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R ADY CHILDREN’S INSTITUTE FOR B R A I N B I O L O G Y A N D B E H AV I O R A L H E A LT H


RETHINKING

HEALTHY

“There can be no health without mental health .”

-BENJAMIN MAXWELL, MD Medical Director, Rady Children’s Inpatient Child and Adolescent Psychiatry Services


“ O U R M I S S I O N I S TO R E S TO R E , S U S TA I N A N D E N H A N C E T H E H E A LT H A N D D E V E L O P M E N TA L P O T E N T I A L O F C H I L D R E N T H R O U G H E XC E L L E N C E I N C A R E , E D U C AT I O N , R E S E A R C H A N D A DVO C A C Y.”


So what do we mean when we say we’re Rethinking Healthy? It is e s t i m ate d t hat 1 in 5 c hil d re n in t h e U. S . w ill e x p e r ie n ce a b e h av io r a l h e a l t h dis o rd e r, w hic h t r a nslate s to ove r 19 0 , 0 0 0 chil d re n a n d a d o l e s ce nt s in t h e S a n D ie go a re a . M a ny of us k n ow s o m e o n e w h o has b e e n af fe c te d , as t h e in cid e n ce of t h e s e co n d it io ns , f ro m a u t is m to d eve l o p m e nt a l d e l ay s to e at in g d is o rd e r s is o n t h e r is e i n o u r co u nt r y. T h e p rev a l e n ce of chil d h o o d d e p re s sio n a n d te e n suicid e in S a n D iego C o u nt y is t h e hig h e s t in t h e s t ate of C a lifo r nia . D e s p ite t his t re m e n d o us n e e d , o u r s y s te m fo r a d d re s sin g it re m ains f r a g m e nte d a n d co m p li c ate d by s t ig m a , re sult in g in co nf usio n fo r f a milie s w it h n o cl e a r p l a ce to t u r n . If we a re to re m ain t r u e to o u r missio n , we m us t b e re l e nt l e s s in o u r ef fo r t s to t re at t h e w h o l e chil d . T his m e a ns co nsid e r in g p hy sic a l , e m ot io n a l a n d m e nt a l h e a l t h as i nte r t w i n e d p a r t s of a co m p l ete pic t u re . It m e a ns Ret hin k in g H e a lt hy, a b ro a d e r a p p ro a ch w hich is t h e mis sio n of t h e R a d y C hil d re n’s I ns t it u te fo r B r ain B io l og y a n d B e h av io r a l H e a l t h . We a re m a k in g a n a ll- o u t ef fo r t to f a ce t h e s e p ro b l e ms h e a d o n , o n b e h a lf of eve r y o n e of o u r c hil d re n a n d f a milie s . A n d we’d like yo u to join us .


Mental and behavioral health issues are the “elephant Rethinking Healthy in the room” of our society. For the most BEGINS BY FACING part, they are shunted aside, rarely discussed, and segregated from the idea of physical health. This is not only archaic thinking, but detrimental for the overall health of our communities, because the impact of these

FACTS

M e nt a l a n d b e hav io r al h e alt h issu e s a re t h e “e l e p ha nt in t h e ro o m” in o u r s o ciet y. Fo r t h e m os t p a r t , t h ey a re s h u nte d asid e , r a re l y dis cuss e d a n d

s egreg ate d f ro m t h e id e a of p hysic a l h e a lt h . T his is n ot o n l y a rchaic t hin k in g , b u t it is a ls o d et r im e nt al to t h e ove r a ll h e a lt h of o u r co m m u nit ie s , b e c a us e

t h e im p a c t of t h e s e co n dit io ns af fe c t s us a ll . It ’s t im e to b r in g t h e s e issu e s

o u t of t h e sha d ows a n d co nf ro nt t h e m as we wo ul d a ny ot h e r h e a lt h e pid e mic .


