August 31, 2020

Approximately 25 percent of children and adolescents in the United States have a diagnosed mental, behavioral, learning, or developmental disorder, and these numbers are growing rapidly as more children and families continue to be impacted by the uncertainty, economic stress and daily disruption caused by the COVID-19 global pandemic.

“Since we began building our developmental-behavioral health infrastructure in The Woodlands in 2016, our focus has been on developing a robust program that serves the broad developmental and mental health care and behavioral needs of children and families,” said Dr. Paul Sirbaugh, chief medical officer at Texas Children’s Hospital The Woodlands. “From diagnosis to a multidisciplinary treatment approach, our patients and families can access services in their own community from behavioral health specialists who treat a myriad of mental health issues.”

The Developmental-Behavioral Health team consists of psychiatrists, psychologists, a clinical social worker and a developmental-behavioral pediatrician who collaborate with colleagues at Texas Children’s, Texas Children’s Pediatrics and in the community to design efficient methods to screen and identify patients in need of our services.

Having developmental-behavioral health services available at Texas Children’s provides the security of knowing that children and families will benefit from science-informed practice and a focus on quality and outcomes, ensuring our patients and their families have access to the right care, in the right place at the right time.

Our patient model of care

Referrals to the Developmental-Behavioral Health team at The Woodlands are routed through the Behavioral and Developmental Sciences Referral Center. A dedicated referral team reviews all patient referrals closely and triages them to the appropriate service, location and provider based on the patient’s needs. The developmental-behavioral health providers can also bring other members of the team on board for those patients who would benefit from more than one service.

Psychology

The psychology team in The Woodlands offers diagnostic assessment and psychotherapy intervention services either through in-person or e-Health video visits for children and adolescents with behavioral health concerns.

“Within psychology, our focus is on using evidence-based tools and interventions to diagnose, treat and monitor outcomes for our patients,” said Chief of Psychology Dr. Karin Price. “Our psychology providers work with a broad spectrum of pediatric and adolescent patients including those with common mental health concerns and difficulties related to acute and chronic health issues.”

The Woodlands team consists of four psychologists and a certified social worker with diverse specialties:

  • Dr. Elizabeth Franklin treats adolescent patients with mood, anxiety and eating disorders. She also serves as the bariatric surgery psychologist for The Woodlands Bariatric Surgery Program, where she conducts pre-surgical psychological evaluations and assists patients with interventions for binge eating disorders.
  • Dr. Jennifer Kazmerski specializes in pediatric behavioral sleep medicine. Working with our Sleep Center, she provides evidence-based therapy services to children and their families for a range of sleep concerns and sleep disorders including behavioral insomnia, nocturnal enuresis and obstructive sleep apnea.
  • Dr. Aime Allain provides family-based interventions for common child and adolescent mental health concerns, including anxiety and depression. She counsels patients on relational concerns whether it be helping families manage conflict and/or social relationships in a healthier, more adaptive way.
  • Dr. Don Caudle provides neuropsychological assessment for patients with illnesses or injuries that impact their cognitive functioning, helping families and educators understand a child’s strengths and weaknesses, and how to best help them in their daily lives.
  • Nikki Adeleke is a licensed clinical social worker who is part of the Traumatic Stress and Resiliency program that provides support and intervention to children and families facing trauma, stress and personal crises.

While psychologists and psychiatrists both specialize in evidence-based diagnostic assessment and treatment planning for patients, Texas Children’s psychiatrists provide more specialization in medication management.

Psychiatry

Under the guidance of Dr. Kirti Saxena, interim section chief of psychiatry at Texas Children’s, the psychiatry team in The Woodlands consists of two psychiatrists Drs. Nabil Guirguis and Humera Danwar, who also see patients through in-person visits or e-Health video visits, making it easier for providers and their patients to connect remotely.

“We have a full case load of patients in our clinic,” said Saxena. “There is a huge demand for children with primary psychiatric needs, but also patients with chronic medical conditions who need psychiatric services. Many of our slots are filled for existing patients, so trying to get new patients in has been challenging for us, but our providers are doing a fantastic job of accommodating as many patients as we can given our current resources.”

Often times, patients with mental health needs may benefit from more than one service. If a patient has been diagnosed with a mood or anxiety disorder, a traumatic brain injury, or is lagging behind in school after a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) – and in addition to psychotherapy – they need medication to manage the symptoms of their illness more effectively, that’s when the expertise of psychiatry comes into play.

