Erika Miller is the clinical practice manager of Psychiatry Consult Services and Emergency Department Mental Health, Seattle Children’s. Kashi Arora is the mental and behavioral health project manager with Community Health, Seattle Children’s. Sophie King is the supervisor of program operations for triage and the Crisis Care Clinic, Seattle Children’s.

Q: What mental health services does Seattle Children’s offer?

A: We offer short-term, outpatient mental health services through our Psychiatry and Behavioral Medicine (PBM) team. We start with a diagnostic evaluation to determine the patient’s needs and the evidence-based interventions recommended for these needs. We also discuss with families where it would be most helpful to receive care (either at Seattle Children’s or in the community).

In order to provide equitable and efficient care, many of our treatment programs operate using a stepped care model. They begin with a group or class for patients/caregivers, followed by short-term individual therapy as needed. Capacity for individual therapy is very limited. For youth pursuing medication, we offer a brief consultation model. We do not provide long-term therapy or medication management.

PBM specialty clinics include the Autism Center; the Program to Enhance Attention, Regulation and Learning for children with ADHD (PEARL); the Mood and Anxiety Program; and our Early Childhood Clinic. PBM also offers mental health services for Deaf and Hard-of-Hearing patients.

Our inpatient unit (the Psychiatry and Behavioral Medicine Unit, or PBMU) offers short-term, crisis stabilization care for children ages 3 to 17. Patients are referred to the PBMU by a mental health provider in an Emergency Department (ED) who evaluates them and determines they would be appropriate for inpatient care. If no PBMU beds are available, patients typically wait in the ED until one becomes available at the PBMU or another facility. Our ED and some others provide coaching to families around safety-proofing the home environment and crisis planning.

We also have a Behavioral Health Crisis Care Clinic for children and teens with active suicidal ideation or suicide attempts.

Q: What services are not offered by Psychiatry and Behavioral Medicine?

A: We don’t offer the following services; see possible resources in the community.

  • Short-term therapy (unless referred by a Psychiatry and Behavioral Medicine provider in one of our subspecialty clinics)
  • Sexual abuse/sexual aggression
  • Abuse/trauma/PTSD
  • Long-term individual therapy
  • Long-term medication management (we do offer short-term)
  • In-home therapy
  • Dyslexia evaluations
  • Parenting evaluations for legal purposes
  • School evaluations after expulsion or suspension (if schools require this, they should provide a list of approved providers for this purpose)

Q: Do patients need a referral for PBM services?

A: Yes, a referral is required for outpatient psychiatric services. The only exception is for our Behavioral Health Crisis Care Clinic, which is available after a phone screen. This clinic is for youth whose primary concern is active suicidal ideation or a recent suicide attempt. The patient, parent/caregiver or a provider can call 206-987-7480 to complete the screen.

For detailed instructions on referring to specific PBM specialty clinics and descriptions of the various therapy groups we offer, visit our newly updated Refer a Patient page.

Q: Are you taking new patients?

A: Yes. All PBM specialty clinics and therapy groups accept new patients. Unfortunately, there are waits for all services, some longer than others.

Q: Are services in-person or via telehealth now due to COVID-19? 

A: During COVID-19, we are conducting most appointments via telehealth, including new patient visits. We continue to offer telepsychiatry services in Washington outside the Seattle area and parts of Alaska.

Q: Is there any way to get seen more quickly?

A: We are triaging services and appointments on a daily basis. Patients whose referral contains complete information are likely to be seen more quickly than patients referred with missing information. Please use our standard referral form: the Seattle Children’s New Appointment Request Form (NARF) (PDF) (Word). Receiving a complete referral — including any measurement data for the patient, such as MASC and SCARED screening tools for children with anxiety or parent and teacher Vanderbilt Assessment Scales for children coming to the PEARL Clinic — is very helpful for the triage process, as well as for the provider who initially sees the patient.

Q: Are there any plans to add providers or expand services any time soon?

A: We recognize the need for pediatric mental health services is significant and is worsening during COVID-19. Mental health is one of Seattle Children’s strategic priorities. Seattle Children’s psychiatry services have just opened up at our North Clinic regional location, and we hope to continue to expand to additional regional sites in the future.

Q: Are there resources families can access while they are waiting to be seen at Seattle Children’s?

A: Yes. We know many families experience long wait times for outpatient mental health care, and they want to be able to help their child right away. Some resources are available in the community. Some top ones we recommend are:

  • The Washington Mental Health Referral Service for Children and Teens is a free service since 2019 that connects families directly with mental health providers in their local area who have appointments available and take their insurance. Families can call 833-303-5437, Monday to Friday, 8 a.m. to 5 p.m.
  • Youth Mental Health First Aid is a virtual class for any adults — including parents and caregivers — who interact with children experiencing mental health problems. This evidence-based, two-part series is a great resource for families waiting to be seen by a specialist. Seattle Children’s offers two classes per month, thanks to a partnership with King County. Youth Mental Health First Aid classes are also hosted by other organizations and community partners.
  • Within Reach is deeply connected to local communities across Washington. They help families navigate the complex health and social health service systems available to them and can offer care coordination and navigation by their multilingual staff in person, over the phone and online. Parents can call 800-322-2588 or visit parenthelp123.org to get started.
  • We’ve collected a list of Mobile Apps for Mental Health.
  • Patients covered by Medicaid typically access mental and behavioral health services through agencies that contract with their managed care organization (MCO). There is a directory of behavioral health and substance use providers for patients with Medicaid insurance available online.
  • “Expert-Tested Tools to Manage Your Child’s Mental Health” is a Seattle Children’s blog article that shares with parents the same proven techniques and tools used by our Emergency Department and Psychiatry and Behavioral Management providers to help children who are experiencing mental health problems to keep them and their families safe.

