Children’s Wisconsin putting therapists in all pediatrician offices
Matthew Duncan, 12, sat in an room at his pediatrician’s office one day in mid-October,…
Matthew Duncan, 12, sat in an room at his pediatrician’s office one day in mid-October, sifting through a small heap of colorful suction toys piled up on the table in front of him.
His doctor was not the reason he was there. Physically, Matthew was fine. But mentally, he’d been rattled.
His mother, Tawyana Duncan, sat on the couch beside him. Across from them was Artie Turner, Matthew’s therapist. He listened patiently as Tawyana explained what had brought them in.
Matthew had a rough day at school the day before. During a volleyball match, one of Matthew’s teammates started telling him the coach wanted him to leave the game and criticized how he was playing. After the game, the teammate started “horse playing” with Matthew, she said, pushing him and kicking his seat. When Matthew said to stop, the teammate flicked Matthew’s shirt, poking Matthew in the eye.
Matthew, who has been bullied in the past, had reached his limit. He hit the boy in the face. Now, he was in trouble with the school.
“Matthew, how do you feel about the situation?” Turner asked, shifting the conversation to the boy.
“I feel kinda mad,” Matthew responded. “Everybody keep on saying that it was a joke. It wasn’t no joke.”
Matthew had spoken quietly and infrequently up until that point, but prompted by Turner, he was able to articulate his emotions. That skill was the result of months of practice: He’d been seeing a therapist at Next Door Pediatrics, run by Children’s Wisconsin, since June. He’d been working with Turner, specifically, since July.
Over those months, Turner and Matthew had formed a trusting bond that allowed the child to voice his feelings and emerge from what his mother described as an isolating, personality-changing mental health struggle. She’d watched her son go from a jolly, loving child to being more closed-off, hurt, even angry, and that’s when she knew it was time to seek out professional help.
In the clinic, Turner reminded Matthew of some of the tools that he’d learned to manage his anger: being aware of how his body felt as frustration built up, recognizing when to walk away, balling up his fists and slowly releasing them, releasing the anger at the same time — or imagining himself as ice cube, melting away to reach a state of calm control.
In other recent situations, Tawyana said, Matthew had been using these skills to manage his anger, maybe without even realizing it in the moment. Matthew’s coach told her he had noticed him balling up and releasing his fists to manage his anger. Turner turned to Matthew, reminding the child that was the goal: to avoid reaching a breaking point and turning to violence.
“I’m proud of you for before ― it sounds like you walked away and you used some of your skills, right?” Turner told Matthew, waiting for him to acknowledge the compliment with an audible “Mm-hmm.”
“You maybe didn’t notice but it sounds like the coach noticed,” Turner said, continuing the encouragement. “So that’s good. We’ll continue to talk about other skills we can use before we reach that that point.”
‘There is no wait’
Across the region and the state, children with mental health issues are sitting on long waitlists to see a therapist.
In July 2021, there were 867 kids on Children’s Wisconsin’s waitlist for outpatient therapy when Jeffery Yabuki, former CEO of Fiserv Inc., gave the health system $20 million to address the issue by putting therapists in every one of their primary care and urgent care sites. Yabuki made the donation in honor of his brother, Craig Yabuki, who had died by suicide four years earlier.
More:Four years after his brother died by suicide, former Fiserv CEO gives $20 million to put a therapist at every Children’s Wisconsin site
In the months since, Children’s has followed through with that charge, hiring 20 behavioral health consultants across its 20 primary care sites, with more to come at its urgent care sites. The health system’s waitlist for outpatient therapy has shrunk by more than half, to 413, as it continues working toward the goal of hiring 36 therapists by 2023.
The changes have been significant for families who otherwise face varying wait times to get an appointment at an outpatient clinic. While some Children’s Wisconsin clinics have no wait time, one still has a one-year wait. The average wait at a Children’s Wisconsin therapy clinic is three or four months, according to the health system.
But at their pediatrician’s offices, patients can see the therapists right away, at no charge to them.
“There is no wait. I think that helps a lot of busy families. I mean, kids are in sports and parents are working and shuffling multiple jobs sometimes ― first shift, third shift,” said Brittni Liebhauser, a behavioral health consultant at Children’s Bluemound Pediatrics. “It’s really important for families to know that when the clinic is open, we’re here. And if that means you call on a Tuesday because you happen to have off and so does your kid, you come in on Tuesday.”
The sessions are meant to catch kids’ issues early, giving them tools to manage how they’re feeling and a place to talk things through before they turn into bigger issues. Along the way, the therapists and doctors are working to normalizing the importance of mental health care for entire families.
The therapists have been overwhelmingly well-received, even by families who start out insisting their kids don’t need therapy. Cheryl Cameron, a pediatrician at Next Door Pediatrics, encourages all of her patients to meet Turner, at least briefly, even if they do not screen positive for any mental health concerns.
“I think as we hopefully get more families aware of it, it will become less stigmatized,” Cameron said. “Often times I tell families we all need a great coach in life and they’re just a great piece of health. It doesn’t mean anything is wrong with you to want to talk to somebody about how to better your life.”
The issues could be as seemingly small as troubles with sleeping, eating habits, or schoolwork stressors to more serious concerns such as bullying, depression and anxiety.
Cameron recalled one patient who throughout the whole physical exam reported no issues, even though she asked them about issues with sleep, school and coping. But the doctor saw on the mental health screening that the child had circled “yes,” to the question: “Do you feel sad most days?”
