New Children’s Wisconsin Emergency Department team treats kids with mental health crises

In April of 2022, Angie Desjarlais, MSW, APSW, a social worker and member of a special Children’s Wisconsin team that supports kids with critical mental health needs, met a mom and her teenage daughter that she won’t soon forget. Angie was working in the Children’s Wisconsin Emergency Department (ED) when the two came in, desperate for help.

The teen was having angry outbursts that involved lashing out at her family and breaking things. She even ran into the street. The mother was worried about her daughter’s safety and brought her into the ED. The mother and daughter met with staff, who worked with Angie to connect the family with community resources to provide ongoing support for the teen.  

“I just remember the mom had no idea there were other resources, including our own Craig Yabuki Mental Health Walk-In Clinic, which could help. She was so appreciative that she started to cry,” said Angie. “I was grateful to be there for them.”

Back in 2020, when Children’s Wisconsin established the Crisis Response Team — which includes a psychiatrist, three mental and behavioral health social workers, a mental and behavioral health navigator and a supervisor — it was estimated the team would support around 800 children a year. But since that time, the number has grown dramatically. The team helped nearly 1,000 kids in 2020 and close to 1,400 kids in 2021. 

The growing numbers reflect how the COVID-19 pandemic has exacerbated the pediatric mental health crisis. New data from the Centers for Disease Control and Prevention (CDC) show that 44 percent of high school students reported they persistently felt sad or hopeless during 2021. And in a 2020 survey from Lurie Children’s Hospital of Chicago, 71 percent of parents said the pandemic had taken a toll on their child’s mental health.

These numbers show the importance and critical timing of a partnership with the United Health Foundation, the philanthropic foundation of UnitedHealth Group. The $2.5 million grant to Children’s Wisconsin in 2020 helped establish the Crisis Response Team to make care available 24 hours a day, 7 days a week and ensure mental and behavioral health consultations, referrals, and follow-ups are as seamless as they are for physical injuries treated in the ED.

“In general, the ED has been used more for psychiatric crises,” said Jennifer Zaspel, MD, the psychiatrist on the Crisis Response Team. “We’ve been seeing a lot of younger kids, even 5 to 11-year-olds. We’ve also noticed a lot of families that have been disconnected from outpatient mental health care or struggling to find outpatient care during the pandemic.”

Connecting patients in crisis to more outlets for care has been a priority of the team. A leadership group was formed to review data and suggest process improvements. As a result, the ED has implemented new care guidelines and improved workflows so that Children’s Wisconsin is providing patients a more collaborative approach. The team has learned how they communicate with patients and our community partners makes a huge difference in outcomes.

“When kids have a follow-up after a crisis, they are more likely to adhere to their treatment plan,” said Dr. Zaspel. “We also follow up with the child’s pediatrician, because that’s an important bridge point while they wait to see a psychiatrist or therapist. Their pediatrician is probably the one who knows them best.”

United Health also supports the role of a mental health navigator as part of the Crisis Response Team. This person follows up with every patient seen in the ED for mental health needs. 

“The navigator has connected families with different community resources or helped them establish relationships with other providers and services,” said Allison McCool, MSW, APSW, the social work supervisor on the team.”That role has really helped us understand the different barriers families face after they leave us.” 

Funding from the United Health Foundation grant also supported de-escalation training and trauma-informed education for all ED nurses and medical staff. This training is used when a patient is acting out in an aggressive or emotional way. When health care workers know how to de-escalate situations, it not only helps to keep everyone safe, but also helps patients calm themselves so they remain an active participant in the care received.

The goal of all this work is to reduce the number of mental health crises among children — and provide a continuum of care that includes better access and improved care transitions. So far, there has been a slight reduction in the number of patients returning to the ED for care, but as the program continues to grow and evolve, the team expects those numbers will continue to improve.

“Rates of mental health challenges among children and adolescents were already trending upward before the pandemic, and today we’re seeing more young people experiencing mental health crises,” said Yusra Benhalim, a senior national medical director for Optum Behavioral Health Solutions, part of UnitedHealth Group, and a board-certified child and adolescent and addiction psychiatrist. “The United Health Foundation is honored to partner with one of the leading pediatric hospitals in the country in establishing this innovative resource to help more youth receive the critical mental health services they need, along with an ongoing continuum of support, through a seamless model of care.”

Tami Hughes Writer Children's Wisconsin

Staff supporting mental and behavioral health care at Children’s Wisconsin includes experts in the fields of child and adolescent psychiatry, pediatric psychology, neuropsychology and psychotherapy.