City Hospital System Is Expanding Children's Mental Health Programs
BY Vivian Wang New York Times September 5, 2017
Recognizing that negative childhood experiences can affect a person’s health long into adulthood, New York City’s public hospital system is expanding its mental health programs for children and adolescents.
The programs, which NYC Health & Hospitals plans to announce on Wednesday, are designed to address the challenges facing many of the hospital system’s young patients, such as poverty, violence and substance abuse — circumstances that doctors said make children more likely to need mental health treatment but less likely to get it.
The programs follow the increasingly popular “integrated care” model, which aims to minimize the bouncing of patients between physical health doctors, psychiatrists and community resources. Instead, previously isolated services are brought into tandem.
The HealthySteps program, for example, pairs a social worker or psychologist with pediatricians, so parents can receive advice on how to structure playtime or gain access to food stamps at the same time as their newborn receives immunizations. Project TEACH trains pediatricians to diagnose and prescribe medication for common disorders such as depression and anxiety. And the 100 Schools Project coaches teachers and guidance counselors on identifying trauma or substance abuse in middle and high school students.
“Traditionally, everything was siloed,” Dr. Charles Barron, NYC Health & Hospitals’ deputy chief medical officer, said of the division between physical and mental health care. “Now we’re recognizing there’s a continuum in a child’s life — at home, in school, certainly in health care centers — and so creating these partnerships is really important.”
The programs reflect an emerging consensus about how early experiences, particularly negative ones, can reshape the brain and make children more prone to disease, mental illness or conflict later in life. While research on the topic has accumulated over the past few decades, acknowledgment of the importance of early childhood mental health has accelerated in the last five years, said Matthew Melmed, executive director of Zero to Three, a nonprofit that promotes healthy child development and runs the national HealthySteps program.
NYC Health & Hospitals is not the first to introduce these integrated programs; 39 medical sites around New York State, including Montefiore Medical Center in the Bronx, have HealthySteps. But the public hospitals’ patients would especially benefit from them, said Dr. Mary McCord, director of pediatrics at Gouverneur Skilled Nursing Facility, Diagnosis and Treatment Center, one of two NYC Health & Hospitals locations to introduce HealthySteps. Between 80 and 90 percent of the children at Gouverneur are on Medicaid, Dr. McCord said, and the vast majority are immigrants or children of immigrants.
“We’re dealing with people with so many social issues in addition to the stressors of everyday life and health care,” said Dr. Warren Seigel, chairman of pediatrics at Coney Island Hospital in Brooklyn, the system’s second HealthySteps site. “It’s not just about your measles, mumps and rubella vaccines. It’s about, do you have adequate housing? Is there heat in your house? Is there food on the table?”
Their patients rarely have access traditional mental health care, such as regular, one-hour sessions with a therapist, Dr. Barron said. And cultural stigmas may also keep parents from seeking treatment.
“Before we had HealthySteps, we would sometimes identify these needs, and then it would be, ‘What am I going to tell this mom?’” Dr. McCord said. “We’d make a referral to a community agency, and maybe the mom would go, and maybe they wouldn’t.”
Now the exam room functions as more of a one-stop shop, or, if parents need additional resources, at least a trusted launching pad. Since giving birth to her daughter, Fatimah Sosa, six months ago, Newliz Hernandez, 33, has come to expect more than breast-feeding tips or weigh-ins during checkups at Gouverneur. Her HealthySteps specialist, Dr. Brittany Webber, a child psychologist who sits in on every appointment, has also helped Ms. Hernandez, who lives with her grandmother, look for housing of her own.
Shalinie Sansarran, 20, who enrolled in HealthySteps at Coney Island after giving birth to her daughter, Arya Tuitt, said that when she did not feel comfortable telling her family about her postpartum depression, she turned to a HealthySteps specialist, Sara Loesch, a social worker, instead.
Both Ms. Hernandez and Ms. Sansarran text, email or call their HealthySteps specialists several times a month.
“I feel self-conscious texting or calling a pediatrician. I feel like it’s a little pushy,” Ms. Hernandez said. But with Dr. Webber, “a lot of things that I’m nervous about, I know I asked at a previous appointment, but I can ask again.”
The programs look beyond the exam room, too. The 100 Schools Project, which started in 43 of the city’s highest-need schools over the past year and will kick off in 58 more this fall, places substance abuse or mental health providers in classrooms so they can observe students’ interactions and offer school staff members tips for addressing them.
The tips can range from recommending counselors to helping a teacher realize that an apparently harmless action, such as touching a child’s arm, might bring up a traumatic memory, said Dr. Marilyn Jacob, senior director of the Jewish Board of Family and Children’s Services, which helps train the providers.
It is a departure from the former model, in which a handful of trained professionals were often inundated with treating only the most troubled 5 percent of students, Dr. Jacob said.
At Harbor Heights Middle School in Washington Heights, for example, one guidance counselor was seeing students with “the most traumatic issues,” said Monica Klehr, the principal of the school. “But the rest of the student body, we’ve been trying to address by ourselves, without formal training for this type of work, all these years.”
Now, Dr. Gemma Barriteau, a counselor with the nonprofit Start, will sit in on classes and weekly faculty meetings, providing staff with that training.
The goal is to reduce teacher turnover, improve graduation rates and curb the tendency of some schools to call 911 immediately when behavioral issues arise, Dr. Jacob said.
More broadly, all three initiatives seek to help pediatricians and other providers reimagine how, when and where to deliver the mental health care that will shape the rest of children’s lives.
“When I was a resident, we didn’t talk about housing. That wasn’t my job — I’m not a social worker. And whether you’re depressed? I’m not a psychiatrist,” Dr. Seigel said. “I was here to make sure your ear infection was better.”
“What we teach now is very, very different,” he said.