May 26, 2023

On May 24, 2022, 19 children and two teachers were killed in a mass shooting at Robb Elementary, forever changing the fabric of a small Texas city.

“Texas Children’s Hospital is only a few hours away from Uvalde…these are our neighbors,” said President and CEO Mark A. Wallace on that tragic day. “[We’re] ready and willing to support the children, parents, families, teachers and administrators of Uvalde in any way we can.”

Texas Children’s immediately reached out to offer assistance and support through centralized state agencies. Led by our psychology and psychiatry teams, we forged a partnership with Community Health Development, Inc. (CHDI), a comprehensive community-based health center in Uvalde.

“Through this partnership with CHDI and city leaders, we developed a three-part plan,” explained Dr. Karin Price, chief of psychology at Texas Children’s. “We started by supporting the Uvalde community after other emergency services (including crisis mental health support) left the area…and since then have been focused on providing trauma-focused behavioral health care and integrating into the community to build trust.”

We have two bilingual behavioral health clinicians on-site at CHDI in Uvalde for two full days every other week, also offering telehealth services to interested families during off-site weeks. Last year, we participated in a community-based wellness fair to share children’s books and information with parents/caregivers on developmentally expected responses to trauma and signs to look out for in children who might need professional help. Two more fairs are planned for this summer, and Texas Children’s has been invited as a key participant.

Since August 2022, a team of child psychiatrists from Texas Children’s have also provided psychiatric care to the community through CHDI. “Initially, the psychiatrists were travelling weekly to Uvalde,” said Dr. Kirti Saxena, chief of psychiatry at Texas Children’s. “Since January, we have provided a combination of virtual and weekly on-site care…and our mind-body interventionist has been facilitating on-site and virtual mind-body practices to the staff of CHDI, which have been well-received.”

Texas Children’s will continue to work with CHDI to develop a sustainable plan for offering comprehensive behavioral health care to the Uvalde community using local and regional resources.

First anniversaries are often the hardest to endure. Please join us in thanking our Texas Children’s and Baylor College of Medicine team members who are committed to supporting Uvalde families through this unthinkable time of grief and loss.

Need support? You are not alone. The Employee Assistance Program (EAP) is confidential and designed to support all Texas Children’s employees and eligible dependents with experienced, licensed and credentialed professionals. If you or someone you know is struggling, please contact EAP at 832-824-3327 or EAP@texaschildrens.org.

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 10, 2020

One in four youth in the U.S. have a diagnosable mental health disorder that often is a direct response to what is happening in their lives. The COVID-19 pandemic, along with many other societal factors, have affected all of us, but for children who already suffer from anxiety or depression, the emotional impact can be severely magnified.

Many pediatricians are seeing more children and adolescents with mental health problems, and they are playing an increasingly significant role in the diagnosis and treatment of mental illness in young people. While numerous surveys of pediatricians indicate they feel they lack the necessary training and skill to manage their patients’ mild to moderate mental health care disorders, a new program at Texas Children’s is providing the support they need.

On May 18, Texas launched the Child Psychiatry Access Network (CPAN), a new statewide pediatric mental health initiative that Texas Children’s and Baylor College of Medicine are partnering on for our region. This state-funded program provides pediatricians, family physicians and other health care providers direct and immediate access to a pediatric mental health specialist to help them manage their patients’ mental health care needs more effectively.

“We want our pediatricians to feel more comfortable managing the mental health care needs of their patients,” said Jennifer Evans, assistant director of the Meyer Center for Developmental Pediatrics and the Psychiatry Service at Texas Children’s and associate program director for the Central Operational Support Hub (COSH) for the Texas Child Mental Health Care Consortium that oversees the state implementation of CPAN. “Pediatricians at our TCPs and The Centers for Children and Women can collaborate directly with our CPAN team about their patient’s plan of care instead of having to refer their patient to our child psychiatry clinic where they would be placed on a lengthy waitlist.”

