Another milestone in the Children’s Wisconsin journey to confront the growing mental and behavioral health crisis facing Wisconsin kids has been reached with the completion of the $5 million Change the Checkup Challenge. Funds raised from this challenge will bring mental and behavioral health care teams — including at least 36 full-time master’s-trained therapists — into every Children’s Wisconsin primary care office and urgent care location, as part of the largest-scale implementation in any pediatric setting in the nation.
The $5 million Change the Checkup Challenge was started in July of 2021 as part of a $20 million commitment from The Yabuki Family Foundation to help Children’s Wisconsin transform the response to pediatric mental and behavioral health.
Therapists and pediatricians are already starting to work side-by-side, fully integrating mental and behavioral health into a child’s routine visit. When fully staffed by the end of 2023, the effort has the potential to benefit more than a third of the pediatric population in southeastern Wisconsin.
The challenge inspired 675 donors who committed over $5.2 million. Supporters came from 29 states and one Canadian province, and 197 individuals made their first-ever gift to Children’s Wisconsin. The largest challenge gift was a $1 million commitment from Billie Kubly, whose family has demonstrated a long-standing commitment to programs that address mental health and improve access.
“The support this challenge has received reflects not only the growing recognition of the importance of the mental health of our kids, but also the generosity, respect and leadership of Jeff Yabuki,” said Peggy Troy, president and CEO of Children’s Wisconsin.
“The trust and faith of our donors is inspiring and we appreciate that so many recognize how much more still needs to be done to put mental health on the same plane as physical health,” said Meg Brzyski Nelson, president of Children’s Wisconsin Foundation.
In late 2019, Children’s Wisconsin shared a five-year, $150 million vision to address the growing mental and behavioral health crisis facing Wisconsin kids. The pandemic has only amplified existing mental and behavioral health issues, while triggering new ones in other children as well. This highlights the importance of completing this challenge. In fact, late last year the U.S. Surgeon General issued an advisory formally acknowledging COVID-19 as impacting the existing youth mental health crisis.
Research indicates that more than half of individuals who struggle with mental health conditions in their lifetime start experiencing symptoms before the age of 14. Yet the average length of time between when symptoms appear and treatment begins is often more than 10 years. This underscores the urgency in changing how mental health services are provided to kids.
“Children’s Wisconsin is uniquely positioned to make a significant impact meeting the mental and behavioral needs of our kids,” said Smriti Khare, MD, the newly appointed chief mental and behavioral health officer for Children's Wisconsin. “Thanks to the generous gifts from The Yabuki Family Foundation we have been able to accelerate progress the past two years. That said, much remains to be done. Mental health must be integrated into all we do so that no matter where kids and families access our system — and whatever their journey — there is never a wrong door to access. I am proud of how this effort has been embraced throughout Children’s Wisconsin and the entire community. It is clearer than ever that there’s no such thing as good health care without mental health care.”
Transformation is already taking place on a number of fronts. Initially, Children’s Wisconsin identified seven initiatives to detect needs sooner, improve access to services and reduce the stigma around the illness. Children’s Wisconsin continues its commitment to these areas, but as the pandemic has intensified the crisis and new programs have been started, it is clear these efforts need to be integrated throughout all of the health system. In implementing this vision, Children's Wisconsin also identified a lack of similar efforts to build upon. As such, a major goal is to back this innovative approach with research that enables them to share lessons and best practices with the nation — saving even more lives.
Children's Wisconsin is transforming the way it practices in order to offer mental and behavioral health services at every touch point — wherever kids and families are. In this way, they care for the needs of the most kids possible.
1) Integrated mental and behavioral health
Children’s Wisconsin has embarked on the largest-scale implementation of integrated mental and behavioral health (IMBH) in any pediatric setting. Since The Yabuki Family Foundation donation in late July, 10 full-time master’s-trained therapists have been supporting families at its primary care offices. In only a few months, those therapists supported more than 2,600 kids. With progress underway in primary and urgent care, the next step is to consider how to more fully integrate mental health support into specialty care services.
2) Universal screening
Mental health screening at routine appointments is crucial to identifying issues before they become a crisis. Depression screening has been integrated into standard practices at all Children’s Wisconsin primary care offices, with nearly 85 percent of all eligible kids age 12 and older screened. All kids whose screens are positive are referred for follow-up care. A suicide screening tool is also in place in the Children’s Wisconsin Emergency Department and Trauma Center (EDTC). Since it was implemented, nearly 30,000 kids have been screened and more than 4,800 have had positive results. That is 4,800 kids who might have otherwise fallen through the cracks and not been offered the support they needed. Next steps include more consistent use of the suicide screen in the EDTC and identifying the appropriate screening tool for specialty clinics.
