CHOC Children’s Mental Health Initiative Making Remarkable Progress

One in five children experiences a diagnosable mental health condition before turning 18.  That’s about 150,000 children in Orange County alone; yet there are no inpatient mental health services for children younger than 12 in the county, and a shortage of inpatient beds for adolescents.  A year ago, in May 2015, CHOC Children’s announced a landmark effort to ensure children, adolescents and young adults with mental illness get the health care services and support they need.  Since that time, CHOC, with the support and encouragement of other community leaders, has made tremendous progress.

Outpatient Support

Young children with serious and chronic illnesses are two to five times more likely to face mental health disorders than their healthy counterparts.  In September 2015, CHOC, in conjunction with Orange County Behavioral Health Services, launched an outpatient co-occurring clinic for patients whose physical conditions, such as diabetes, cancer or epilepsy, are complicated by mental health challenges. Psychologists and psychiatrists are available to provide specialized care for these children in their medical clinics, in the hospital, or in a special outpatient mental health clinic.  In the upcoming months, additional psychologists, psychiatrists and social workers will join the clinic to allow it to serve more children.

In addition, CHOC’s cystic fibrosis (CF) program recently received a grant from the Cystic Fibrosis Foundation that enables the team to expand its social worker’s availability and have a designated psychologist to help patients and caregivers.  They will provide screenings, evidence-based guidelines and follow-up care for depression and anxiety, as well as develop a community referral network of mental health providers.  CHOC’s CF model, if successful, could be replicated in other specialty clinics.

In the primary care setting, CHOC has rolled out mental health screenings for all 12 year olds at their well child visits.  The American Academy of Pediatrics recommends that children be screened for depression during routine medical visits as many teenagers (up to 13 percent) have depression but do not receive any treatment.  Children that screen positive for possible depression receive information about depression and mental health, and can receive referrals for mental health treatment if needed.  CHOC is also completing a pilot in the primary care clinics where a psychologist is present to help the medical team screen for and address mental health issues, and help families address childhood obesity.

Emergency Department

Due to the lack of inpatient mental health services, children and teens who require inpatient psychiatric services are waiting lengthy periods of time—usually days—in local emergency departments until beds become available or they are stable enough to return home.  CHOC is developing strategies to begin treatment in its emergency department, to connect patients to follow-up care and other community resources, and to track outcomes.  As part of this effort, CHOC has increased a social worker and psychologist’s time in the emergency department — an additional eight hours a day, seven days a week.  Patients get screened to determine the need for inpatient services or access to other resources, and staff is following up with families to ensure coordinated care.  Plans are to expand these services to include a specialized evidence-supported treatment that can be given in the emergency department to help families address their children’s needs in the home whenever possible.  This treatment was developed at Boston Children’s Hospital.

Recruiting Mental Health Experts

Orange County has fewer psychiatrists, psychologists and licensed social workers than the state average.  CHOC is working with its partners on strategies to attract experts to the region, as well as to increase specialized training of students in local counseling, psychology and nurse practitioner programs.  Most recently, the hospital has hired two psychologists, one neuropsychologist and two part-time board-certified child and adolescent psychiatrists.  Additional staff training and recruitment is currently underway.

Rendering: CHOC's Inpatient Mental Health Center private patient room.
Rendering: CHOC’s Inpatient Mental Health Center private patient room.

CHOC’s Inpatient Mental Health Center

CHOC is proud to be building Orange County’s first inpatient program that can accommodate children younger than 12.  The center will have 18 private rooms in a secured and healing environment, including an outdoor area.  It will provide a safe, nurturing place for children ages 3 to 18, and specialty programming for children younger than 12.  The center’s innovative floor plan was designed with guidance from national experts and incorporates elements of several exemplary programs observed by CHOC staff.   Construction is expected to be completed at the end of 2017.

CHOC ‘s vision for a comprehensive mental health system of care is ambitious.  While there’s been tremendous progress, CHOC continues to need community support to help ensure every child and young adult in Orange County who needs behavioral health treatment receives high quality services without stigma or barriers to access.  To learn more, visit www.choc.org/giving/mental-health/.

Meet Dr. Perry Eisner

CHOC Children’s wants its referring physicians to get to know its specialists. Today, meet Dr. Perry Eisner, a pediatric anesthesiologist at CHOC Children’s at Mission Hospital.

