Generation REACH: A Year of Progress Toward Transforming Youth Mental Health

Last May, Seattle Children’s launched Generation REACH, a multifaceted initiative based on the simple yet transformative premise that child health always includes mental health.

“We’ve seen increasing need for mental and behavioral health care throughout our services, as have our colleagues at children’s hospitals around the country,” says Dr. Jeff Ojemann, senior vice president, chief medical officer and executive sponsor of Generation REACH. “It really validates mental health as a strategic priority for [Seattle] Children’s and Generation REACH as an overarching initiative.”

Each letter of REACH stands for an area of focus and aims to convey the breadth of this transformative initiative. To celebrate the first full year of Generation REACH, InHouse checked in with leaders working in each area and asked them to share a few highlights of progress over the past year.

Research and Innovation

Vision: Develop new and more effective ways to prevent and treat mental health problems

Progress: Group therapy is a major component of the mental and behavioral care Seattle Children’s offers. The pandemic and a commitment to linguistically appropriate care have both driven new approaches to how we provide those interventions, says Dr. Lawrence Wissow, director, Psychiatry and Behavioral Medicine. “For example, there’s been tremendous innovation around shifting from in-person to virtual visits, especially for therapeutic groups, including trying United Nations–style simultaneous translation so that groups can be multilingual and inclusive of patients who speak languages other than English.”

A national youth mental health crisis

• Three leading U.S. pediatric health organizations declared a state of emergency in youth mental health in October 2021. The U.S. Surgeon General issued a youth mental health advisory shortly after.
• Referrals to Seattle Children’s for anxiety and depression spiked 53% between the last quarter of 2021 and the first quarter of 2022.

Providers are also finding new ways to shorten evidence-based treatments so we can offer them to more people at once and in shorter periods of time and developing “stepped-care” models to ensure the treatment we provide matches each family’s needs.

Ecosystem and Equity

Vision: Build an equitable ecosystem of care that is available when and where kids need it; increase capacity in the continuum of care

Progress: We have been working with primary care clinics to incorporate integrated behavioral health (IBH) services into their practices.

The primary aim is to improve the health of children and adolescents by providing mental and behavioral health training and education for providers and implementing evidence-based universal behavioral health screening, behavioral health navigation and appropriate services within primary care settings.

Additionally, the hope is to create models than can be replicated in other primary care practices.

In partnership with Seattle Children’s Care Network (SCCN), we are providing the clinics with initial salary support to bring a therapist on staff, operational and program support, data and outcomes evaluation and IBH coaching and training. In 2021, the first cohort of practices we worked with screened almost 18,000 patients for behavioral health concerns and completed behavioral health visits with almost 2,000 patients. Evidence has shown that without this type of model, diagnosis is delayed 8 to 10 years and that only about 50% of kids referred our for mental health services ever connect with care.

“We’re creating opportunity for kids to get routine screening and early behavioral health interventions in  familiar, trusted settings in their community where they’re already receiving care,” says Dr. Sheryl Morelli, SCCN chief medical officer. “That’s great for kids’ health and in turn creates more capacity in our longitudinal care continuum.”

Progress: “We’ve made headway filling in key gaps that have long existed at the high-acuity end of the continuum,” says Dr. Alysha Thompson, clinical director, Psychiatry and Behavioral Medicine Unit (PBMU).

Youth in crisis or who need hospitalization can receive intensive services at Seattle Children’s Behavioral Health Care Crisis Clinic, Emergency Department (ED) and/or the PBMU. This used to be where intensive treatment stopped and patients returned to routine outpatient care.

“As we roll out new intensive outpatient programs (IOPs), we’ll be able to offer treatment to kids both before and after crisis to bridge the gap between hospital care and living back at home, so they can transition home successfully with continued improvement rather than slip back into crisis,” Thompson says.

IOPs typically offer group treatment for three to five hours a day, several days a week.

Thompson adds, “Though these programs are still small, adding them is a step in the right direction toward expanding the continuum of care and improving access, specifically for youth with Medicaid.”

Seattle Children’s was part of a coalition that successfully advocated with state legislators to secure pilot funding for the IOPs and subsequently ensured that Medicaid will cover the treatment. Seattle Children’s now offers IOPs for anxiety, disruptive behaviors, eating disorders and obsessive compulsive disorder, as well as one for teens struggling with suicidality/self-harm (Dialectical Behavioral Therapy IOP). A partial hospitalization program is in development for later in 2022.

Access

Vision: Improve access to care through community collaboration and innovative crisis intervention models

Progress: Responding to a huge increase in eating disorders during the pandemic, Adolescent Medicine, Nutrition and Psychiatry expanded their collaborative Eating Disorders Program and adapted the care model to maximize resources and reach more families — including offering telehealth consultations, meal support services via Zoom and a brand-new intensive outpatient program, among other innovations.

Because the need is so great, and it’s essential to provide effective interventions as early as possible, Seattle Children’s experts are training community mental health providers across the state. The Eating Disorder Treatment Network has so far offered two rounds of a four-day training, and both were filled to capacity.