“We collaborate with our psychology partners regularly to ensure that we provide the most comprehensive, individualized treatment plan for our patients,” said Danwar. “We also work with colleagues in developmental pediatrics. If we have a patient with autism whose symptoms are not being managed well with other therapies, and medication management is needed, that’s when my expertise is needed to assist with their treatment plan.”

Developmental Pediatrics

The Meyer Center for Developmental Pediatrics at Texas Children’s is the third component of the comprehensive model of care for patients and their families enrolled in the Developmental-Behavioral Health Program in The Woodlands.

Led by Dr. Robert Voigt, the chief of service for the Meyer Center and head of the section of developmental pediatrics in the Department of Pediatrics at Baylor College of Medicine, our developmental-behavioral pediatricians provide medically directed diagnostic consultations for infants, children and adolescents spanning the full spectrum of developmental-behavioral pediatrics – from intellectual disabilities, autism spectrum disorders, and cerebral palsy to learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and motor coordination disorders. The Meyer Center also provides medically directed developmental evaluations for children at increased risk for developmental-behavioral disorders due to prematurity or other neonatal complications, medical conditions such as congenital heart disease, genetic syndromes, or neurologic disorders, or adverse psychosocial experiences.

“Our approach is interdisciplinary and family-centered, and our evaluation considers the individual and collective impact of biological, genetic, environmental and social factors,” said Dr. Candice Allen, the only developmental- behavioral pediatrician at Texas Children’s Hospital The Woodlands. “Our team evaluates each child and works with the family on assessments, team meetings and conferences to develop an individualized treatment program so that every child who seeks our services receives the care and support they need to achieve their highest potential.”

As medical director of the SOAR (High Risk Neonatal Follow Up) Program at The Woodlands, Allen works closely with families to ensure a seamless transition of care following their infant’s discharge from the NICU. Through this program, the infant’s early growth and development are tracked to ensure that any developmental concerns are detected and addressed as early as possible. If developmental concerns arise, The Woodlands team of SOAR Occupational, Physical and Speech therapists are ready and able to provide any therapy services that are needed.

“It’s so critical that our patients are able to readily access all of our developmental-behavioral health services in The Woodlands,” Allen said. “The sooner that a patient’s mental health, neurodevelopmental and/or neurobehavioral concerns are diagnosed and treated early on, the better the long term outcomes will be for the patient and their family.”

August 25, 2020

Pediatric Surgeon Dr. Paul Minifee has worked at Texas Children’s for almost three decades. Over the years, one of his primary focuses has become educating and mentoring residents and medical students on rotations in pediatric surgery.

“I have always enjoyed sharing my knowledge and experience with others, especially young people who are early in their medical careers,” Minifee said. “It’s been one of the most fulfilling parts of my career.”

Recently, Minifee got the opportunity to teach and operate with a very special student – his son, Dr. Chris Minifee, a third-year surgical resident at the University of Texas Medical Branch. Chris is spending two and a half months at Texas Children’s on rotation with the Orthopedic Surgery Department.

The day he collaborated with his dad in the operating room he was performing an anterior scoliosis repair with Dr. Brian Smith, Texas Children’s chief of orthopedic surgery. Paul came in at the beginning and the end of the surgery to open and close the patient’s chest. Chris assisted him with the procedure, a common practice for orthopedic surgeons in cases such as the one they were working on.

“I immediately went to the coaching skills I learned in baseball,” Paul said about how he handled guiding his son in the operating room. “They worked back then and they seemed to work that day too.”

Paul said his son did a great job and that he executed his part of the procedure very well. What made him most proud was the positive comments from his colleagues about his son’s work in the operating room that day and on other occasions during his rotation.

“It was truly a joy to be there with him and to hear from others what good work he’s doing for others,” Paul said. He added that the father-son duo was making history that day in that he, the first Black pediatric surgeon trained in Texas and the second to be licensed in the state, was operating with his son, who is one of a small but growing number of Black surgeons in the state and the nation. “We were making history in there,” Paul said. “I’m glad it was at Texas Children’s, a place where I have always felt comfortable, accepted and able to grow in my career.”