When a pediatrician calls the CPAN hotline (1-888-901-CPAN Monday – Friday from 8-5 excluding holidays) to reach the Baylor hub, a Texas Children’s behavioral specialist, licensed counselor or licensed clinical social worker will answer the phone. Depending on the patient’s needs, they will connect the pediatrician to a Texas Children’s psychiatrist who can provide real time consultation on various mental health issues. For instance, if there is a question about a patient’s medication, they can advise whether to adjust the medication dosage. The CPAN team can also help pediatricians develop a behavioral or safety plan for patients with depression or suicidal tendencies, and other mental health disorders. Pediatricians can also call the CPAN hotline to access educational resource materials on mental health.

“Through CPAN, our pediatricians are given the knowledge, skill, training, and support they need to address and treat mild to moderate mental illness,” said Dr. Laurel Williams, medical director for COSH and Division Head of the Child and Adolescent Psychiatry Division at the Menninger Department of Psychiatry. “If we can collaborate more directly with our PCPs, our psychiatry team will have greater access for youth and families that need more regular, intensive specialty care.”

Baylor College of Medicine is one of 11 centers participating in the CPAN initiative. Each Department of Psychiatry across the state of Texas has a region that they are responsible for supporting. Baylor and Texas Children’s are providing support to the seven counties in the Greater Houston area. However, there are times when our CPAN team has provided mental health consultation and training to pediatricians in other parts of the state including El Paso.

Extending our reach in the community

Along with the CPAN initiative, Texas Children’s psychiatrists also provide mental health care support to patients and children in the community in other ways. Through a 4-year grant from the Substance Abuse and Mental Health Services (SAMHSA), our teams at Texas Children’s and Health and Human Services are able to provide more comprehensive evidence informed treatments for youth with serious mental health disorders (SMD) like bipolar and psychosis. The grant provides assistance in building infrastructure that can be maintained beyond the life of the grant through cultivating collaborations and coalitions across important teams that assist children with SMD.

“We transfer 6 to 7 kids per week to inpatient units and these are mainly bipolar patients who are having a really hard time,” Evans said. “SAMHSA has changed the dynamic of care for these patients. Instead of sending them to the hospital, we can have intensive services in the home. It’s like an intensive outpatient service in your home.”

As part of the Texas Child Health Access Through Telemedicine (TCHATT) program, our psychiatric team is also collaborating with various independent school districts – Houston, Spring, Conroe, Pasadena, Center for Success Charter School and Sheldon – to provide in-school behavioral telemedicine care to at-risk children and adolescents that include free comprehensive assessments and up to four clinical sessions either with a physician or a therapist.

“Through our CPAN, TCHATT and SAMHSA partnerships, our psychiatry section will be able to grow by three physicians and over 10 licensed therapists allowing our team to provide these new services without taking away from our current services,” Williams said. “In collaboration with Dr. Kirti Saxena, our interim chief of psychiatry at Texas Children’s, we have six physicians, along with our child psychiatry fellows, social work interns and trainees who will spend a portion of their time working on these programs to ensure every child gets the care they need.”

May 28, 2019

 

The Section of Child and Adolescent Psychiatry recently hosted its Third Annual Mental Health Awareness Week Celebration. Events took place at each of our Texas Children’s Hospital campuses and were multidisciplinary collaborations between numerous Texas Children’s departments and programs, bringing together experts from:

  • Psychology
  • Trauma and Grief Center
  • Developmental Pediatrics
  • Autism Center
  • Social Work
  • Child Life
  • Employee Assistance Program

The theme of the day was “It’s Okay to Say …,” highlighting the importance for children to be able to acknowledge and be mindful of their feelings. Vibrant information booths were decorated to represent the different characters/emotions featured in Disney’s animated film, “Inside Out:” Joy, Sadness, Fear, Disgust and Anger. Arts, crafts and activities were all designed to encourage children to identify and express an emotion. At the Disgust booth, for example, children could place their hands in a box, where they’d feel the squish of cold noodles or the wrinkled skin of a prune, and were then asked to describe how the sensation made them feel. At the Fear table, children were asked to draw a fearful face and decorate it while discussing different ways to cope with being afraid.