Additional resources can be found on Seattle Children’s Psychiatry and Behavioral Management “Resources for Patients and Families” page, as well as on our new Mental Health Resource Hub page.

Q: What is the Partnership Access Line (PAL) line for?

A: If providers need support with a patient’s mental healthcare, such as diagnostic clarification, medication adjustment or treatment planning, they can call PAL for free at 866-599-7257 on weekdays, 8 a.m. to 5 p.m., Pacific time, to be directly connected to a child and adolescent psychiatrist.

PAL also serves providers in Wyoming and Alaska.

 Note: PAL cannot expedite your referral to Seattle Children’s, despite their affiliation with the hospital.

COVID-19 and Kids’ Mental Health This Fall and Winter

Q: What mental health concerns are you expecting to see exacerbated by COVID-19 this fall and winter, and what can PCPs do to help?

A: One thing we are seeing in our own Emergency Department is more kids presenting with eating disorders. With eating disorders, we often talk about patients trying to have an element of control when life feels outside their control, which makes sense given the pandemic situation.

What this points to is how important it is to have a number of well-rounded coping skills. Everyone should have a variety of coping skills, not just one or two. If exercise and dieting are your only coping skills, it can lead to trouble.

Q: What does it mean to have well-rounded coping skills?

A: We want to make sure people (kids and adults) have lots of different coping skills to support them with a number of different stressors or triggers. We often talk about having coping skills in five different areas:

  1. Artistic: Something that helps you express your emotions or be present in the moment, for example, playing with Legos or Play-Doh, playing an instrument, drawing, singing, crafting, performing, etc.
  2. Athletic: Anything that helps you move and get energy out of your body. This can be going for a walk, playing a sport (safely with physical distancing) or some calming athletic activities that can reduce stress such as yoga or meditation.
  3. Problem-solving: Assertive communication and advocacy skills to help us solve problems. This might be encouraging everyone to use an “I Statement” or to implement the Six Hour Rule during intense family discussions.
  4. Distraction or self-soothing: Skills that help us calm down and momentarily distract from the immediate problem or stressor with pleasurable experiences, i.e., smelling fragrant lotion, wearing fuzzy slippers, drinking warm tea, watching a movie, reading a book, doing a puzzle.
  5.  “Anytime, Anywhere” coping skills: These skills require no special materials or space, i.e., deep breathing, making a gratitude list or doing a mindfulness or meditation practice.

As we head into fall and winter, be sure to talk to kids about coping skills. Taking any one coping skill to the extreme can be problematic, so it’s important for kids to have multiple coping skills in each “category” and be able to pull on them equally for different situations.

Q: What else can providers do to support kids’ mental health?

A: You won’t be surprised to hear that Washington is seeing a statewide uptick in substance abuse among youth during COVID-19. As we head into winter, kids need an environment that is set up to keep them safe. That means locking up all substances they can have access to.

It’s a good time to remind families to secure all medications and substances like alcohol and marijuana that are harmful to kids. If a child is struggling with suicidality or self-harm, then the family should lock up all medications, including over-the-counter medications in large quantities like a Costco-sized bottle of Tylenol, as well as other potentially harmful items. See Seattle Children’s Safe Medicine Storage handout.

Q: What else do you want PCPs to know about kids’ mental health during COVID-19?

A: It’s really important to remember that especially during COVID-19, mental health is a challenge for kids and parents alike. The reminder to have well-rounded coping skills does not just apply to our kids. I’ve had kids come to the ED and tell me their parent is actually the one struggling with mental health, not them. The fact is COVID-19 is affecting all of us. As providers, we need to give parents grace and support them too.

I’d love to see every adult and child in the home make a Coping Card and then have parents model how to use it. They might say to their child, “I had a rough work day today. It was really hard. My coping skill is going to be a 10-minute walk and then I will be ready to help you on your school project.”  As adults, we are the most powerful models of how kids can do this.

Q: Some PCPs hesitate to use a youth suicide screener even though it’s recommended because they aren’t sure of the best course of action if the child answers affirmatively. Do you have advice? 

A: We recommend the Ask Suicide-Screening Questions (ASQ) Toolkit, used at Seattle Children’s. It’s a validated tool for youth ages 10 and up as well as adults and can be used in inpatient and outpatient settings.  All the resources you need to implement are in the toolkit, including how to screen, scripts, how to follow up on a positive response, handouts and training videos. The screener is quick to use and effective in identifying kids at risk.

Some of the many materials available in the toolkit include:

  • What to do when a patient screens positive for suicide risk:
    • Brief Suicide Safety Assessment Guide (PDF | HTML)
    • Brief Suicide Safety Assessment Worksheet (PDF | HTML)

Seattle Children’s is hearing from the state about increases in adolescent suicidal ideation and attempts. Screening for suicide ideation and talking with families about safety proofing are more important than ever. Please refer to last month’s Provider News article, “Seattle Children’s Sees Early Spike in Fall Mental Health Visits to ED.”