ohio State University’s College of Medicine, encourages pediatricians to screen all children for mental health issues during annual wellness checks.
As an ER physician, she is well aware that suicide is the second-leading cause of death for 10- to 25-year-olds in the United States. And because 82 percent of young people who kill themselves with a firearm use one from their home, she’s involved with the Store It Safe program, established in 2015 by the Ohio Chapter, American Academy of Pediatrics. Since its inception, the program has distributed 3,500 firearm lock boxes, often through primary care doctors, and provided training to health care workers and information to families about gun safety, depression and suicide risks.
“I hope parents are having open conversations at home with their children about this, so they can share if they’re having any problems, and we can address those,” Wells says. “We also have to be mindful of what our children have access to: firearms, medications, recreational drugs and alcohol.”
Parents also should be aware of the Mobile Response and Stabilization Program for youth up to age 21, Wells says. The service, which is available 24/7 for families of young people who are experiencing a severe mental health crisis, is an alternative to calling police that can provide immediate de-escalation and stabilization. Calls to the program at 888-418-6777 typically receive a response within an hour.
On Our Sleeves Initiative Expands
One well-known children’s mental health program, On Our Sleeves, underwent a major change in April. The 6-year-old campaign by Nationwide Children’s Hospital to reduce the stigma around mental health diagnoses was folded into the Kids Mental Health Foundation.
On Our Sleeves will continue its work, coupled with the foundation’s free resources to increase mental health knowledge and bolster wellness habits. “We want people to know what tools can help mental health so they can start conversations about this with every child—not just those we’re worried about,” says psychologist Ariana Hoet, executive clinical director of the foundation.
The foundation offers more than 500 free guides, videos and articles for parents, caregivers, coaches and teachers, plus resources for teachers on subjects including bullying and test taking. The information is “in the upstream space,” says Hoet, and is meant to catch problems early and provide tools to promote mental wellness.The foundation also shares its resources with other hospitals, youth organizations and camps, Hoet says, and recently established a program to help television and film scriptwriters accurately depict children with mental health issues.
Nationwide Children’s also added a research arm to its work on children’s mental health this year. The Institute for Mental and Behavioral Health Research was set up at the pavilion to study the causes of pediatric mental health conditions, as well as prevention and treatment. The Center for Suicide Prevention and Research is part of the institute, which also works with several departments at Ohio State University.
Another expansion of mental health help for young people is taking place at the Buckeye Ranch, a nonprofit that has provided emotional, behavioral and mental health services since 1961. In collaboration with Nationwide Children’s, the ranch is adding a new 57,000-square-foot facility on its main campus in Grove City for patients who have been hospitalized and need intensive transitional care. The 48-bed residential treatment center is scheduled to open next year.
Although the Silvermans’ children are young, the couple knows that their mental health isn’t something to be ignored.
“We definitely talk plainly with them about our emotions and try to normalize all the emotions,” says Sarah Silverman. “They see me cry, they see me frustrated, they see us fight but they see how we move on from that.”
The Silvermans try to limit the amount of television news their children see and how long they watch TV each day. “But what’s more important than how much time they’re watching TV or how much time they’re on a tablet is knowing as a parent what they’re watching,” she says.
As a teacher of special-needs preschoolers, Sarah Silverman sees how anxious parents can be, and she sees how that anxiety passes to their children. “If their mom is worried, they’re going to be worried, too,” she says.
Syntero’s Dangler says parents need to be flexible but firm, particularly as children get older. “Plant the seeds early about how to exist in a world of technology,” she says. “Have conversations around it and let them know they don’t have to totally navigate things on their own. Tell them that if there’s a problem, they can come to you. Come at their questions with curiosity and compassion, not with anger.”
Sarah and Aaron Silverman plan to do just that.
“There’s such a small amount of time that kids can live in a world that feels carefree, and I feel like this generation isn’t getting any of that,” Sarah Silverman says. “There’s just a lot of hate and distrust in the world, and that’s trickling down. What happened to the idea of being innocently happy because you’re 4 and your life consists of just playing and more playing?”
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