There was also an extensive parent resource table with materials from all the event’s participating programs and departments, as well as community partners outside the Texas Children’s system. These resources included information on:

  • Helping children grieve
  • Inpatient psychology
  • Depression/anxiety support
  • Finding mental health providers
  • Postpartum depression
  • Preparing children for adulthood
  • Suicide prevention
  • Support groups and other programs

At our Texas Medical Center campus celebration, the guest speaker was Marlon Lizama, poet, writer, artist, author, dancer and co-founder of Iconoclast Artists, a program that focuses on empowering youth in underserved schools and incarcerated youth through the arts. Lizama spoke to the audience about his personal journey with mental health and how through creative writing as a teenager he was first encouraged to recognize and explore his emotions. He also told the assembled workers and care givers that he had been the kind of child who they help every day and applauded the work they do to help children acknowledge and be mindful of their feelings, and to help parents recognize their children’s mental health needs.

September 18, 2018

September is National Suicide Prevention Month and along with continuing to inform people about warning signs, Texas Children’s has recently elevated our prevention tactics with the use of the Columbia Suicide Screening Rating Scale (C-SSRS).

“Texas Children’s Hospital recognizes that our team, our system has an essential role to play in helping young people and their families who may be struggling with mental health problems and suicidal thoughts or actions,” said the Chief of Psychiatry at Texas Children’s Hospital, Dr. Laurel Williams. “Over the past 18 months our Psychiatry, Social Work, Psychology, Nursing and Pediatrician partners have been improving our assessment and care for these young people.”

According to the Columbia Lighthouse Project, C-SSRS supports suicide risk assessment through a series of simple, plain-language questions. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs.

Texas Children’s is currently using the C-SSRS in all three emergency rooms for all youth over the age of 11 since March 2018, and to date we have screened more than 1,700 adolescents. Individuals who screen positive are given specific treatment plans based on the level of severity, including either further assessments by our psychiatry team or our partners, Mental Health Solutions. Mental Health Solutions is an outside team of social workers who will come to our hospital emergency rooms to assist parents. Their health care teams also locate appropriate locations for inpatient psychiatric care within Houston and surrounding counties for youth needing such specialty services.

“Additionally, the inpatient teams have undergone increased training for nurses and patient sitters in order to better address mental health needs for patients with either suicidal thoughts/actions or aggressive behaviors,” Dr. Williams said. “A safety sweep checklist was developed and is employed for any young person identified as having suicidal thoughts or actions to improve the care environment for them while admitted to our care.”

Suicide is the second leading cause of death in the United States among adolescents between the ages of 15 and 24. This is more than cancer, diabetes, cardiac and neurologic diseases and yet there is still a stigma attached to suicide. Over 450,000 emergency rooms visits annually are secondary to individuals who have self-inflicted injuries.

“This screening process has allowed our team at Texas Children’s Hospital to act on the information received to intervene prior to a suicide attempt,” Williams said. “A treatment plan is also designed to avert harm and improve the patient’s mental health.”

Future plans for C-SSRS include screening other localities within our system such as specialty and general pediatric clinics in conjunction with depression screening.

Suicide is preventable and overall, mental health disorders do have effective treatments. We encourage our entire team to fight against the stigma. For those who might be experiencing suicidal thoughts we encourage everyone to consider the following resources:

  • Emergency or urgent needs – 1-800 273-TALK (8255)
  • Texas Children’s Hospital’s Psychiatry Clinic, For outpatient assessments and treatment – 832-822-3750
  • Texas Children’s Hospital Employee Assistance Program – 832-824-3327

Click here to learn more about suicide prevention. Click here to become more involved in suicide prevention awareness.