1 in 5

NUMBER OF U. S. CHILDREN WHO WILL EXPERIENCE A

1.4

%

less than

10

%

C H I L D R E N W H O R EC E I V E ANY KIND OF MEDICAL AT T E N T I O N FO R B R A I N A N D B E H AV I O R A L H E A LT H C H A L L E N G E S

THE

=

B E H A V I O R A L H E A LT H D I S O R D E R

P O R T I O N O F T H E U. S . H E A LT H C A R E B U D G E T A L LO C AT E D TO T E E N S

14

%

P O R T I O N O F T H E U. S . P O P U L AT I O N M A D E U P OF CHILDREN BET WEEN T H E AG E S O F 10 -19


= 190,000

CHILDREN I N G R E AT E R SAN DIEGO

3X

TIMES

A S M A N Y P R E-S C H O O L CHILDREN ARE BEING

TEEN

SUICIDE

E X P E L L E D D U E TO B E H AV I O R A L I S S U E S

R AT E

T H A N S T U D E N T S K-1 2

R AT E I N S A N D I EG O CO U N T Y I S T H E H I G H E S T I N T H E S TAT E O F

3,497 HIGH RISK CHILDREN I N FO S T E R C A R E I N S A N D I EG O CO U N T Y

C A L I FO R N I A .

The numbers speak for themselves.


G ROW T H I N M E N TA L H E A LT H ( M H) S P E N D I N G I S S LOW I N G T H E N U M B E R O F I N PAT I E N T P S YC H I AT R I C B E D S I S D EC L I N I N G D R A M AT I C A L LY

MORE THAN

60% DECLINE

MH SPENDING EXPECTED TO LAG

ALL HEALTH SPENDING GROWTH

THROUGH

2020

OVER THE PAST

46 years

ALMOST

79%

INCREASE IN ER VISITS

OVER THE PAST

25 years The Mental Health landscape today

A GROWING

EMERGENCY DEPARTMENT VISITS FOR MENTAL HE ALTH DISORDERS ARE STE ADILY RISING


AG I N G P O P U L AT I O N O F AC T I V E P S YC H I AT R I S T S

G ROW I N G S H O R TAG E O F P E D I AT R I C P S YC H I AT R I S T S

20% EQUALS

70%

PEDIATRIC POPULATION AFFECTED

~14,721,000

8,236 Equals

ARE

PEDIATRIC PSYCHIATRISTS

PER CAPITA

1,787 PATIENTS

50 OR OLDER

1Doctor

FOR

ACTIVE PSYCHIATRISTS

22.9%

PERCENT OF US POPULATION <18

DOCTORS IN PEDIATRICS:

6.8%

P E D I AT R I C P O P U L AT I O N I S U N D E R S E RV E D

years old


Rethinking Healthy

MEANS ACKNOWLEDGING

COMPLEXITY H u ma ns have a nat u r al te n d e n c y to w a nt to la b e l t hin g s . B y d ef inin g a sit u at io n , we fe e l m o re co nt ro l ove r it . M ov ing fo r w a rd c a lls fo r a b ro a d e r v iew. M e nt a l a n d b e hav io r a l h e alt h issu e s co m p r is e ma ny f a c to r s a n d circu ms t a n ce s . Fo r e x a m p l e , a chil d w it h a n e at ing dis o rd e r is alm os t ce r t ain l y suf fe r in g f ro m a n x iet y ; a chil d w h o has w it n e ss e d a t r a u mat ic eve nt is of te n p ro n e to d e p re ssio n . T h e co m binat io ns of s y m pto ms a n d sit u at io ns a re e n dl e ss . We b e lieve t h e b e s t a p p ro a ch a b a n d o ns t h e id e a of a â&#x20AC;&#x153;o n ce-a n d-fo r-a ll â&#x20AC;? dia gn osis . T h e b e s t o u tco m e s o ccu r w h e n we re m ain o p e n a n d at t u n e d to cha n ge s in t hin k ing , m o o d , b e hav io r a n d re lat io ns hips ove r a n ex te n d e d t im e h o r ize n , a n d a djus t t re at m e nt p la ns a cco rdingl y.