Chris said operating with his dad has thus far been the proudest moment of his medical career. The operating lounge they were in after surgery, Chris said, was the same lounge he saw his dad in years ago when he shadowed him during junior college. It was around then that he decided to pursue medicine instead of his first love – baseball.

“I wanted to be a professional baseball player but that didn’t pan out,” Chris said. “I’m glad I had a backup plan (orthopedic medicine) and that I have come to love it as much as or more so than baseball.”

Chris said a lot of what his dad taught him on the ballfield translated over to the classroom and now the OR. Some of those things include team work, persistence, and the desire and drive to be your best.

Throughout his rotation at Texas Children’s and from what he’s seen and heard through his dad over the years, Texas Children’s is a place where people’s best is exhibited across the board. He said that includes diversity among the organization’s workforce.

While operating at Texas Children’s, Chris said, the OR has been filled with people from different ethnicities and walks of life. “You probably didn’t see that 20 years ago, but things have changed, which is refreshing.” he said.

Volunteer Services hosted several events last week for employees to make face buttons. The buttons worn by employees are intended to help put patients at ease, as they give them a glimpse of the smiling Texas Children’s face beneath the ‘ll and other personal protective equipment.

August 24, 2020

Texas Children’s medical staff is sharing a collection of wellness tips covering a variety of topics in hopes it will help those working so hard for our patients and families during the pandemic. Read more

August 18, 2020

As a new school year begins, Denise Tanner-Brown shares helpful tips to prepare parents and children for virtual learning at home during COVID-19. Read more

August 17, 2020

As children across Texas head back to school this month and next, Texas Children’s is preparing for a potential spike in COVID-19 cases. Although it is unclear what will happen when kids return to class, there is a chance that more people will contract COVID-19 due to increased exposure to the virus.

Denise Tanner-Brown, assistant vice president of Community and Ambulatory Nursing, said she is cautiously optimistic considering many schools are starting back virtually, but that no one knows what the next step might be and how that will affect the situation.

“We are standing ready for a second wave of cases and are not letting down our guard,” Tanner-Brown said. “As patient volumes decrease, we have a deactivation strategy where we can temporarily close down units. But, we also have an activation strategy in place where we can turn it back on really quickly should the situation change.”

Critical Care Director of Nursing Shannon Zerber said one of the things Texas Children’s has done well throughout the pandemic that’s reduced the stress of potential surges is adequate planning for space and staff.

A team of experts from across the organization has a tri-campus multitier plan that lays out multiple levels of response. The plan starts with sending patients to the Special Isolation Unit at Texas Children’s Hospital West Campus. Additional beds dedicated to COVID-19 patients are designated at Texas Children’s Hospital in the Medical Center Main Campus, including 13 acute care beds, and six additional ICU beds.

“As our COVID-19 volumes change at Texas Children’s, in Houston and the region, we adapt and flex to demand,” Zerber said. “There is a patient placement group that meets routinely to look at the latest data, so we are ahead of things, not behind. We are anticipating what will happen next.” As a result, Zerber said “everyone is prepared for a spike when school goes back, especially face to face. We all hope it won’t happen but we are ready if it does.”

Handling a surge

Dr. Amy Arrington, medical director of the SIU, said the biggest surge Texas Children’s has seen so far was at the end of June and the beginning of July. During that time, all 18 beds in the dedicated biocontainment unit were full and patients were also being cared for at the Medical Center campus.

Since then, the number of COVID-19 patients has dropped, but there has been an increase in the number of patients with multi-system inflammatory syndrome (MIS-C), a delayed inflammatory response to COVID-19 that typically presents four to six weeks after exposure. The syndrome is typically seen in children and teenagers and has varying effects on vital organs, including the heart. Arrington said although the condition is rare, clinicians across the nation are seeing an uptick in cases and that this trend could continue as more children head back to school and are potentially exposed to and contract COVID-19.

Caring for patients with MIS-C takes a tremendous amount of resources and expertise as many patients require stays in the intensive care unit, some of whom need specialized treatment such as extracorporeal membrane oxygenation (ECMO), a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream.

Texas Children’s has the resources and the expertise to care for these patients. We have intensive care specialists, cardiologists, surgeons, and specialists in rheumatology, infectious diseases and immunology investigating and treating the children as aggressively as needed to ensure they have the best possible outcome.

