Seattle Children’s bold new initiative to address the growing youth mental health crisis, called Generation REACH, makes a long-term commitment to youth mental and behavioral health as an inextricable part of child health. Dr. Jeff Ojemann talks more about what Generation REACH aspires to do and what it’s already accomplishing today.

The pandemic has exacerbated an existing mental health crisis. How is that showing up at Seattle Children’s?

Jeff Ojemann

Dr. Ojemann: We began seeing a large increase in mental health–related ED visits, particularly for suicidality, last summer and a huge increase in eating disorders. That was followed by reports in the fall of a 30% increase in the suicide rate among Seattle-area youth.

The Psychiatry and Behavioral Medicine team responded to the increased demand with a quick pivot to telehealth for about 90% of visits, increased crisis clinic capacity and coordination with community EDs to help avoid inpatient admissions when possible.

What do you hope Generation REACH will achieve?

Dr. Ojemann: As a provider for 20 years, working with acutely ill children, I’ve seen over and over the impact mental health has on our patients and their families. This is a long-term initiative that expands our focus to include a broad upstream approach to what contributes to children’s mental and behavioral health. It will address the full continuum of mental health care, filling in gaps and creating innovative, evidence-based approaches. The elements of REACH describe how we’ll address access, resource, equity and best practice challenges so that every child in our region can receive the most effective mental and behavioral health services when and where they need them — before they land in crisis.

We’ll know we’ve succeeded when every child has access to the support and resources they need to succeed — and to be happy, safe and well within their family, school and community.

It’s an audacious goal, and we can’t and shouldn’t do this alone. Part of the vision of Generation REACH is a significant collaboration — the intent is to involve a broad coalition of community partners who represent the communities we serve and to be anti-racist in our approach to transforming care, policy and research.

What role does equity play?

Dr. Ojemann: We recognize that Black, Indigenous and People of Color have been underserved by the mental health system and underrepresented among mental health care providers. These communities have also been disproportionally affected by the pandemic. Generation REACH includes a commitment to develop services in the geographic areas where the need is highest and to provide care that is linguistically and culturally responsive to the needs of each child and family. So that means we need to develop and support a diverse mental and behavioral workforce to reflect the communities we serve.

You’ve stressed that this is a long-term commitment. What progress have you made so far?

Dr. Ojemann: We’ve made progress on all of the four components of our strategic plan’s FY21 goal, “Develop a full continuum of accessible and equitable mental and behavioral health care services.”

  1. Increase access through regional and virtual expansion: The pandemic sped up our transition to telehealth, and for many families, especially people who live outside of Seattle, that’s been a huge boon in terms of access. We increased our family crisis navigation services, created a phone triage team to help providers and families interested in our services and created a Spanish-language clinic, CALMA Clinic, that will be located at our Federal Way clinic. We added mental health services at our North Clinic in Everett, including stepped-care treatment for anxiety. We also increased our embedded psychosocial services in oncology.
  2. Ensure seamless transitions of care across the continuum: We created a new care team that supports families as their child transitions from inpatient to outpatient mental health care. The team stays in touch with families and makes sure that plans are working and that outpatient clinicians get the information they need from the inpatient stay. And we are building a new mental health innovation hub — for care, training, outreach and research — at our 70th and Sandpoint location.
  3. Expand programs and services to keep patients from needing the ED and PBMU: We added new intensive outpatient programs to help kids stay out of the ED and still receive the extra care they need. And because we know most patients diagnosed with a substance use disorder also have a co-occurring psychiatric condition, such as depression or anxiety, and research suggests patients benefit when both conditions are treated simultaneously — preferably by clinicians with expertise in both substance use disorders and mental health conditions — we added a dually credentialed mental health and substance use clinician to our Co-occurring Disorders Clinic.
  4. Increase our impact and advance outcomes through integrated behavioral health and primary care: We are partnering with Seattle Children’s Care Network (SCCN) to support pediatricians and primary care providers in integrating mental and behavioral health services into their practices with training and salary support to hire behavioral health professionals and psychiatric consultants. The goal is to integrate mental and behavioral health services into a child’s medical home, enabling them to get screened early, treated in primary care if possible, and linked to appropriate services if needed.

We’ve also continued to advocate for mental health as our organization’s top legislative priority in Olympia, leading to breakthrough achievements this year. These include:

  1. Permanent funding for the Washington State Mental Health Referral Service, which is operated by Seattle Children’s and provides critical supports to youth and their families around the state.
  2. $8.5 million for Seattle Children’s and Sacred Heart to expand a pilot of Intensive Outpatient and Partial Hospitalization programs that fill a critical gap in the continuum of care between routine outpatient services and inpatient hospitalization. This will be a major component of future efforts to help keep kids out of the ED and PBMU.
  3. A Medicaid rate increase for behavioral health, which will make it more sustainable for PCPs to integrate behavioral health services into their care.
  4. A mandate that each region in the state have a youth mobile crisis team (King County has one already). This is a step in the right direction toward reducing inequity in access to youth crisis services for rural communities.

Lastly, I think it’s important to emphasize what a difficult year this has been for all healthcare workers, including our Seattle Children’s workforce. We’ve stepped up our efforts to support the mental health of our staff and their families.

Is Generation REACH part of a national effort?

Dr. Ojemann: There is growing awareness nationwide of the pediatric mental health crisis. Not every children’s hospital is trying to tackle it, however, because of the enormity of the issue. Seattle Children’s has to address it, though, because it’s hard and the right thing to do. Generation REACH is Seattle Children’s initiative; some other children’s hospitals are doing something similar under a different name.

Importantly, our national Children’s Hospital Association recognizes mental health as an urgent priority, which is a huge step that brings with it their funding and research. It also elevates the issue with members of Congress, who are now talking more about child mental health than ever before and beginning to prioritize it.