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TEDx Portsmouth - Ben Hillyard

Updated: Sep 17, 2019


Changing Well Child Visits to

Whole Child Visits:

A new vision for effective

childhood mental health.


A 12-year-old boy I’ll call Sam sits in my office, giving the me the side-eye. It’s his

first appointment, and Sam doesn’t want to be there. He’s getting C’s and D’s at school

and being reprimanded by his teachers. At home, there are 3-hour homework battles,

slammed doors and frequent arguments. And he’s no longer getting invitations to

birthday parties. Sam is constantly getting the message that he’s the problem, and his

self-talk—I’m no good. Everybody hates me —has gotten very negative. Sam is angry

and depressed. But he’s also hanging in. He’s still going to school, keeping his head

above water. He’s resilient but not in a positive way. And the only coping mechanism

Sam is practicing is avoidance, which video games provide. Nothing like being

successful at Fortnite to help Sam feel like he’s fitting in.

Now if we could wave a magic wand and go back to when Sam was very young,

what we’d likely see is a boy who was really motivated. But then Sam started to run into

an invisible wall. It could be undiagnosed ADHD that stops his momentum and causes

him a lot of frustration. When Sam experiences this frustration enough times, he starts

to anticipate failure and develops a sense of learned helplessness – I can’t. This

situation leads to a host of other issues: academic failure, family arguments,

depression. So by the time I see twelve-year-old Sam, I am attempting to untangle

problems that have become like a tightly knotted fishing line.

Imagine giving a child a bike helmet AFTER she’s gotten a concussion instead of

while she’s learning to ride her bike. This is the way we currently deliver mental

healthcare to our children.

And nationwide surveys are not encouraging about how well that’s going .... The

median age for the onset of anxiety is 6 and for ADHD it’s 11. Yet, only 15 to 25% of

children with a mental health disorder receive treatment. And why is that?

While dedicated pediatricians follow well-established Well Child guidelines,

respond to parent concerns, and check for developmental disorders at annual wellness

visits, there are ZERO required mental health checks until a child is 12. And then only

for depression.

Considering over half of all mental health issues occur BEFORE the age of 14.

To borrow and outdated term from my industry, that’s just plain crazy.

But at least we’re catching depression, right? Nope. Even for those kids who

have depressive disorders, only 40% receive treatment. The director of a large, local

pediatric practice confirms the problem, “We routinely check developmental progress

but from 30 months to 12 years we don’t screen for mental health issues. We just don’t

have the time,” she said.

The current healthcare system is failing our children, and we can do better. The

solution? I propose we turn child wellness visits into Whole Child Visits that include a

mental health check with an experienced mental health professional. Mental health

providers could relieve the unfair burden put on schools and pediatricians and offer

more support for families.

These annual visits would allow an on-site psychotherapist to track a child’s

mental health in the same way a pediatrician tracks a child’s physical health and

development. And because these mental health checks would become a routine and

accepted part of wellness, this would go a long way in alleviating the stigma of mental

health issues. Plus, they would help normalize children talking about their feelings. But

most importantly, children and their parents would get the treatment and support they

need when they need it, so common mental health problems don’t go undiagnosed or

become engrained and more complex. So families wouldn’t have to say, as I’ve heard

them say so often after years of struggle and frustration, that they wish they’d come to

see me much sooner.

A pediatric office that integrated physical and mental health checks could have

helped David before he started having suicidal thoughts. This sensitive, intelligent

young man was pale, anxious, and depressed. David ran track and complained about

being tired all the time and said that his heart raced even when he was resting. What

looked like depression, anxiety, or both turned out to be a failing thyroid. After

collaborating with his doctor, David’s anxiety and depression disappeared. He’s now

excelling in school.

And consider Becca who had yelled at her teacher and had pushed several other

students to the ground. Every week Becca had long tantrums and repeatedly went to

the nurse for stomach aches. But Becca could also be motivated, polite, and funny. As it

turned out, Becca felt panicked in large groups. The slightest hint of rejection cascaded

her into fight or flight response. Becca was practicing the only coping mechanism she

had and asking for help the only way she knew how. Imagine if Becca had been able to

share her feelings of anxiety earlier and if we’d been able to teach her age-appropriate

techniques to better manage her stress.

Let’s enable therapists to get ahead of problems instead of being left to react to

them. Enable them to help families identify early signs of concern, even before a crisis

makes a problem diagnosable by looking at a child’s response to ordinary situations at

home.

Therapists, for example, could help families spot their child’s emotional and

behavioral tells. A tantrum, for instance, is a child’s language of distress but can easily

be dismissed as normal. A therapist could help parents and children decode this

language by asking them to describe their child’s behavior 1 minute, 15 minutes, 60

minutes before a meltdown. Instead of focusing on the tantrum, they could get at its

cause--possibly, hunger, lack of sleep, or overstimulation.

Or a therapist could ask what happens when their child is sent to get ready for

bed on her own. If she’s reluctant to go up alone, it could be an indicator of anxiety. Or if

she goes up alone but then doesn’t get ready for bed, it might indicate she needs help

with Executive Function skills—those cognitive abilities that allow us to have control

over our behavior.

An integrated Whole Child Visit would allow psychotherapists not only to identify

potential problem but also help address them. They could work collaboratively with

pediatricians and parents to be a resource, offering advice and strategies, making

referrals, prioritizing treatment options, and checking back in about the effectiveness of

the suggested strategies.

This is particularly important now. We are in the middle of an epidemic of anxiety.

Our children are living in a world of constant “on” and their brains and bodies get

fatigued. They fall into patterns of anticipating failure, reacting to minor signs of distress

with a flight or fight response. What is far worse, they don’t know how to practice

responding to problems by pushing forward and problem solving.

Let’s return to Sam. If Sam had gotten Whole Child Visits, a psychotherapist

might have asked his parents to describe what it was like for him to learn to ride a bike.

Learning to ride a bike takes courage, determination and multi-tasking. There are

almost always falls. A question like this could reveal Sam’s difficulty with what’s called

“frustration tolerance.”

The therapist could then offer Sam tools for better success, helping him slow

down, step back and try out other possibilities when he’s frustrated. This would help

change Sam’s self-talk from, “It’s impossible” and “I can’t” to a new, more positive story.

Faced with his next challenge, Sam could build on his previous success and develop

more positive resilience.

Identified early enough, barriers that children face can offer wonderful

opportunities for them to develop useful life tools, like emotional intelligence, flexibility,

frustration tolerance, safe risk taking, delayed gratification, and the ability to learn from

their mistakes. Whole Child Visits could support children in this practice and better

prepare them for the stressors in their lives, especially as in today’s fast-paced online

world, kids are exposed to cyberbullying, pornography, and sexting that they are not

developmentally ready for and have limited time to process.

Giving our kids the right tools at the right time can avoid more serious,

complicated problems from developing, change their narrative from negative to positive,

and build their resilience. But the timing matters.

Whole Child Visits that integrate medical, emotional, and educational support

would facilitate early and effective mental health care for our children and provide the

greatest long-term benefit.

Let’s give our children that helmet as they learn to ride not after the concussion.

© Benjamin Hillyard 2019

AloftNH.com

Centerforcollaborativechange.com





#TEDx #mentalhealth #wholechildvisits

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