Chief of Critical Care Dr. Lara Shekerdemian, who has been directly involved in the organization of the intensive care of the 30 plus MIS-C cases at Texas Children’s throughout the pandemic, said Texas Children’s has the capacity to handle a surge of these patients even if it means using areas that aren’t currently being used. Although she said it is unlikely we will see an exponential growth in the number of cases of MIS-C, Shekerdemian emphasized that the capacity is there to care for all those who need the specialized care Texas Children’s can provide.

Arrington agreed and said “So far, space and staffing have never been an issue due to adequate planning and dedicated staff willing to show up for countless extra shifts, work as a unified team and generally go above and beyond. But, we must remain vigilant in our prevention and safety measures.”

Dr. Judith Campbell, medical director of Infection Control and Prevention, added that clinicians at Texas Children’s and other medical institutions from across the world are in a much better position to care for COVID-19 and MIS-C patients than they were in March when the pandemic began.

“We have good evidence now about how to care for patients safely,” Campbell said. “We also have a better supply of personal protective equipment, which makes clinicians and staff feel safer when they are caring for a positive patient.”

Staying on top of the latest research, looking at where we can do better and remaining steadfast in our dedication to our safety measures and protocols, however, are key to our continued success, Campbell said, adding that there is no room to lessen our determination in this pandemic.

Staying safe

Texas Children’s remains committed to providing the safest environment for our patients, families and employees. Since the beginning of the pandemic, we have done an excellent job at keeping people safe while continuing to be there for our patients and deliver top notch care.

Three safety measures that have been implemented across our system and that work very well revolve around screening, social distancing and wearing the proper personal protective equipment. We are constantly adapting and improving these efforts as the situation progresses and changes, but believe we have established a good foundational practice that will be part of our organization for some time to come.

As a reminder, everyone who walks into one of our facilities is stopped and screened for symptoms of COVID-19. Patients, family members and employees alike must fill out a questionnaire about any current symptoms they might have and any recent trips they might have taken. The screening process also includes a temperature check. Months ago, we invested in thermal imaging cameras at our three hospitals to expedite the process and to make it safer for our employees who are administering the screenings.

When on our campus or in any of our facilities, we ask patients, family members and even our own employees to please keep a safe distance of approximately 6 feet from others whenever and wherever possible, including waiting in line and riding in our elevators. We have placed signs and stickers across the system to help keep social distancing top of mind.

Wearing a mask is a must if you want to visit one of our facilities. Patients, family members, visitors and employees are issued a hospital-grade mask after being screened at one of our screening stations. Providers working in certain areas of our system wear additional PPE such as an N-95 mask, a procedure mask, goggles and/or an isolation gown depending on their risk level.

We also have instituted visitor restrictions, video and drive-through visits, precheck-in and online appointment and payment via MyChart, and curbside pharmacy pickup to mitigate any potential exposure to COVID-19 and to alleviate people’s worries about coming to one of our facilities for care.

We have robust testing capabilities and the nation’s largest pediatric primary care network in the nation standing on the front lines of this pandemic triaging patients who might have the virus and helping care for those who do. Texas Children’s Pediatrics is also helping administer COVID-19 tests at our testing sites across the organization and they are continuing to administer much-needed wellness visits and routine vaccines, including the flu vaccine, which will be more than ever for people to receive.

“We have been thoughtful and careful in our planning so that we can turn on a dime if we need to,” said Texas Children’s Pediatrics President Kay Tittle. “Throughout this pandemic, we have figured out how to be more flexible to meet the needs of our families. This will continue to be key in order for us to stay the course and to face whatever comes next.”

Shekerdemian said testing will be extremely important when school opens in order to slow the spread of the virus. It is imperative, she said, that people are honest with themselves and others when they don’t feel well.

“Don’t brush things aside,” Shekerdemian said. “If you (or your family member) don’t feel well, then call your physician and if necessary, isolate yourself and get a test.”

Campbell agreed and said the fall will definitely present an interesting chapter in the story of COVID-19 as it overlays other virial infections that occur commonly in the fall and winter months.

August 11, 2020

Jennifer Abernathy shares how fulfilling a new hobby has helped her stay mentally grounded during COVID-19, and hopes her experience inspires other nurses to pursue fun activities to help them relax and recharge during this pandemic. Read more