News: A Child's Anguish

Mental health care for kids is a public health issue

Jymi Bolden

Social worker Lucy Allen (left) works with clients at Central Clinic. Dr. Charles W. Collins (right) is director.

If your child breaks an arm, you rush her to the hospital without worrying about the cost. But if a child is depressed or anxious, she might go untreated because your insurance won't pay for mental health care or your family doesn't have the resources or know where to turn.

This is where the Child and Family Treatment Center of Central Clinic comes in. With substance abuse, displacement, violence and neglect facing so many young people, the demand for mental health care is strong.

Dr. Charles W. Collins, director of the Child and Family Treatment Center of Central Clinic, started his residency in internal medicine but switched to psychiatry. He became a child psychiatrist in 1990.

"After I realized that so many people were ill because of psychosomatic kinds of things, the psychiatry part started to interest me more," he says. "We see a lot of kids with depression, anxiety, children who are victims of sexual abuse and we see a lot of children with attention deficit disorder."

The racial mix of clients at the Child and Family Treatment Center has changed through the years and now consists of about 65 percent African Americans, according to Collins. There are also more boys in the program than in the past.

The center sees young people ranging in age from infancy to 18 years old.

"We serve kids all over Cincinnati, particularly the kids from the city," Collins says.

Suicidal pre-schoolers
The center runs prevention programs in 12 Cincinnati public schools, and clinic services are available to daycare centers as well.

"We're available to 200 different daycare centers," Collins says.

Collins and his staff work to promote mental health for young people and focus on prevention of problems at the school level.

"Many times the children won't even have to be referred because you end up taking care of the problem right there," he says. "A kid's life consists of school, so we actually do a lot of work and consultation around the school."

Many of the clients at the clinic are referrals from schools.

"The violence that happened in Columbine has caused schools to be on kind of an alert," Collins says.

Problems occurring outside school can also manifest months or even years after a trauma, particularly when a child has been sexually abused.

"It's shocking the amount of sexual abuse that happens with children," Collins says. "It's surprising how much trauma children experience. I think people underestimate the impact of some of our dysfunctional families at times."

Some children who are not even old enough to be in school might experience serious issues. The center is seeing more 4- and 5-year-olds exhibiting increasingly violent behavior.

Staff members coordinated by social worker Kate Merrilees help infants and their caregivers through the Infant Intervention Initiative. Their clients are caregivers who have been identified as having problems raising or forming an attachment to their children. The staff members meet with clients in their homes.

One cause of problems could be postpartum depression, something Collins says is very common and tends to only become stronger if left untreated.

"The more children she has, the worse it becomes if you don't make any intervention," he says.

The Infant Intervention Initiative videotapes sessions so counselors can work with clients to improve parenting skills.

"It's often very helpful for the moms and dads to see themselves in action," Collins says. "You're there in the environment and you kind of see exactly what the interactions are."

The staff who work with the children at the center include psychiatrists, psychologists, clinical social workers, counselors, educational consultants and psychiatric nurses.

"Most kids here average about 14 sessions of treatment," Collins says. "We're pretty pleased by that."

A large part of the funding for the Child and Family Treatment Center comes from the United Way. The agency also receives funding from managed-care contracts and private donations. This helps to offset some of the cost for clients.

Many clients who go to the clinic for family and child services are self-referred or go at the suggestion of pediatricians, according to Collins.

"We do a lot of education to the public," he says.

In the past the African-American population had been a population under-served in the mental health community.

"I think it was sort of a cultural barrier," Collins says.

Today the demographics are changing. In addition to the children who need care, Collins and his staff try to involve everyone who has a major influence on the life of a child.

"If it's a family problem, you need to work with the whole family," he says.

Sometimes anxiety and depression that children experience can be reactive symptoms to their environments. At other times it might be related to genetics or other factors.

"We have a percentage of kids who will develop a major mental illness regardless," Collins says.

The types of cases Collins sees has changed in recent years. The clinic has seen children as young as 4 or 5 who are suicidal.

"The children are more aggressive and we have more children that are really anxious," he says. "When you look at what happens with the context of their lives, you kind of understand."

Prevention is the best medication
For children with serious mental health problems, Collins says resources for long-term care are not as plentiful as they used to be. Millcreek Psychiatric Hospital for Children closed in 1995.

"There are no long-term hospital beds anymore," Collins says.

Patrick Tribbe, president of the Hamilton County Community Mental Health Board, recognizes the demand for mental health care for children. The board is working to put a levy on the May ballot for more money for mental health services for both adults and children.

The current mental health levy generates about $27 million a year. If the new levy passes, it would generate about $5 million in additional money, according to Tribbe.

State and federal money provides 60 percent of the board's funding, with the rest generated by the levy.

The board funds children's programs at places such as Central Clinic, Beech Acres Children's Home, the Center for Children and Families, St. Aloysius Orphanage and St. Joseph Orphanage. "We have to provide the full range of services to kids who may be in the family situation that they can't afford mental health care," Tribbe says.

Because other county agencies have made cuts in children's services due to tightening budgets, the levy is even more important. Many times, according to Tribbe, children in other county programs also need mental health care. This could be because of involvement with the juvenile court system or because of substance abuse.

"Kids are faced with a lot more challenges out there now," Tribbe says.

Some children might have to be enrolled in special programs that require care in another state, such as a child with a history of sex offenses. Tribbe says care for children with serious needs can cost as much as tens of thousands of dollars annually. These needs have to be addressed.

"In the public mental health system, we don't pick and choose," he says.

According to Tribbe, 90 percent of the board's funding goes to people with more serious mental health needs, although the board would like to focus on more general programs in places like schools.

Tribbe says quality mental health care is needed to help children before their problems get out of hand.

"We do really feel a priority to treat the kids in most need first," he says. "That's not a good way to break the cycle for some of these kids."

Kids who receive the care they need are more apt to grow up into healthy adults, according to Tribbe.

"We try to have a philosophy here that intervention and treatment early on will help kids to graduate out of our services," he says. ©

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