3) School-based mental and behavioral health
Children’s Wisconsin is now supporting school-based mental health in nearly 70 schools throughout Wisconsin. During the pandemic, this program adopted digital tools to allow staff to continue to support kids through digital visits. This was critical as the social isolation caused by the pandemic intensified the needs of most children. This support continues to be necessary as some kids have had to adjust back to in-person learning. Some kids were experiencing increased anxiety over fears of being sick, while others struggled with emotions and behaviors back in the classroom. This approach increases access to early intervention by treating kids quickly in a comfortable, accessible, familiar setting — places that families already know and trust. Children’s Wisconsin is also exploring how to broaden its support for other community-based programs in the coming three years.
Children's Wisconsin is transforming its infrastructure and adding unique entry points to better serve kids when a mental health need is identified.
4) Urgent and emergent mental health care
Children’s Wisconsin recently opened the Craig Yabuki Mental Health Walk-In Clinic on the Milwaukee campus. The clinic is open seven days a week from 3-9:30 p.m. and provides immediate support to kids with urgent needs through licensed therapists, social workers and clinical assistants.
The Children’s Wisconsin Crisis Response Team has been in place in the EDTC for more than a year. The team provides de-escalation and other intervention measures for kids in mental distress, and also provides post-discharge care to help families establish continued care. The team has been activated more than 2,000 times since it was established.
5) Early childhood mental health
Children’s Wisconsin is coordinating the work of multiple specialists and programs for kids ages 5 and under across the state. Children under 5 suffer from mental health challenges and conditions that are difficult to diagnose and therefore often go untreated. Yet early treatment can influence the trajectory of young children and their families — enhancing parent-child interactions and attachment, supporting healthy social-emotional development in infants and toddlers, and even improving parents’ mental health.
6) Partnerships with inpatient and residential care providers
In 2021, the Integrated Healing Program was created, which provides support to teenagers who have physical pain to such an extent that they are experiencing emotional distress and are not able to participate in day-to-day activities like school or family events. The program brings together child and adolescent psychiatrists from Rogers Behavioral Health, and physical therapy experts from the Jane B. Pettit Pain and Headache Center at Children’s Wisconsin. Together, the team is providing intensive rehabilitative, medical and mental health services.
Progress also continues on the new Milwaukee County Mental Health Emergency Center, a project Children’s Wisconsin is partnering on with Milwaukee County, Advocate Aurora Health, Froedtert Health and Ascension Wisconsin. Planned to open in the fall of 2022, it will provide a new psychiatric emergency department in Milwaukee to serve kids and adults.
Children’s must help address the national shortage of mental health providers, especially ones trained to support kids. To meet that need, new training models and fellowship programs must be created to increase the number of people seeking these careers and decrease the time it takes to complete their training.
7) Therapist Fellowship Program
There are 14 fellows currently in the Therapist Fellowship Program, and eight who completed the program within the last year and have accepted positions at Children’s Wisconsin. A total of 28 aspiring therapists have now participated in the program and have supported more than 1,285 families through more than 16,000 sessions. Not only is the program preparing more licensed therapists, it is doing so faster. While it typically takes around five years for prospective therapists to complete 3,000 hours of clinical training, Children’s Wisconsin fellows are completing those hours in less than two years. This progress is encouraging, yet it will only meet a fraction of the therapists needed — not to mention other providers and staff. Two years after making a commitment to address mental health needs, Children’s Wisconsin recognizes the need to broaden this initiative to support additional workforce development needs.
Funds from donors play a critical role in these efforts. Since the announcement in 2019, more than $52 million has been raised to support mental and behavioral initiatives at Children’s Wisconsin.
These funds come from more than 1,000 donors, with the following people and organizations committing $1 million or more to the effort: The Boldt Company, Dan and Karen Buehrle, Sue and Curt Culver, Jerry and Becky Jendusa and family, Kohl’s Corporation, Billie Kubly, the Reiman Foundation, Rexnord Foundation and United Health Foundation.
To make a donation to support the future of pediatric mental and behavioral health, visit shinethrough.childrenswi.org/donate.