Pediatricians who heed a recommendation to screen all children for depression starting at age 12 could look to how it’s done in Collier County.
Updated screening guidelines from the American Academy of Pediatrics were in the works before the Feb. 14 school shooting in Parkland, which exposed shortcomings of the mental health system in Florida. Nikolas Cruz, 18, accused of killing 17 students and staffers and injuring 14 at Marjory Stoneman Douglas High School, had a history of depression and acting out as a student. He refused treatment after he turned 18.
Gov. Rick Scott has announced a three-pronged initiative aimed at preventing future school shootings. It would cost $500 million if the Legislature goes along. Scott’s plan would earmark $50 million for mental health programs for kids.
“Florida has always been at the bottom for mental health funding,” said Dr. Scott Needle, a pediatrician and medical director for patient safety and quality of care at the Healthcare Network of Southwest Florida. “Anything that can turn it around and give it the attention it deserves is a good thing.”
The pediatrics academy in the U.S., with 66,000 members, has recommended depression screening for kids 12 and older for quite some time. What’s new is that the Canadian Pediatrics Society and psychiatric associations have joined the academy in endorsing it, according to the updated guidelines.
Screening kids 12 and older for depression has been happening in Collier County for many years through the Naples Children & Education Foundation. The foundation, which sponsors the annual Naples Winter Wine Festival, raises millions each year for children’s programs. Children are screened when they come in for wellness checks, and a behavioral health clinician can see a child during that visit in what is called an integrated care system.
Lee County physicians are looking at the Collier program, Needle said. “We are much further along than most other communities in Florida,” he said. Maria Jimenez-Lara, chief executive officer of NCEF, said queries have come from around the country about Collier’s integrated care system. It’s too early to say how the tragedy at Parkland might boost calls for information about the program, she said. Since the Parkland shooting, Collier residents have become vigilant about behavior of children and more kids are being referred to the David Lawrence Center, said Scott Burgess, president and CEO of the nonprofit mental health center in East Naples. “This is an appropriate response,” he said. “We should always take these issues seriously, not just after a tragic shooting. “It is always better to be safe than sorry when it comes to seeking further professional assessment and potentially treatment.”
NCEF has funded $9 million since 2007 for the integrated system of care, locally called Beautiful Minds. The initiative is possible because four mental health groups agreed to work together to address shortcomings in services and long wait times. The four groups are the health care network, the David Lawrence Center, the National Alliance on Mental Illness in Collier, and Florida State University’s College of Medicine in Immokalee.
The Golisano Children’s Hospital of Southwest Florida joined the initiative in 2014, when it was awarded NCEF funding for an autism navigator in Collier. An estimated one in 68 children in Collier has autism spectrum disorder. Thirteen behavioral health providers are embedded in clinics run by the health care network to provide immediate services for children with symptoms of depression or other problems.
The nonprofit healthcare network is the medical home for 60 percent of children in Collier County. The screening takes place in waiting rooms, where kids 12 and older are given an iPod with survey questions that are engaging and friendly, said Jimenez-Lara, chief executive of NCEF. For children younger than 12, parents are asked to fill out the survey. “By the time the child is seen by the doctor, the doctor has the results,” she said. “The psychologist is already (alerted). It is completely seamless. It is pretty incredible.” The psychologist can begin intervention during the same office visit, and that helps overcome stigma associated with a behavioral health issue.
“We really work to create quick access and we want to alleviate symptoms,” said Victoria Frehe, a psychologist and director of the behavioral health team at the health care network. “We’ve been doing universal screening depression for about four years now,” Frehe said. “It opens the gate to discuss other things that can be happening.”
The health care network completes 1,000 screenings per quarter for depression and substance abuse among pediatric patients 12 and older. Each month, 700 to 750 patients are seen for behavioral health issues. Frehe said 10 percent of all pediatric patients in the health care network are getting treatment for behavioral health problems. There isn’t anyone else in Southwest Florida with an integrated model of primary care and mental health like what’s in Collier, she said. Some states, such as Massachusetts and Tennessee, have been doing it longer, Frehe said.
“Before Beautiful Minds, our only option was to send kids to David Lawrence, and now that we have Beautiful Minds, we can start kids’ treatment and (determine) what type of care they need,” said Needle, the director of patient care for the health network. “David Lawrence can focus on the really complicated cases.” The David Lawrence Center endorses universal screening of kids 12 and older for depression at wellness checks, said Nancy Dauphinais, chief operating officer at the center.
National data show one in five teens experience depression at some point during their adolescence and often go untreated, she said. “We know there are too many kids who suffer in silence and even when assessed, treatment can be delayed,” Dauphinais said. “I believe the next step is to have universal screening in the schools.”
The Beautiful Minds initiative has supported specialists and the partial hospitalization program at the David Lawrence Center, among other things, she said. The eight-bed crisis unit for kids runs full, and some kids are still being sent to Lee County for a bed, she said. Burgess, the CEO of the David Lawrence Center, said it is unacceptable that communities lack mental health services, with research finding there often is a 10-year delay between the first signs of mental health symptoms and someone getting treatment. “There should be no stigma, no shame, no hesitancy to refer or come in for an assessment and treatment,” he said.
NAMI CC NOTE: The HUGS (Health Under Guided Systems) program we operate is our contribution to the Beautiful Minds initiative. This program facilitates early intervention for social, emotional, behavioral, and mental health challenges for children ages 3 months to 18 years. HUGS team members currently provide coordinated, universal screenings, clinical assessments, and culturally competent system navigation, serving over 2,200 children annually. They facilitate early identification and access to mental health care to mitigate the effects of untreated problems later in life. In addition, HUGS staff teach the NAMI signature program, Ending the Silence, for children in the Collier County school system, helping to break down barriers and de-stigmatize mental illnesses.