Promoting Healthy Children

By Patricia Obletz
From Washington Park Beat August-September 2007

Medical services for our minds are rarely treated as a health priority. And yet, untreated mental illnesses among our youth can lead to school failure, delinquency, substance abuse, entry into the criminal justice system, anxiety disorders, eating disorders, self-mutilation, suicide, and more. Prevention and identification of early risk factors and early intervention are key to helping both children and adults achieve productive, meaningful lives. Unfortunately, there are those Wisconsinites who disregard mental health needs. The federal government is much closer than Wisconsin to passing legislation to ensure equal health insurance coverage of medical services for mental/behavioral health issues equal to that awarded for physical health problems; 40 states already have parity laws.

I know first hand the havoc ignorance plays on families when mental illnesses strike seemingly out of nowhere. That’s why I accepted the opportunity to join Children’s Hospital of Wisconsin’s Child and Adolescent Psychiatry Advocates Committee. At the meeting last June at CHW, Bill Seymour, PhD, and Shane Moisio, MD, spoke about their work in the community to raise awareness of and access to effective treatment for mental/behavioral health issues among children and adolescents.

Assisting Primary Care Doctors

Bill Seymour, PhD, who works with pediatricians and also sees patients in the clinic, said, “Primary care doctors who suspect that some of their young patients are experiencing ADHD (attention deficit/hyperactivity disorder), depression or anxiety often need help in diagnosing and treating these conditions. That’s why I was attracted to the Evaluation Clinic initiative, which Russell Scheffer, MD, former CHW medical director, modeled on a successful program in New York City. We reached most primary care doctors in Southeast Wisconsin through our promotional materials and meetings in clinics around metro Milwaukee, informing them that the Evaluation Clinic can assist them in helping their patients with mental health concerns by providing them with accurate diagnoses, treatment recommendations and medication management guidelines. We make it clear that their patients return to them for care management after we collect as much information as possible in two visits in two consecutive weeks. These efforts proved successful, emphasizing the need for this service.

“Due to the increasing volume of responding doctors, other colleagues here at the center have become involved. In addition to the actual evaluations, we draft reports for patients, parents and their doctors. If medication is warranted, and it isn’t always, we coordinate with referring pediatricians. If psychotherapy is necessary, which also isn’t always the case, and pediatricians don’t have a relationship with local psychotherapists, we work with the family to find someone suitable for their child. Typically, it’s up to the parents to obtain that service independently, but it can be bewildering to navigate public and private health systems.”

Healthy minds, bodies and spirits aren’t a given for about 200,000 Wisconsin children who suffer from a major mental illness resulting in significant problems at home, school and with peers. Another truth is that there are not enough mental health care providers in this state to help those in need. What’s more, statistics also show that suicide is the second leading cause of death among the 10 to 19 year old population in Wisconsin and that firearms are the most common means of suicide. Recent statistics show that the rate of suicide by Wisconsin young people is 36 percent greater than elsewhere in the country; 90 percent of these kids who killed themselves suffered from depression.

Suicide Prevention

The facts above inspired Shane Moisio, MD, to attempt to reach out to the local community. As part of his Assistant Professorship in Child and Adolescent Psychiatry at the Medical College of Wisconsin, Shane has a personal goal of reaching out to the community. Shane said, “We’re working on forming a local suicide prevention coalition. As part of this, we are considering a community-based program to educate and to identify students who may be at risk for suicide. One screening program that has a successful track record is the Columbia University TeenScreen program. It has been used in a number of states, as well as in Wisconsin’s Fond du Lac and Sheboygan school districts. Fond du Lac’s program is listed as a ‘Model Site’ for TeenScreen nationally. Raising community awareness and education would be an important goal of the coalition. Regarding screening, any measure must be voluntary and parental consent is mandatory. Confidentiality is paramount, as is contacting parents of those students who may be at risk for suicide for whom a mental health evaluation would be recommended. To start, the coalition would need to review current policies and curriculum, education and screening procedures. Ideally, the coalition would consist of public health and police liaisons, pediatricians, parents, students, teachers, administrators, guidance counselors and school psychologists.”

Mood Instability Increasing Among Children

Shane and Bill also weighed in on the growing number of very young children being diagnosed with bipolar disorder. Shane said, “Diagnosing early onset bipolar is challenging because the diagnostic criteria were originally designed to apply only to adults. Here, and around the country, doctors are researching this phenomenon in youths. Additionally, it’s important to assess the various biological, social and psychological variables which may be contributing to a youngster’s problems. We try to assess everything that’s going on in a child’s life to see what exacerbating conditions could be causing disturbances.”

Bill added, “I’m not aware of any children under age three being diagnosed with bipolar disorder, and it’s rare that a child of three receives this label. But as Shane said, mood disorders in children and adolescents, including depression, are not uncommon. And when families leave us after the two-visit evaluation service, we urge them to check in with us to let us know how their child is doing. If things aren’t going well, we suggest they bring the child back for further evaluation. We also keep in touch with the pediatricians we partner with, consulting with them as needed.”

Temper Tantrums

In addition to the Evaluation Clinic, cutting-edge research and individual and group therapy sessions and consultations, Children’s Hospital has a specialty clinic that serves parents and their children who are five years old and under who have severe behavior problems which manifest in temper tantrums. To qualify for this clinic, tantrums must occur more than two times daily and last more than five minutes each; children should have fewer than three developmental delays, and parents need to commit to six sessions on a once-a-week basis. New patients are seen on Thursdays beginning at 10:30 AM. Kimberly Gerlach, LCSW, heads the Temper Tantrum Clinic, which is staffed by a child psychologist and a child psychotherapist who employ a variety of behavior management techniques in conjunction with child-centered parent guidance. Most families notice improved behavior in six to eight sessions.

“I’m hopeful that, eventually, youth mental health issues will be socially thought of within the same context as diabetes and other chronic medical conditions. When this begins to happen, screening will begin to occur as a matter of course, in order that, down the road, complications are less severe,” Shane concluded.

24-Hour Help is Available:

Crisis Walk-In Center, 9499 Watertown Plank Road, 414–257–72222 (Children’s Hospital of Wisconsin’s Education Center) (Suicide Prevention Resource Center) (American Foundation for Suicide Prevention)
1–800–784–2433 (National Hopeline Network)
1–800–273–8255 (National Crisis Hotline)
1–800–448–3000 (Girls and Boys Town National Hotline)

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Last edited by Tyler Schuster.   Page last modified on September 09, 2016

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