Riley Children’s Health program addressing youth mental health

Mental health issues are crushing today’s young people.

Dr. Laura Calili has seen the problem balloon in her practice on the southside of Indianapolis. The IU Health pediatrician would have more and more young people who were suffering from depression, anxiety, suicidal thoughts and more issues come to her for help.

Trying to get them the right care in an overwhelmed mental health care system was disheartening.

“Mental health in our world has taken a steep decline over the past five or six years. COVID was really hard on kids, and as pediatricians, we’re kind of helpless,” Calili said. “We’re thrown into this world of being not only their pediatrician, but their mental health provider, and we were not prepared for that.

“There was just nowhere to send them.”

A recently started program by Riley Children’s and IU Health aims to remedy that. To connect young people in Indiana with the mental and behavioral health care they need, the health care system has launched the integrated behavioral health program.

Mental health services are now embedded in 27 IU Health primary care offices throughout the area, providing young patients with immediate care for conditions such as anxiety, depression and conduct disorders such as ADHD, all within their own doctors’ offices. Those with more acute and complex cases can be quickly referred to the Riley Children’s outpatient psychiatry program.

From its launch in early 2024 until the end of the year, 1,224 referrals were made to the program, accounting for 1,916 visits.

The program is working, said Dr. Leslie Hulvershorn, Riley’s integrated behavioral health program lead. The challenge is making sure families know that it’s available to them.

“We’re here because we want to help kids with all of their health; mental health is just as important as physical health. We know that behavioral health patients struggle to find services more than any other area, so it’s really nice to be able to say, go to your pediatrician’s office and we have a top-notch program you can access tomorrow,” she said.

Research into the state of mental health among young people is bleak.

More than 200,000 Indiana children are facing mental health crises. Suicide is the second-leading cause among adolescents in the state, according to the Indiana Center for Prevention of Youth Abuse and Suicide. Among high school students, 22% of girls and 12% of boys seriously considered attempting suicide in the last year, the center determined.

Three out of 10 high school students report their mental health is not good most of the time or always, according to the Indiana 2021 Youth Risk Behavior Survey.

“There’s a lot of suffering involved. For every one person who actually dies by suicide, there are many, many more who have attempted to harm themselves,” Hulvershorn said. “The bottom line is, kids are very stressed, they’re suffering a lot. It’s affecting their functioning, it’s affecting their schoolwork, it’s affecting their sports. And parents are very stressed trying to deal with this.”

But as the number of young people experiencing those problems has grown, the number of care providers has not kept pace.

“It’s very hard for families to find psychiatric care,” Hulvershorn said. “Every therapist is full, every psychiatrist is full. They have to go to the ER, which is not a very satisfying experience. So we tried to think about how we could scale across all of our practices around the state.”

Health officials and government leaders have recognized the urgent need to address these problems. To attempt to do so, Riley Children’s gathered more than 220 stakeholders to create a pediatric mental health strategic plan for Indiana. Those participants included physicians, educators, families and community leaders.

In 2023, their findings were published in a report, “Racing to Respond.” The report focused on four strategies to address the crisis: Expand early intervention and prevention resources; increase access to outpatient services; ensure safe interventions for kids in crisis, and ensure the right type and distribution of inpatient services.

Riley’s integrated behavioral health program addresses all four.

“There’s all kinds of research that says if you treat mental illness when patients are young … if we help them when symptoms are presenting at these ages, they’re much less likely to go on to have more severe problems later on,” Hulvershorn said.

In 2022, the Indiana Division of Mental Health and Addiction granted $7.5 million towards such a program, with the provision that Riley match that amount. An $8 million commitment from Indianapolis residents Sarah and John Lechleiter to the Riley Children’s Foundation completed the match and created a $2 million endowment to sustain the program into the future.

Other contributions included the Indianapolis Colts donating $500,000 through its Kicking the Stigma initiative, and the Indiana District of Kiwanis pledging to raise $1 million as part of its Reach Out Indiana Campaign.

In April 2024, Riley Children’s announced that the integrated behavioral health program had launched in family medicine and pediatric offices around the area.

“We get hundreds of referrals to Riley psychiatry a week, so our hope is that we can serve more kids and get kids the care they need in their community, in a place where they’re comfortable,” she said.

The mental health interventionalists working in these offices have received specific training to address anxiety, depression and disruptive behaviors in kids with mild to moderate symptoms.

The more serious cases are referred to a psychiatrist or psychologist to get the proper treatment they need.

“It’s kind of a needle-in-a-haystack problem, to know where they are. This allows for us to find those kids who need a higher level of care and whisk them over to psychiatry,” Hulvershorn said.

For Calili, the results have been momentous. Before the arrival of the integrated behavioral health program, they would have to tell young patients and their families with mental health issues to try and find a counselor. Many times, those patients faced monthslong waits, even extending to a year, to get an appointment.

That has all changed.

“They’ll come in with the same issues, they can’t wait months. So I’ll suggest that they could see a provider in our office — she’s wonderful, she can see you quickly. And their jaws just drop,” Calili said.

Since the problem launched at her practice, Calili has watched as families quickly get the care they need. Seeing them finally see a treatment for the crisis they’ve been going through has been consistently amazing to her and her staff.

“We say at work that it’s like these angels dropped out of the sky from somewhere,” she said. “It’s really been a game-changer for these kids and their families.”

AT A GLANCE

Integrated Behavioral Health Program

What: Embedded mental health services in pediatric and primary care offices to reach children and families early and before they are in crisis.

Who: Riley Children’s Health and IU Health providers

When: The program launched in early 2024.

Reach: By the end of the year, 1,224 referrals had been made to the program, accounting for 1,916 visits.

Information: rileychildrens.org