Groups like Connected Families NH work to bring families and organizations together

Monadnock Ledger-Transcript
Published: 10/12/2022 12:25:09 PM

Third of a series on mental health and children.

In October 2021, the American Association of Pediatrics, along with the American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association, declared an emergency regarding the soaring rates of mental health challenges among children, adolescents and their families.

One year later, care-coordination groups like Connected Families NH in Keene continue to address this emergency by providing system of care services for those in need as mounting numbers of children continue to need help.  

Connected Families Director Dennis Calcutt said the need for care for children with mental health needs is extremely high right now in the region and around the state, and the workforce is extremely limited in terms of capacity.

“There are not enough therapists to care for children and youth in the region and there is a morass of social issues for them,” he said, adding that a big cause of increased need for children has been the lack of socialization due to being out of school during the pandemic, as well as a variety of other social factors that create a diffusion or a lack of grounding for children.

On the hopeful side, he also thinks youth are more open to share that they are looking for help and that families are talking about mental health more.

“I work in it, and people are asking me all the time, ‘Could you recommend a therapist?’” he said.

However, Calcutt said a stigma still exists and people aren’t always comfortable acknowledging they need help.

“The reality of needing help with mental health is out there, but I don’t think it’s out there enough,” he said, adding that for youths, the causes can’t be pinned to one thing. 

According to the National Survey of Children's Health, 12.6 percent of New Hampshire youth have one or more emotional, behavioral or developmental condition, and of those, nearly half received mental health treatment or counseling within the past year.

Nearly one in five children in the United States has a mental, emotional, or behavioral disorder such as anxiety or depression, attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), disruptive behavior disorder or Tourette syndrome, according to the CDC, and only about 20 percent of children with mental, emotional or behavioral disorders receive care from a specialized mental health care provider.

Finding access to mental health care is crucial, said Calcutt, who cited the an increase in the numbers of children waiting in emergency departments for psychiatric care as a sign that not enough children are receiving the care they need. On Oc. 4, the state had 17 youths boarding in emergency departments. 

Susan Stearns, executive director for the National Alliance on Mental Illness (NAMI), said, “What we've been told is that when you get up towards 20 it's going to be two weeks or longer.”

Stearns said they are seeing higher reports of anxiety, depression and self-harming behaviors, especially in girls and also more suicidal ideation.

“We’re also seeing that this is quite pronounced amongst people of color,” she said. “That's not a surprise, and we also know that our LGBTQ+ kiddos are at significant risk in terms of suicide. We need to be making sure that we are providing adequate support to these kids of any risk group because they they are at such risk.”

Prior to the pandemic, Calcutt said mental health organizations like his knew the majority of those youth who frequented emergency departments because they were connected to the broader statewide system. But now, he said, “We’re seeing kids who are commercially insured.”

One of the solutions to this problem, Calcutt said, is the system-of-care approach that includes the FAST Forward (Families and Systems Together) program, designed to provide support to children, youths and their families by using a wrap-around approach that helps children and families connect to services. The program adheres to a care model that includes community-based services and supports for children, youth and young adults with, or at risk for, mental health and related challenges, along with their families.

Stearns said mental health needs for children didn’t just appear because of the pandemic, but that it has been exacerbated because of it. She cited a specific example of this by pointing to the increase in numbers of children and families NAMI is working with through the FAST Forward program. In January of 2020, NAMI was serving 175 children and their families, and today it is serving more than 450.

“That increase has been going on for a year,” Stearns said. “And there’s no question we saw a different phenomenon happen during COVID in that typically the state has this issue with folks waiting in emergency departments for an inpatient psychiatric bed. Pre-COVID, particularly in the summers, we would see those numbers for kids boarding would drop way down. And I remember distinctly it was August of 2020, August, when the numbers suddenly shot up. We've had some dips, but it continues to be at a higher level than we saw.”

Connected Families uses a system-of-care approach, and Calcutt said it is helpful to think about this in two ways -- the general mental health side and the effort that take place across the state.

Calcutt said the Monadnock region has been fortunate, through Cheshire County’s status as a Substance Abuse and Mental Health Services Administration (SAMSHA) grant-holder. New Hampshire received a system-of-care grant from SAMSHA, and the region has received a grant intended to build infrastructure in support of children’s mental health across the state.

“We are fortunate since we have that in our region,” he said, adding that there has also been a lot of effort around the 988 rapid response – the newly established suicide and crisis lifeline formerly known as the National Suicide Prevention Lifeline.

“There’s more for the youth here and 988 is a component of system of care. It’s a full continuum of services,” he said.

Calcutt said most people know what therapy and psychiatric care are, but that most people don’t know what’s in the middle.

“No. 1, it is very sporadic,” he says, explaining that living in Portsmouth versus living in Peterborough is vastly different when it comes to services. “The availability of services between those two places is vastly different.”

Some of this is related to the workforce and population base, he said, adding that in Portsmouth a child could have the option of having a partial-hospitalization program, which is different from a psychiatric facility that a child lives in at all times. A partial-hospitalization program exists in Portsmouth, but it doesn’t exist in Peterborough, he said.

“I’ve been in conversations with families whose child is in therapy one day a week and then their issues increase. Now they want residential treatment. But why not think about what’s in between?” he said, adding that sometimes the availability doesn’t exist. “But in that case, I would ask, ‘Can you talk to your therapist and make plans to visit three days a week instead of one hour a week over three different days?’ There are things people can do.”

Some of the other supports that exist in the region, Calcutt said, include recreation departments and after-school programs such as Avenue A Teen + Community Center in Antrim.

“We’ve been doing work with them to find out what other options we can put in place,” Calcutt said. “Peterborough doesn’t have [a teen center] and Keene doesn’t have it. This is where disparities come in play. If you’re a family of means, you can buy these things by say, putting your child in a travel soccer program or a ski program.”

One of the goals of the system-of-care approach, Calcutt said, is to overcome the siloed effect that takes place with care. Pediatricians work in hospitals, therapists work in private practices, and part of the job of Connected Families is to coordinate care for families.

“It’s family driven,” he said. “We sit down with people and find out their needs and strengths.”

Another side of coordinating care is for children and youth transitioning from residential treatment or psychiatric hospitalization.

At the moment, he said there is a push to develop other resources in region.

For the long term, Stearns said she hopes broader systemic changes will be created to increase Medicaid rates to cover mental health issues and increase the workforce in this area.

“Mental health centers have the problem of not being able to pay salaries that may be competitive with the private sector,” she said, returning to the importance of the wrap-around efforts organizations like Connected Families implement in terms of their work to keep families and children connected to services.

The importance of this work is illustrated by a Kaiser Family Foundation  survey that came out earlier this month, Stearns said. In the survey, 2,000 adults were asked questions regarding mental health issues in America. Of those 2,000, 500 were parents, and the study found that 47 percent of parents said the pandemic has negatively affected their children’s mental health.

“Mental health and suicide impact us all, and no matter who you are, you have a role to play,” Stearns says. “Whether that is being an advocate or a provider providing services, or just being a caring member of the community who is knowledgeable and able to respond in a caring supportive way.”

Next: Schools and the laws around special accommodations for students with emotional disorders.


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