JONAH’S STORY

Jonah's Story

When Jonah was jus t 2 year s old, his parent s, Erin and David, noticed their lit tle boy was no longer learning new words or using the ones he already knew. “J o na h ha d s t a r te d to t a lk a n d t h e n s to p p e d ,” Dav id s ays . “At t hat t im e , h e w as dia gn os e d w it h a n a u t is m sp e c t r u m dis o rd e r at R a d y C hil dre n’s , w h e re h e su bs e q u e nt l y re cei ve d c a re at t h e Au t is m D is cove r y I ns t it u te .” “ When you get that f ir s t diagnosis, you feel so alone,” Erin s ays. “ You have this information and you don’t know what to do with it . One of the things that really impressed us about Rady Children’s is that they

recognized this need. So many kids are diagnosed ever y year, and we want them to know the Autism Discover y Ins titute is available, with people who c an help them put together a plan of ac tion.”


Soon af ter Jonah was diagnosed, his speech therapist recommended that the family par ticipate in the Stepping Stones program, using a struc tured play curriculum designed to enhance communication bet ween parent s and child and bet ween children.

“Jonah’s nonverbal and verbal communication grew exponentially during the time he was receiving services ,” David says . “By the time he was 8, he was speaking in full sentences and typing 26 words a minute , writing stories on his laptop.” “Stepping Stones was a really great place for Jonah to learn social skills and interac t with other children. It was also good for Erin and me because we met other parent s with kids on the autism spec trum.” TODAY, Jonah is 9 years old, progressing well and at tending school on a modified schedule with his t ypically developing peers. His parent s have been so pleased with his progress and their experience with the hospital that they have become enthusiastic suppor ters of Rady Children’s programs.


Rethinking Healthy

CALLS FOR EARLY

INTERVENTION Pe r ha ps t h e m os t s t r ik ing d eve l o p m e nt in t h e f ie l d of b e hav io r a l h e a lt h is o u r u n d e r s t a n ding t hat all t h e s e co n dit io ns have p hysic a l lin k s to t h e b r ain . T h e re a re bio l ogic a l ma r ke r s in t h e b r ain t hat p re ce d e cha n ge s in b e hav io r. St r id e s in n e u ros cie n ce a n d ge n et ic te s t ing all ow us to id e nt if y t h e s e m a r ke r s e a r lie r t ha n eve r b efo re . T his is cr it ic al , sin ce ma ny of t h e s e co n dit io ns c a n b e misu n d e r s to o d u nt il t h ey b e co m e s e r io us . A chil d w h o a p p e a r s s hy o r w it h dr aw n , fo r e x a m p l e , is of te n mask ing w hat re all y a m o u nt s to d e p re ssio n . T h e R a d y C hil dre n’s Ins t it u te fo r G e n o mic M e dicin e is pio n e e r in g r a pid ge n o m e s e q u e n cing in chil dre n . T his gi ve s us a h uge a d v a nt a ge in e a r l y d ete c t io n a n d inte r ve nt io n . B y ma k ing e a r l y s cre e nin g a p a r t of ro u t in e c a re , we c a n m a ke a f u n d a m e nt al dif fe re n ce in t h e co u r s e of chil dre n’s li ve s . It ’s t im e to s hif t t h e b a la n ce f ro m re a c t i ve m e dicin e to p reve nt at i ve c a re . Eve r y m o m e nt m at te r s .


“You could be born with a risk for one of these conditions , and then it doesn’t really show up until adolescence . That’s still a mystery . What we do know is that these differences are chronic and progressive . Taking a ‘they’ll grow out of it’ approach will only make things worse and more complicated down the road . The earlier you address an issue , the better your chances of long-term success .” -JAY G IED D, MD Chair, Rady Children’s Child Psychiatry

As one of the world’s leading researchers in the area of pediatric brain development, Dr. Jay Giedd is one of the most highly cited neuroscientists of his generation. In addition to his numerous academic awards, Dr. Giedd’s work has been prominently featured in the general media with cover stories in Time, National Geographic and national newspapers as well as over 30 television documentaries.