Dr. Perry Eisner

Q: What is your education and training?
A: I attended the Ohio State University School of Medicine. My internship was in pediatrics at UC Irvine and with all of my rotations spent at CHOC. When UC Irvine no longer had their pediatric residents at CHOC, I transferred to Harbor-UCLA Medical Center, where I completed my pediatric training. I then became board-certified in pediatrics, and in 1988, I began a specialized program at the main UCLA campus in Westwood that combined general anesthesiology residency with a fellowship in pediatric anesthesia and pediatric critical care medicine.

Q: Administrative appointments:
A: I have been the chief of surgery at CHOC Children’s at Mission Hospital for the past six years.

Q: What are your special clinical interests?

A: My interest is in making surgery as stress-free as possible for both my pediatric patients and their families.

Q: How long have you been on staff at CHOC
?
A: Twenty-one years

Q: What are your most common diagnoses?

A: My patients have a range of conditions. We have everything from trauma patients with brain injuries or children with orthopaedic injuries to kids with head and neck problems. It runs the gamut.

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: At CHOC at Mission, we have four fellowship-trained pediatric anesthesiologists and ensure that children undergoing surgery have not only the safest but also the best experience possible. There is not a hospital in the county that provides a higher level of care.

Q: What inspires you most about the care being delivered here at CHOC?
A: What inspires me the most is the dedication of the entire team that CHOC Children’s has assembled to care for pediatric surgical patients. From the surgeons and the nurses to the critical care physicians and the hospital-based physicians, it is a team that cannot be matched. We have practitioners that were trained in the finest facilities in the country and who care not only about delivering state-of-the-art care, but also care equally about reducing the stress of an illness or surgery for both our patients and their families.

Q: Why did you decide to become a doctor?
A: I became fascinated with medicine when I was in high school and worked in an emergency room in downtown Cleveland as an orderly. I have also loved interacting with children. I found that when one works with kids, you can take a horrifying and stressful situation and transform it into a minor event. That is my goal each day in the operating room.

Q: If you weren’t a physician, what would you be and why?
A: Honestly, I don’t know. It’s all I’ve ever wanted. I didn’t have a back-up plan. It’s not something I’d recommend, but it’s not something that I did. I didn’t have a plan B.

Q: What are your hobbies/interests outside of work?
A: My hobby is playing racquetball. I began playing 40 years ago and play two to three times per week.

Q: What have you learned from your patients?
A: With kids, when they’re going through something stressful, I find that if you can divert their attention by doing something that they think is funny or makes them laugh. I’ve learned though that this works for adults too. It seems so natural with kids, but it works just as well with adults as kids. When there’s something stressful going on, if you can divert your attention to something light or funny, it can get you through anything.

CHOC Opens Wing for Adolescent, Young Adult Cancer Patients

A new wing at the Hyundai Cancer Institute at CHOC Children’s will provide a customizable healing experience tailored for adolescent and young adult (AYA) patients.

The new AYA wing features a lounge area and four specially outfitted rooms dedicated to this unique patient population. Patient room amenities include vibrant paint colors and customizable wall art.

Dr. Leonard Sender, medical director of CHOC Children's Hyundai Cancer Institute, Kara Noskoff, CHOC child life specialist and Kimberly Chavalas Cripe, CHOC president and chief executive officer celebrate the opening of the inpatient infusionarium and lounge.
Dr. Leonard Sender, medical director of CHOC Children’s Hyundai Cancer Institute, Kara Noskoff, CHOC child life specialist, and Kimberly Chavalas Cripe, CHOC president and chief executive officer celebrate the opening of the inpatient infusionarium and lounge.

Taking a cue from the Infusionarium, which opened in 2014 inside CHOC’s outpatient infusion center, the lounge features large, vertically oriented television screens that create a similar immersive, healing environment for patients.

There, AYA patients have a dedicated place to play video games, watch television and movies, or just hang out with their peers. The lounge was developed by Reimagine Well, a company that uses emerging technologies and digital media to create immersive healing environments tailored to patients’ requests.

To develop these virtual scenarios, the company posed a question to patients: Where would you want to heal?

Nick Meza, a 20-year-old patient, immediately knew his answer. As a lifelong Californian and committed Eagle Scout, his life was dotted with dips in the pool, canoe adventures along the river, and seaside snorkeling expeditions before being diagnosed with cancer two years ago.

