The Middletown Press (Middletown, CT)
Intensive therapy expands to younger clients
Branford facility aims to meet needs as depression, anxiety increase in children
BRANFORD — Responding to the increasing depression, anxiety and suicidal thoughts of young teenagers and preteens, Shoreline Family Health Care is expanding its intensive outpatient program to clients as young as 11.
Previously, IOP services were available to youths ages 14-18.
Mental health professionals say the expansion is a response to an increased need for intensive therapy for younger children.
Whether it’s problems coping at home, in school or out with their friends and teammates, “for the majority of kids we’re seeing, it’s usually all three of those areas,” said Sarah Beard, director of children’s services at BHcare and director of IOP services at Shoreline Family Health Care.
The Branford clinic is a collaboration between BHcare and Fair Haven Community Health Care in New Haven. Primary care also is offered at the clinic at 221 W. Main St. BHcare also has an intensive outpatient program at its Parent Child Resource Center in Derby.
While the COVID-19 pandemic has increased isolation, depression and anxiety, “there’s been kind of a shortage of services, even right now, just a greater need for children’s services across the state, so we’re happy to fill the void,” Beard said. She said there are immediate openings available, both in person and by telehealth.
Intensive outpatient programs are intended for young people who have been discharged from the psychiatric unit of a hospital or to prevent them from needing to be admitted, Beard said.
She said IOP is for shortterm stabilization so the client can move on to lessintense therapy. “It’s a real infusion of coping skills, emotional regulation and social skills because they’re coming three hours a day, four days a week,” Beard said. The program lasts eight to 12 weeks and includes family sessions and curricula on trauma and substance use, she said.
“They can learn from one another and also realize that they’re not alone in some of the issues that they’re facing,” Beard said.
Dr. Benjamin Oldfield, chief medical officer at Fair Haven Community Health Care, said, “One way to think about it is, it’s a level of care between regular outpatient care and being in the hospital.”
He said the program is meant for preteens and teens who may have “anger outbursts, emotional dysregulation and exacerbation of mood disorders.”
“One thing I think is special about this program … it’s embedded within the primary care clinic and that has some benefits,” Oldfield said. “One is, if families desire, they can get their primary care in the same location.”
Also, it’s not as obvious that they are going for mental health care. “Sometimes stigma is a reason families don’t seek behavioral care,” Oldfield said. “That can be attractive to kids that don’t want to be labeled.”
“We are seeing more symptoms of depression in this age range,” as well as anxiety and suicidal thoughts, Oldfield said. Part of the issue is that, while people were isolated for much of the last two years, “we are returning to more normal interactions,” he said.
For 11- to 13-year-olds, that two-year period is when “identities are being formed, abstract thought is beginning … understanding where we fit in with others,” Oldfield said. “The pandemic has really disrupted that.”
Another issue is “returning to in-person learning leads to academic expectations,” Oldfield said. “Some kids have a fear of infection. They fear COVID and now that they’re back in school that fear is more present and real and intense for them.”
Children also pick up on their family stresses, such as the deaths of loved ones, “jobs changing, difficulty accessing child care,” he said. “We have noticed locally that there is an increase in suicidal thinking among our young people.”
“I always feel like, for parents, when they’re questioning something … that’s the time when you pick up the phone and call,” Beard said. Danger signs might be falling grades or a change in mood, but also more serious issues. “Self-harm, suicidal thoughts, that is a majority of the kids that we’re seeing,” Beard said.
“Life has gotten more stressful for everyone,” she said. “You think about what life is like for adults and in a family it trickles down to the children. … In general, middle school is a difficult time: the onset of puberty, for a lot of kids they’re going through a lot of changes. … Things get more complicated to navigate.”
Dr. Yann Poncin, a psychiatrist with the Yale Child Study Center, said the increase in mental health issues among young people has been unprecedented. The center, which historically offered IOP services as young as 5, raised the age to 8 because of the pandemic.
“During the pandemic, at one point we were always full with a waitlist,” he said. “It was very hard to get people in from the community who had not come in through the emergency room or the inpatient unit.” He said the center had not had a waiting list for outpatient care in 100 years.
Poncin said young people’s issues worsened if they had to wait to get into an intensive outpatient program. Many were sent to Yale Child Study Center from the Emergency Department to avoid admitting them to the hospital. “We had to prioritize those kids,” he said. “Ideally, they don’t go to the inpatient unit and they come straight to us.”
The wait has decreased “from a nine-month wait to a month or two, which is better,” he said.
Poncin said the issues were “exacerbated by the pandemic [which] affected a lot of kids, kids who were not good at being at home for whatever reasons, not good at getting online, worried about their parents.”
“There’s definitely more kids with suicidal feelings, depression and anxiety than there was before, but that was already happening before the pandemic,” Poncin said. “But the pandemic added fuel to the fire.”
Poncin said, “It seems to go against reality. The first months of the pandemic were not so bad. Kids were at home, they were getting more sleep.” The problems increased in fall 2021, he said.
Also, “puberty is happening younger than ever before,” he said. “But kids are also exposed to more things. They’re trying to figure out who they are, what they are, while all these hormones are surging through them.”
Social media “are very confusing” because they present an idealized picture of teen life. “Girls will get on Instagram and they’ll have airbrushed others to compare themselves to,” Poncin said.
Changes include “kids are playing less with each other, they’re more on their phones, their parents are less available to them, there’s more information about the world outside of here,” he said.
Social and athletic activities are more structured, as well. “Normal childhood development historically is, you go out, you hang out with your friends, you negotiate your own rules, you learn how to deal with kids who are not as nice to you,” Poncin said.
Ultimately, “it’s really hard to tease out what is the cause” with so many factors going on at once, he said.
One positive note is that while “there’s definitely more kids coming in with suicidal complaints,” completed suicides have declined, Poncin said. The highest year for suicides in Connecticut for 19-year-olds and under was 2017, with 27, Poncin said. In 2020, there were 15. The data for 2021 is not in yet, he said.
For more information about Shoreline Family Health Care, call 203-8714188. Yale Child Study Center can be reached at 203785-2540.