Enhancing the Pathways of Children's Mental Health

Wendy Wallace is an experienced pediatrician with a history of working in the hospital and ambulatory care setting. She has studied Osteopathic Medicine and is the director at Children’s Hospital of Philadelphia, where she works with children to improve their mental health and quality of life.

In an interview with Healthcare Business Review, Wallace talks about her journey in the healthcare space and her current roles and responsibilities. She talks about the ways she helps children of all ages manage symptoms of mental illness, working with autistic children and helping them go through the various obstacles of life. She includes how she uses technological innovations like Epic, an EMR platform, and video visits to strengthen their mental health and seek support in times of crisis.

Could You Provide Some Insights Into Your Current Responsibilities?

For the past three years, I have been the director of the primary care network for behavioral health, where we developed educational programs with the Department of Child and Adolescent Psychiatry to manage behavioral concerns and mental health. These educational programs helped the providers learn more about the basics of depression, anxiety, and ADHD. We taught them how to prescribe selective serotonin reuptake inhibitors (SSRI) for managing such conditions and provide the support they needed during and after their fellowship.

Our clinical-based pathways or educational tools provide a structured approach for professionals to assess their health concerns and ensure appropriate actions are taken. The clinical pathways offer in-person support for providers when they are dealing with a child with depression. We have a telephonic consultation service and an E-consult system with Epic, an EMR platform, for internal consultations. These initiatives have been the crux of my work for the past seven years, even before I became the director.

I am in my fifth year of training providers across the CHOP network. Before the onset of the COVID-19 pandemic, we were already aware of increasing suicidality, particularly among African American girls. Despite this, we continued to train, but the impact became more evident after the pandemic hit.

This situation has allowed us to prepare the primary care network for the wave of challenges that will go on for many years. It is also important to understand that the impact of the pandemic on children’s development cannot be isolated as the effects may vary depending on their age. Even adolescents face challenges like increased anxiety with their college years being online instead of being in person.

Now, with primary care providers, we are providing a home for mental health in healthcare. As a pediatrician, I believe in advocating for my patients and being an effective communicator. One critical piece is that when a child goes into therapy, there is often a lack of feedback and communication with parents regarding the sessions. They are left wondering how their child is doing, and the only impact they notice is changes in the child’s mood and engagement in family activities.

I conduct self-assessments and let them know the strategies we implemented or highlight positive changes. I encourage the parents to share their perspectives, creating a safe space for both to openly express their thoughts and share their struggles. This approach avoids situations where the child requires an emergency room (ER) evaluation for suicidality, which is a traumatizing experience for them.

Another aspect of our work is navigating the mental health journey of autistic children. While autism has always been there, we are just getting better at diagnosing it. I feel so proud while supporting autistic children as they navigate through the different stages of their life by overcoming barriers, advocating for themselves, and reaching their full potential.

What Are Some Technological Advancements Have Had An Impact On Primary Healthcare Or Healthcare Overall?

One technological advancement within medical records, is the implementation of the Epic, which we have been using for the past 15 to 17 years, for its flexibility to customize individual workflows and facilitate unique processes.

One specific thing that has helped the efficiency of care is the ability to assign screens consisting of a few questions to children before their visits. The questions allow the child’s voice to be heard, giving us insights into their feelings. The screens are scored and used in my notes, which makes the whole process easier and faster than manually scoring them.

Another technological advancement that has really helped with mental health is the ability to have video visits. While I prefer seeing a child in-person, video visits maintain the continuity of care and connect with them even when they cannot make it to in-person appointments. Due to this, the child often feels safer as I have seen their environment.

There are also other personal advances that are so interesting, for instance, the HAIKU application. Even though it connects me to my phone a lot, I can have real-time interactions with parents about their children’s treatments or experiences.

Technological advancements have also allowed me to overcome various barriers to providing effective treatment. My phone is like a mini-computer that facilitates accurate information at my fingertips. Safety screens can be downloaded into a child’s phone, providing them with the necessary guidance and help when they are feeling down.

There are also apps to address anxiety, that are beneficial for kids. These can help strengthen a child’s mental health and offer support in times of crisis. By using tools that children are open to and familiar with helps them build their mental muscles and enhance their ability to reach out for help and communicate.

What Potential Disruptions Or Transformations Do You Envision In The Care Management Industry Within 18 To 24 Months?

One significant barrier in care is insurance. Insurance companies do not cover therapy, and the variability of insurance coverage for these services is complex. The confusion around reimbursable insurance coverage is also challenging for families seeking care.

Language and cultural barriers are another big thing. We still have a predominantly English-speaking therapeutic intervention, and around 20 to 25 percent of them are Spanish-speaking patients. These children grow up in the U.S. speaking English and Spanish, often struggling with their identity as a result. So, finding a Spanish-speaking therapist that the parent and child feel comfortable talking to can be incredibly challenging. So, we can open a whole field that educates about being culturally sensitive to therapy and help children embrace their stories.

There is a program in Africa where elders from the tribes are trained to provide support. They sit on a bench and invite individuals to share their goals on a weekly basis, after which the elder nurtures the individual and helps them take small steps towards bettering their lives.

I engage with parents and seek their feedback on the treatment. However, parents still find the whole system confusing and overwhelming as it is an emotionally hard topic, and they are still unsure how to navigate the complexities of therapy and mental health care.

The LGBTQ+ community is still a very fragile group facing significant challenges. I have personally seen the bravery of children on a journey of self-discovery within this community. Some have done transgender-related treatments and undergone various surgeries like breast removal. However, their progress gets undermined by discriminatory laws in states that criminalize their identity. We have come so far in embracing these individuals and giving them options, but some people still don’t agree with it.

There is still a lot of work to be done in that aspect. Beyond just providing medication, it involves years of counseling, consultations, discussions, and reinforcements with the whole family to provide the right care and support.