While a sense of normalcy has emerged on many fronts from the all-encompassing COVID pandemic, for children and their families, the lingering mental health effects are still very real. The good news, though, is that our region’s hospitals have stepped up to meet rising needs with innovation and expertise that are helping children and families continue to adjust, cope and heal from both the lasting mental health impact of COVID, as well as new and existing challenges they may face every day.
According to regional pediatric mental health experts, including Inova Health System in Northern Virginia, we are still in crisis mode with no clear end in sight. While the crisis evolved over the years, the pandemic was an important milestone in that children lost social support, which led to isolation resulting in rising anxiety and mood disorders during that time—and continuing today. Suicide remains the second leading cause of death for ages 18 to 24. According to some experts, the high rates of social isolation had a negative impact on developmental milestones and increased the use of technology-based social and learning interactions. The lack of a play-based childhood also leads to higher rates of anxiety and a lack of socialization, which can be a barrier to learning the everyday skills of communication, success, failure and building relationships.
The continuing struggle of post-pandemic readjustment coupled with the everyday family pressures of academics, work, family obligations, social and peer influences and social media, to name a few, can be overwhelming for any family.
So, what are parents to do, and what can they expect if mental healthcare is needed for their child? While mental health experts prioritize wellness outside of the hospital, including social, educational and family support, hospitals have a unique role in times of mental health crisis. Hospitals are making great investments in providing excellent care, including ambulatory care, individual and group therapy, testing, medication management, partial hospital programs and substance abuse services through a wide variety of expertise, programs and services.
Here are some highlights of the variety of services offered at the region’s leading hospitals (though not all are available at all hospitals) that are providing new and expanded ways to help children and their families create opportunities for success, coping and healing.
Pediatric and adolescent -specific mental health units designed for children and families
First impressions are everything, and it’s no different—and maybe even more important—when a child needs mental healthcare. Regional hospitals such as Inova have put great care and resources into creating spaces that are warm, inviting and safe for children and their families. This can include everything from comfortable furnishings, lighting and color to sensory spaces specially designed for children to meet their developmental needs, and where they can feel calm and safe. These spaces may also include room for social activities and interactions with peers, and quiet for homework.
Multidisciplinary care teams working with parents and caregivers
Psychiatrists, psychologists, child and family therapists, clinical social workers, mental health nurse practitioners, child life specialists, art therapists, pet therapists, administrative staff and other mental healthcare and pediatric experts comprise these special teams that care for children in mental health crises. Their specialized training in child development provides families with expert care and resources to support their child in the most effective ways. In addition to mental health experts, providers at Inova stress the importance and expectation of parents and caregivers as critical partners in the care team.
Pediatric emergency departments specific to children’s needs
Many hospitals now have separate, kid-friendly emergency departments specially designed and staffed to accommodate the needs of children. The tailoring of these pediatric emergency departments includes pediatric emergency doctors, nurse practitioners, physician assistants, pediatric nurses certified in Pediatric Advanced Life Support (PALS), Certified Child Life Specialists, specially trained facility therapy dogs, sensory-friendly environments and services and family navigators to assist with connection to community resources. Their role is to stabilize children in mental health crises and determine the best next steps of care. The focus is to help kids feel safe and secure and help families prepare and have access to appropriate resources and care outside of the hospital.
Partnership between psychiatry, primary care and other healthcare teams as appropriate
With the national shortage of mental healthcare professionals—and our region is no exception—there is an evolving partnership between mental health professionals and pediatricians to care for children with mental healthcare needs. This partnership provides the advantage of coordinated care between a child’s primary care physician and their mental healthcare team.
Family navigators
Specially trained professionals—often social workers—can help families prepare for their child’s return home and connect the family and caregivers with vital community-based services and resources for both the child and their family. These services are vital to providing a comprehensive approach to care once the child is home.
Opportunity for social interaction with peers
An important component of inpatient mental healthcare for children is to provide social interaction and activities with peers. The effects of isolation contribute to depression and anxiety. Knowing this and the importance of social connection for children and adolescents, many hospitals have space for supervised social interaction and activities to combat isolation and promote normalcy and healthy connections in their lives.
Testing
A critical component to all hospital children’s mental health programs is to provide testing to get a proper diagnosis. Effective treatment, support and care starts with an accurate diagnosis.
Individual and family counseling
At most hospitals, the child, parents and caregivers can connect through individual and family counseling. This may start in the hospital, and families can continue this care through connections to community resources for long-term support.
Art therapy
Art therapists are specially trained mental healthcare professionals that help children express themselves beyond words or language using creativity. Art therapists are trained in art and psychological theory and work with children of all ages experiencing mental health challenges.
Pet therapy
A number of hospitals’ pediatric emergency rooms, as well as children’s hospitals and children’s mental health units, have therapy dogs that are trained to provide emotional support to children in the hospital. For children and their families who desire a visit from one of these gentle, warm and furry friends, they can expect the dogs’ interactions to promote calming, comfort, diminished feelings of isolation, increased motivation and improved general mood and sense of well-being.
Certified Child Life Specialists
A Certified Child Life Specialist is a healthcare professional who helps children and their families cope with the challenges of illness, injury, disability, trauma or hospitalization. They are an integral part of the healthcare team, as they provide additional support resources to children and families to help them process the often-stressful situation of an illness or injury.