When Cameron asked more about it, the child insisted there was no problem. Cameron persuaded the patient to meet Turner anyway, just to say hello.
After a lengthy talk with Turner, the patient left the office with a follow-up therapy session on the calendar for the whole family. An issue that was not even on the patient’s parents’ radar was now out in the open.
“That’s a time where that family would not have sought out our care,” Cameron said. “They wouldn’t have thought they needed it.”
Teaching lifelong mental health skills
The work of the therapists, formally known as behavioral health consultants, is in many ways different from outpatient therapy options.
Instead of only working with longer-term interventions for major issues, the therapists working in Children’s Wisconsin’s primary care offices manage many different levels of concerns. Sometimes, they meet with a patient just a few times, to teach them tools to manage specific issues. Other times, they serve as a bridge for patients who have been referred to get more specialized care but are stuck on a waiting list.
In every case, the goal is to teach tools and healthy coping mechanisms that last a lifetime ― ideally before mental health conditions grow into something more debilitating.
“Just like teachers are teaching ‘two plus two equals four’ and ‘this is how you do an experiment,'” Liebhauser said. “We’re teaching those really foundational skills that kids ― humans ― need throughout their lives.”
One example is a tool called “ABC Please,” which is used to teach children about managing emotions. Turner gives a sheet explaining the skill to all of the patients he meets. The acronym reminds families to practice certain things every day:
- “Accumulating positives” by doing something you enjoy every day.
- “Building mastery” by encouraging kids to participate in and hone skills that they’re good at to build self-esteem.
- “Coping ahead” by knowing when stressful situations might come up in the day and thinking through how to respond, like nerves during gym class or an upcoming test.
- “Please” is a reminder to maintain physical wellness, from eating and sleeping well to avoiding mood-altering substances.
Turner splits his time between the Next Door clinic and another Children’s primary care site: River Glen Pediatrics. Both offices primarily serve children of color. As a Black man, Turner said he finds it important that his patients see his face and know that he’s a resource to them. He remembers walking in to meet one Black family. The father just kept looking at Turner, almost incredulous.
“He was like, ‘I’m sorry if I’m making this awkward just starting at you but this is just incredible that a young Black man just walked in here to help my son out. There’s just not a lot of people like you out there that we can go to. You’re just here. We came in to see the doctor and you’re here,'” Turner recalled.
The father started tearing up. Turner felt himself getting emotional, too.
“It was just a really powerful moment,” he said.
The behavioral health consultants are part of a larger five-year, $150 million plan at Children’s Wisconsin aimed at fundamentally rethinking and fully integrating mental health care into the medical treatment of every child.
The effort, now halfway complete, has shown some promising results and has the potential to impact thousands of lives. Through its primary care offices, Children’s reaches roughly one-third of the kids in southeast Wisconsin.
More:Children’s Wisconsin announces plan to improve access to behavioral health care for children, adolescents
Long term questions remain, as the health system works to figure out how to make its vision for early intervention sustainable in the long run. Leaders of the initiative say they’ve been working with insurers, for example, to figure out how to change perceptions about what mental health treatment looks like beyond weekly outpatient therapy sessions or major crises that send people to the emergency department.
Children’s Wisconsin’s approach has been different from its peers around the country, said Amy Herbst, vice president of mental and behavioral health.
“A lot of other health systems have in-patient psychiatric units,” Herbst said. “They focus more on that higher level of care, and we do too, but just in a very different way than I think most of our colleagues across the nation.”
Pediatricians and social workers saw the mental health crisis emerging and knew that earlier interventions were needed, said Dr. Smriti Khare, a Children’s Wisconsin pediatrician and chief mental and behavioral health officer.
“It was very clear, I think, to the people who were in the room building that strategy that we have to get to a place where we’re doing better by our kids,” she said. “We can no longer treat mental health as an optional thing. … That was not an option anymore. You could not have good physical health without having good mental health.”
For young Matthew Duncan, access to therapy has meant a return to a happier, lighter version of himself, before bullying and trauma led him to shut himself away, before he found himself struggling with suicidal thoughts and depression.
In Turner’s office, he commandeers Turner’s computer to pull up images of memes and cartoon characters on Google. He plays games that carry lessons; his favorite is a version of Jenga where as he and Turner take turns pulling out blocks from the tower, they name an emotion and have a conversation about it.
Matthew says he’s learned tools to keep a cool head. He knows that it’s OK to feel his emotions and to accept them, while also forgiving the person who may have caused him hurt or anger. Therapy makes him feel more open, he said, like he has to hold less in. He wants other kids to learn the same.
“Never try and hide what’s inside you,” he said.
- National Suicide Prevention Lifeline: 800-273-8255
- HOPELINE: For emotional support, text “Hopeline” to 741-741
- Milwaukee County 24-hour crisis line: 414-257-7222. When needed, a mobile team can meet adults and adolescents anywhere to talk and connect them to resources.
- Milwaukee Coalition for Children’s Mental Health: Find resources for mental health support, assistance with other basic needs, and tips for helping children cope with life during the pandemic at mkekids.org.
- Wisconsin Office of Children’s Mental Health: Find resources for accessing health care, hotlines, peer support, child care and more at children.wi.gov.
Contact Devi Shastri at 414-224-2193 or[email protected]. Follow her on Twitter at@DeviShastri.