The Fayetteville, NC healthcare provider recently opened the Dorothea Dix Care for Adolescents to improve access to care and expand treatment to include the whole family.
With one in four children experiencing depression and one in five struggling with anxiety as a result of the pandemic, healthcare organizations are scrambling to develop new ways of addressing the mental health crisis. And they’re finding that treatment works best if it extends to the family.
Cape Fear Valley Health in Fayetteville, NC, recently opened the new Dorothea Dix Care Unit for Adolescents with that strategy in mind. The new facility also addresses an acute need for access in the Fayetteville-Cumberland County area, where families either have to visit the local hospital ER or drive more than an hour for mental healthcare services.
HealthLeaders recently chatted by e-mail with John Bigger, Cape Fear Valley Health’s corporate director of clinical services, about this new facility, and how it improves upon traditional healthcare services for children and adolescents.
Q. What services will the Dorothea Dix Care Unit for Adolescents offer?
JB: The Dorothea Dix Care Unit (DDC Unit) at Cape Fear Valley Health System (CFVH) will be designed specifically to provide help to adolescents from ages 12-17 and their families during periods of acutely exacerbated psychiatric illness in the CFVH system service area. During their short-term stay, youth will participate in individual, group, and/or family counseling with a focus on evidence based adaptive skill building as a foundation for successful reintegration into the community. An individualized treatment plan is developed with the youth and their family that will address and problem-solve around the issue(s) that may have contributed to the current crisis.
A secondary goal of the DDC Unit is to assist the youth and/or their families with accessing support services that will continue to help the adolescent in improving overall functioning within their home or community setting. Having this unit in Cumberland County, NC allows this for a much easier transition for the youth. This unit will likely serve adolescents that utilize resources at a higher level than most when seeking services.
Q. Will you be featuring any digital health tools or platforms? How does digital health figure into your treatment strategy, both now and in the future?
JB: Digital health tools will be utilized to provide psychoeducation through streaming programs related to self-care, education regarding mental illness, and so on. In addition, video components will be utilized to provide opportunities for role playing healthy activities and communication strategies.
In the future, we see digital health as increasing in both capacity and content, which will be utilized to assist patients in adaptive coping skills and learning. As technology improves, digital health will have a positive impact on helping with emotional regulation, biofeedback, access to telecare, and so on.
Q. How do mental health services for adolescents differ from services for adults?
JB: Adolescents are in a unique phase of life where they are trying to establish psychosocially independent functioning through distancing from parents and integration into various peer groups. This presents significant challenges as the adolescent navigates through emotional connection to the family and the push-pull relationships. In addition, the emotional and physical maturity of adulthood has not been established yet, causing significant challenges as well. Mental health services for adolescents need to be delivered through consideration of these unique life challenges and programming will need to be developed which incorporates these elements into the daily treatment.
Finally, parent and family involvement tend to be at a higher level of investment for adolescents so that family therapy is more enhanced.
Q. It sounds as if family and/or caregivers figure prominently in treatment plans. How will this new facility address family and/or caregivers?
JB: Family and caregivers are essential in adolescent care. Oftentimes, mental illness has impacted the entire family, not just the adolescent receiving care. Our psychotherapists in Fayetteville will meet with family members to not only assess functioning within the family dynamic, but to also focus on developing strong aftercare plans, which incorporate ongoing care of the family and the adolescent. This can be achieved through family therapy during aftercare in conjunction with individual and/or group therapy for the adolescent.
Q. The pandemic has certainly brought the need for these services into the spotlight. What lessons have you learned during the pandemic that will affect how you treat adolescents or how you designed this new facility?
JB: The pandemic has presented significant challenges with adolescent mental health care across the country. Social distancing has impacted the ability to identify and establish appropriate social integration and social groups. School isolation and limited extracurricular activities have limited the ability for people to interact. In addition, social media has become a social norm, and this is fraught with its own challenges in relation to fitting in, social bullying, and so on.
The lessons we have learned play a key role in how we approach treatment. We will have more face-to-face sessions while at the same time utilizing the digital learning platforms listed earlier to help guide adolescents through establishing appropriate interactions with others, both interpersonally and through social media platforms. We will also work with the adolescents to focus on challenges they face through the pandemic and how we can help to address them on an individual basis.
Q. What are the biggest challenges you face in providing mental health care for adolescents?
JB: The biggest challenges we face are related to simply finding the right resources for adolescents upon discharge from our facility. Simply put, we need more outpatient providers that support adolescents through evidence-based practices. We do not have enough in our community, and the need is there. In addition, challenges remain regarding how to navigate the journey into adulthood while dealing with the pressures of peer groups, social media, and the like.
Having a strong support group/system becomes critical for adolescents facing the stage of life. The Dorothea Dix Care Unit is a step in the right direction for the Fayetteville-Cumberland County region, allowing patients to work with board certified psychiatrists, and for local families to be more involved in the treatment process. The unit opens the doors for better access, meaning children in crisis can get immediate care, rather than waiting for a bed elsewhere while spending longer periods of time in the Emergency Department.
Q. What new technology or services would you to use in the future? What’s out there that you’re excited about trying out?
JB: As mentioned earlier, digital technology development will have a dramatic impact in the future, where adolescents will be able to reach out for help through various platforms. It would be great for an adolescent to be able to use an app so they can check in with a therapist, access breathing techniques, have biometric information on their phones they can utilize to provide biofeedback, and so on. Other future things involve checking medication levels remotely, utilizing technology to learn about one’s body, and so on.
Q. How will these services or this facility evolve?
JB: I think research leads this area. While there are a tremendous number of ideas regarding technology, there needs to be development into functional realms prior to implementation. Then, once the functionality of an idea is developed, it needs to be researched through evidence-based research to ensure that it works, and works the way it’s supposed to.
Finally, parameters need to be put into place to ensure the new technology is not able to be used in a harmful way. As an academic/teaching hospital we’ll be able to establish cutting edge techniques to help our patients.
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.