Family-centered care is key to prevention, coping and recovery
According to experts from our region’s hospitals, there is an increased awareness among parents and caregivers about the rise in mental health issues with children, which can help make putting key actions into place to help kids easier and more impactful. Addressing mental health needs—as with all things when it comes to raising children—takes a team with the family at the center for success. Here are some ways families can take the lead:
Kids thrive on community. During the pandemic, social activities and a sense of community were compromised, and the isolation had a serious impact on children’s ability to thrive. Parents and caregivers can re-establish a sense of community for their children by re-engaging in social activities and doing activities as a family. Encouraging both family time and time for kids to be with their friends in social, sports or faith-based activities gives them a sense of belonging to their peer group and builds confidence.
Make mental health a priority at home. Cultivating a home atmosphere of social support for everyone helps reduce anxiety and depression. Be sure your children know they are in a home that values open communication where they can share their feelings.
Follow through with connection to community-based resources. If your child and family are dealing with a mental health concern, be sure to follow through with connection to community resources that can assist and help ensure progress.
What to do if you think your child needs mental healthcare services
Parents know their child best. Be aware of changes in your child’s behavior and demeanor that may indicate mental health challenges. For teenagers, changes in social engagement, eating habits, sleep routine, mood or academic performance, or signs of struggling in other parts of their life, can be indicators that they need help. Younger children wear their emotions on their sleeve, so changes can be more evident, but some of the same indicators there are for teenagers can be present as well.
The role of the pediatrician – In non-acute or non-crisis situations, the child’s pediatrician can be the first resource for a discussion of mental health concerns with your child. The child’s pediatrician will be able to advise on the best next steps and is connected to pediatric mental health experts in your community.
When to go to the emergency department – For mental healthcare, the emergency department is best suited to address acute situations of crisis. The goal is to provide security and safety for the child, stabilize them and provide timely attention to serious mental health situations by quickly accessing pediatric mental health experts.
What to expect from your local hospital – If a child is admitted to the hospital for mental healthcare, parents/caregivers can expect a four- to six-day stay. Testing and diagnosis are done during this time, and the family is connected to resources for the child so they can return home with a care plan and community support.
What to expect before discharge from the hospital – Having a child in a mental health crisis is nothing families can prepare for. The time during which a child is hospitalized is the time for active preparation for the support they will need when they return home. The hospital can help parents think about the home environment and determine what supports need to be put in place, as well as help build up parents and caregivers.
It takes a team. With families at the center, the healthcare team works to provide the best course of care to help ensure the best outcome for the child.
Anyone who needs support for a suicidal, mental health and/or substance use crisis, or who has a loved one in distress, can connect with a trained counselor by calling, chatting or texting 988.
Lisa Clough is a health journalist and Certified Health Communications Specialist.
Inova Health System Mental Health Services
Provided by James Murphy, MD, MBA, division chief of Child and Adolescent Psychiatry and interim chair of Behavioral Health at Inova Health System
Child and adolescent mental health services provided at Inova Health System
Inova Health System is focused on developing a multidisciplinary clinical and therapeutic team based on the recognition that one type of therapy does not work for every child. Its evidence-based care model provides unique and creative ways to support the child and includes occupational therapy, social work, art therapy, music therapy, recreational therapy, movement and physical activities and animal therapy, as well as an environment specially designed for children and their families to feel comfortable and safe.
Inova’s philosophy is that all work together as joint stakeholders, sharing in the responsibility of caring for the child. Multidisciplinary morning rounding ensures the entire team has insight into a patient so that the team can set and achieve reasonable expectations. The care team is racially, ethnically and linguistically diverse, and for those children that need it, interpreters are with them throughout the day.
What parents and caregivers should know and expect
While a mental health crisis often leads to the Emergency Department as the first stop, there are important things for parents and caregivers to know. The role of the Emergency Department for children in mental health crises is to stabilize and then determine if the child should be connected to outpatient services or be admitted to the hospital. While the hospital is the highest level of care, the stay is often brief (four to six days) so that the child’s support system is not interrupted and so that appropriate family and community support can be put in place for when the child returns home.
Parents and caregivers are a critical part of the care team. And while they can understandably feel helpless at this time, Inova encourages parents and caregivers to be active participants in the treatment of their child. Inova provides support for parents and caregivers by connecting them with community resources and counseling for how to build, strengthen and maintain a support system for the child.
The team wants to hear parents’ thoughts and understand the child’s situation so that they can make the best recommendations for each family. Inova encourages families to ask questions, and if a recommendation does not work for the child and family, let the team know.
Programs and spaces designed specifically for children
The Inova pediatric and adolescent mental health care team operates on a three-pronged model of care: trauma-informed care, patient and family -centered care and collaborative problem solving (CPS). Trauma-informed care aims to recognize, understand and empathize with the impact of trauma. Patient and family -centered care strives to provide care that is specific to each individual and within the context of the family. CPS aims to identify gaps in skills while resolving issues and difficulties in a collaborative and mutually satisfactory way.
Additionally, Inova has created a unique and creative environment that features sensory spaces that include sensory lighting, colors and sounds that promote comfort; sound dampening floors; comfortable furniture and interactive spaces with recreational therapy.
Learn more about Inova Health System’s mental health services for children and adolescents at inova.org/our-services/inova-behavioral-health-services/programs-and-services/child-adolescent-services.