“We’re focused on training providers who are able to take Medicaid because it’s particularly challenging for families with this insurance to access care for eating disorders,” says Dr. Cynthia Flynn, who directs the psychiatry aspect of the Eating Disorders Program.

Culturally responsive care

“One of the most transformational aspects of this effort will be cultural adaptation of treatments and services, so they are responsive to families’ traditions and views — this means we will tailor and customize in ways that are respectful and effective at the same time.” 

— Hereri Contreras Basurto, senior director, Mental and Behavioral Health Services

Both the training and ongoing facilitated group consultation are free to community mental health providers, thanks to philanthropic support.

Progress: In the past, when a child or teen came to Seattle Children’s ED with a mental health crisis, they would be assessed, then either admitted to the PBMU or discharged home or to services in the community. Now, due to increasing need and limited inpatient beds, there might be as many as eight patients at a time “boarding” in the ED — awaiting admission or appropriate services in the community.

“That’s driven us to rethink the model of care for ED mental health,” says David “Bernie” Bernstein, manager, Mental Health Consultation.

Recent innovations include expanding the number and type of mental health–related roles present in the ED, including adding masters’-level behavioral specialists equipped to meet the particular needs of kids with autism who are in crisis.

“We’re also developing programming for patients who are boarding so that we are initiating treatment in the ED,” Bernstein adds. “It’s not about turning the ED into a care unit, but responding to the boarding crisis by saying, while you’re waiting for admission, how do we start treatment and address the whole spectrum of needs?”

Capital

Vision: Create a behavioral health hub to bring together mental and brain health experts from across Seattle Children’s to facilitate clinical collaboration and research

Progress: Thanks to the generous support of our community, particularly the Sunderland Foundation and the Norcliffe Foundation, the Autism Center and outpatient Psychiatry and Behavioral Medicine will move to a newly remodeled, combined location at 70th and Sand Point Way in Seattle later this year.

Healthy Families and Communities

Vision: Decrease stigma; ensure parents, siblings and community members understand and support a child’s journey toward mental wellness

Progress: Psychiatry and Behavioral Medicine recently developed free, video-based community classes to help parents and caregivers support their child’s mental health and recognize the signs and symptoms of mental health problems so they can intervene early, if needed.

Dedication that meets the need

“It’s been a difficult couple of years for all healthcare workers, and I am tremendously appreciative of the dedication of everyone at [Seattle] Children’s working to meet the intense need for mental and behavioral health care.”

— Dr. Jeff Ojemann, executive sponsor, Generation REACH

Finding Mental Health Care in Washington State: Where to Start is designed to empower families to take steps toward connecting with mental and behavioral health care services and includes a question-and-answer session. It is also offered in Spanish now. Future classes will be recorded and available in both English and Spanish.

Sandra McAteer, family advocate/case manager, is one of the instructors and co-creators. She says the class offers a unique walkthrough of search tools and advocacy tips for families.

“Our goal was to create a platform to educate families about the types of care, address how to access them and answer basic questions about the mental health system that caregivers have,” McAteer says. “Our most-asked question is one that we wish we had a good answer for: ‘Why didn’t this class exist sooner?’”

Another new early intervention resource is a series called Early Childhood Parenting Skills, for parents of children ages 0 to 5 with behavior challenges. Topics will include healthy sleep habits, dialogic reading, child-directed play and others.

Meeting families where they are

“There’s much more work going on in Psychiatry and Behavioral Medicine and with our partners throughout [Seattle] Children’s than we’ve had room to share here — and all of it is important,” reflects Hereri Contreras Basurto, senior director, Mental and Behavioral Health Services. “Even so, there’s still a lot to do. One of the things I’m most energized by is creating powerful and strategic partnerships with other organizations that are offering culturally specialized, responsive care.”

After learning about Generation REACH at a recent Family Advisory Council meeting, Parent Advisor Sarah Harper shared her perspective. “The piece that touched me most is the focus on partnering with families, so that you meet us where we are — working together to provide care that draws on our strengths, including our values and traditions. I’m looking forward to seeing how you put that into place,” says Harper.

Kashi Arora, program manager for Generation REACH, reflects that awareness about youth mental and behavioral health is increasing. “We are seeing more conversations, more investment, and more collaboration than ever before. Generation REACH truly brings together work from across the organization so we can move toward the same ‘north star’ and collaborate with our community partners across the mental and behavioral health system.”

Much of this work is enabled by Seattle Children’s Guild Association and scores of other generous donors, who have given $83 million to mental and behavioral health initiatives so far. Arora notes, “The combination of philanthropy, strategic prioritization, government advocacy, and the extraordinary, daily commitment of the Psychiatry and Behavioral Medicine and Autism Center workforce moves us closer to realizing the vision that all children, teens and families can live their healthiest and most fulfilling lives possible.”

Published in Seattle Children’s workforce newsletter, InHouse, May 31, 2022