Photo: Prior to its weekly meeting, the Harriet Lane’s mental health team of, left to right, Justine Larson, Emily Frosch, Barry Solomon, Dana Yates, and Jim Tanner, discuss a case with resident Lisa Kantz, third from right.
Mental health has become a high priority issue in Hopkins Children’s Harriet Lane Clinic. “We are seeing an increasing number of children with symptoms of anxiety, depression and behavioral problems,” says Lane Medical Director Barry Solomon. “Unfortunately, many are reluctant to take advantage of mental health services in the community. And we have good ones.”
The Division of Child and Adolescent Psychiatry at Johns Hopkins has long teamed with Lane clinicians to evaluate individual patients and recommend action, whether to send to Hopkins Children’s or to refer. “The coordination of care between primary care and mental health providers, however, has been a longstanding challenge,” says Emily Frosch, director of education and training in the division.
Concerned about the consequences for untreated children and a lack of continuity in their care, Frosch, Solomon and colleagues developed, with support from private foundations, a model of mental health services within a primary care practice. “Our comprehensive approach exemplifies our interest in ‘one-stop shopping’ for Lane children and families,” says Solomon. “We now offer more services on site and help get them in the door to community-based services. And we’re teaching a new generation of pediatricians how to collaborate with mental health professionals and break down barriers to care.”
Their current model took root, in some respects, in 2006 when, with funding from the Aaron & Lillie Straus Foundation, the Lane hired a full-time, mental health consultant, James Tanner, to evaluate patients and consult with pediatric residents and other providers. “Our ability to link on-site mental health services with better comprehensive care led to additional funding from the Blaustein Foundation and the Weinberg Foundation and a recent three-year renewal grant from Straus,” Solomon adds.
A year later, he and Frosch initiated a two-week rotation in mental health in which senior pediatric residents train with child psychiatry colleagues in the Lane and other settings. “Peds residents spend years calling in psyche consults, now they’re learning to deliver one,” says Solomon.
To encourage families’ use of recommended outpatient services, Assistant Professor of Child and Adolescent Psychiatry Justine Larson, with Solomon and Frosch, secured an American Academy of Child and Adolescent Psychiatry Pilot Research Award and another from the Thomas Wilson Sanitarium for Children of Baltimore City to identify and remove obstacles—whether a lack of transportation or fear of stigma— in seeking psychiatric care. Today, Larson helps coordinate referrals and streamline communications between providers in the Lane and in the Johns Hopkins Children’s Mental Health Center in East Baltimore.
Focused on Lane families’ overall mental health, counselor Dana Yates helps to screen mothers, during early well-baby visits, for postpartum depression and intimate partner violence and refer them for care. “We’re the first hospital clinic we know of to provide this level of adult services in a pediatric primary care setting,” says Solomon of the initiative funded by the Leonard and Helen R. Stulman Charitable Foundation.