Patients at Children’s Hospital of Michigan’s General Pediatric and Medicine Clinic typically come for primary care, including wellness visits. But a special and equally important part of their initial visit is a mental health screening to assess behavioral, psychiatric or substance abuse problems. It is the first step in the clinic’s Integrated Care Program, which began with a grant from the Ethel and James Flinn Foundation and is now being funded by Children’s Hospital of Michigan Foundation.
Clinic social workers Victoria Meyring and Karen Gall alert physicians if there are indicators of a mental or behavioral issue based on a Pediatric Symptom Checklist completed by patients and their parents. Clinic pediatricians then decide whether to refer their young patients for treatment provided by psychology doctoral students from Wayne State University, who are supervised by licensed clinical psychologists.
“By being part of a medical clinic, we eliminate the stigma of mental health and financial and accessibility barriers,” says Karen Gall. The psychologist- trainees work with their patients and often their families once or twice a week for as long as necessary. Unlike most mental health treatment covered by public or private insurance, there is no cap on the number of visits—a major advantage, say clinic social workers.
Through support from the Foundation, almost 1,500 patients a year have been screened for mental health conditions and 200 have received treatment, according to Douglas Barnett, Ph.D., professor and director of the Wayne State University Psychology Training Clinic. This program fills an important need, he says, because it is difficult to find mental health services for children, even with health insurance.
Treatment and family education are provided for attention deficit disorder, depression, anxiety, school phobia, substance abuse, self-harming and suicidal thoughts. “We use research supported treatments and avoid using medication first. A child doesn’t need to have a diagnosis—we are big on prevention. We try to promote kids being more connected and becoming more successful in school,” says Dr. Barnett.
Many patients live in neighborhoods where instability and violence are not uncommon. As a result, some children may have behavioral issues due to trauma, clinic social workers say, and the mental health screening tool includes some special questions—“Has anything scary happened? Do you feel safe in your own home?” The clinic’s physicians, social workers and therapists meet monthly to discuss patients. “I learn if my patient is attending therapy, what the therapeutic goals are and what issues are being worked on. This allows the therapist and clinician to jointly develop a plan to better manage the patient’s overall health and well-being,” says Sharon Marshall, M.D., clinical chief, Adolescent Medicine, Children’s Hospital of Michigan and associate professor of pediatrics at Wayne State University. “By being part of a medical clinic, we eliminate the stigma of mental health and financial and accessibility barriers.” pediatrics at Wayne State University. “The mind and body are equally important, and many physical conditions have behavioral components,” says Dr. Barnett. The program’s atmosphere is very optimistic, he says, because “kids get better.”