“It is when I am in the water that I find the serenity and courage to stay positive and focus on what is right with the world,” Nick says. “When I am in, around or close to a body of water, I forget about troubles and my life’s struggles and suddenly water becomes my life, my strength and my healing place.”

A young cinematographer was then paired with Nick to create an immersive film capturing life under the sea; additional videos explored healing scenarios suggested by other patients.

These films will be broadcasted on the large screens in the lounge, as well as on smaller-scale, portable multimedia stations in each of the wing’s patient rooms. The mobile units will also have access to educational, “cancer survival” videos and eBooks that feature CHOC experts.

The AYA wing dovetails with the Cancer Institute’s recognition that teens and young adult patients with cancer have unique needs. In fact, CHOC’s is among the few pediatric cancer programs in the country with dedicated services for this patient population.

“When it comes to treating an adolescent or young adult with cancer, their medical needs are unique – but so are their psychosocial needs,” says Dr. Leonard Sender, medical director of the Hyundai Cancer Institute at CHOC Children’s. “The AYA wing will give these patients a venue to heal on their own terms and a place to call their own.”

 

Join us May 21 for Orthopaedic Medicine: What Every Pediatrician Should Know

Education on performing routine exams on knees, back and hips; diagnosing common upper and lower extremity issues; and ways to improve the patient referral process from PCP to orthopaedic specialists are among the topics featured at an upcoming conference hosted by CHOC Children’s. We spoke with Dr. Afshin Aminian, medical director of the CHOC Children’s Orthopaedic Institute, about what guests can expect on May 21.

Q: What is the importance of the “Orthopaedic Medicine: What Every Pediatrician Should Know” conference?  

A: Orthopaedic injuries and musculoskeletal problems are common problems that our general practitioners see on a routine basis. They range from newborn hip screening exams to diagnosis of overuse athletic inures and scoliosis screening exams, among other common issues. We hope that we can partner with our attendees to provide them some valuable, interactive education so that they feel confident when facing these issues with their patients.

Q: What will attendees be able to take away from your presentation on the management of back pain and scoliosis?

A: The incidence of back pain is on the rise in adolescents, and scoliosis is very prevalent in adolescent females. Our attendees will develop an algorithm for diagnosis and management of back pain in children and be able to succesfully perform a scoliosis screening exam.

Q: What can attendees expect at the breakout sessions?

A: The break out sessions will feature hands-on training on performing musculoskeletal exams and a chance for one-on-one tutorials with the expert group leaders.

Q: When should a pediatrician refer a patient to a pediatric orthopaedic specialist? 

A: Referral guidelines will be discussed in an open forum style with audience participation and input. The referral guidelines currently on the CHOC website, will then be updated for ease of access to our referring physicians.


An internationally-recognized and sought-after expert in pediatric orthopaedics, Dr. Aminian has presented at numerous conferences and meetings in the United States and abroad. His clinical interests include scoliosis surgery, treating spinal deformities in children, and assessing surgical correction in relationship to patient outcome in radiographic parameters. Dr. Aminian is board certified in orthopaedic surgery, and is affiliated with the Pediatric Orthopedic Society of North America, the American Academy of Orthopedic Surgery and the Scoliosis Research Society.


“Orthopaedic Medicine: What Every Pediatrician Should Know” will be held on May 21, from 8 a.m. to 5 p.m., at CHOC Children’s Hospital, in the Harold Wade Education Center.

CHOC designates this live activity for a maximum of 7.25 AMA PRA Category 1 Credit™. 

Click here to register and learn more.   

Join us for CHOC Charity Golf Classic, April 25

An annual golf tournament, “CHOC Charity Classic” benefiting CHOC Children’s is set for April 25, at The Resort at Pelican Hill golf course.

Presented by Cigna, the popular event attracts our community’s leading business leaders and golf enthusiasts in support of children and the future of their health and well being.

“We are so grateful to all our donors and participants that come together in support of CHOC and the families we are privileged to serve,” says Zachariah L. Abrams, director of special events, CHOC Children’s Foundation. “The tournament promises a relaxing day of world-class golf with ocean views and a one-of-a-kind opportunity to support a great cause.”

Participants will enjoy 18 championship holes on Pelican Hill’s north and south courses, a TravisMathew golf shirt, continental breakfast, box lunch, raffle, and a brief barbecue reception.

Click here for the entry form, sponsorship opportunities and more.