There is a universal response to a child who begins to Rethinking Healthy display undeniable signs AN ENTRY POINT ofMEANS concerning behavior: Confusion. What could this FOR EVERYONE be? What is the cause? Where do I turn for help? How do I know if I’ve made the right choice? The amount of information available on the Internet, while miraculous, does not T h e re a re ma ny co m m o n re sp o ns e s w h e n a chil d b egins to dis p lay u n d e nia b l e sig ns of co n ce r ning b e hav io r : C o nf usio n . Fe a r. P a r a l ysis . W hat co ul d t his b e? W hat is t h e c a us e? W h e re d o I t u r n fo r h e lp? H ow d o I k n ow if I ’ve ma d e t h e r ig ht ch oice?

T h e a m o u nt of info r mat io n av aila b l e o n t h e inte r n et , w hil e a b u n d a nt , d o e s n ot al ways p oint to t h e b e s t re s o u rce s . Pre cio us t im e c a n b e l os t w hil e

f a milie s p u r su e “mir a cl e cu re s” o r go d ow n w hat a m o u nt s to b lin d a ll eys . Wo r s t of a ll , co nf usio n c a n re sult in ina c t io n .


WE BELIEVE THERE SHOULD BE A SAFE, UNIVERSAL S TA R T I N G P O I N T FO R E V E RY C H I L D A N D E V E R Y F A M I LY. A PLACE WHERE THEY FEEL FREE AND SUPPORTED FOR ACKNOWLEDGING A PROBLEM AND SUPPORTED AS THEY N AV I G AT E S O LU T I O N S .

“ Parents are the experts on their children . We are the experts in science and health . The best path forward is forged together.” -WA LT E R K AY E , M D


ANNA’S STORY

Anna's Story

A s a mid dl e-s ch o o l e r, A n na was o bs e ss e d w it h p e r fe c t io n . “ I p us h e d mys e lf to b e t h e b e s t s o cce r p laye r, t h e b e s t vo ll ey b a ll p laye r. G et t in g a l ow A ins te a d of a hig h A was u na cce pt a b l e.” W hat A n na c a lls t h e “p e r fe c t s to r m” – p e r fe c t io nis m , a n x iet y a n d at h l et ic s – to o k it s to ll o n h e r in t h e si x t h gr a d e. W h e n class m ate s te as e d h e r a b o u t h e r m us cula r at h l ete’s b o d y, sh e b e c a m e d ete r min e d to l os e weight to t h e p oint of o bs e ssio n . H e r p a re nt s s o o n re alize d s o m et hing w as w ro n g . H e r weight l oss b e c a m e s o d r a m at ic t hat w it hin we e k s h e r h e a r t r ate a n d b l o o d p re ssu re p l u m m ete d , a n d s h e w as hav ing dige s t i ve p ro b l e ms . T his b eg a n a p at te r n of t re at m e nt a n d re la ps e t hat las te d fo r ye a r s , w it h p e r io ds w h e re s h e w as co nf in e d to a w h e e l chair b e c a us e h e r h e a r t was s o we a k .


Af te r A n na w as t re ate d at s eve r al ot h e r f a cilit ie s , s h e a n d h e r f a mil y eve nt u a ll y c a m e to t h e M e dic al B e hav io r al Unit at R a d y C hil dre n’s . W h e n s h e w as s t ro n g e n o u g h , sh e b eg a n to at te n d t h e Ad o l e s ce nt Day Tre at m e nt Progr a m fo r E at in g D is o rd e r s at U C S a n D iego. B et we e n t h e o u t p at ie nt p rogr a m a n d t h e in p at ie nt c a re , s h e b eg a n to m a ke re a l p rog re ss .

“I felt someone really cared , not just as a professional but as a person . When I could not finish a meal they would take time to motivate me in the right way .” Af te r t wo m o nt hs of inte nsi ve t re at m e nt , A n na w as re l e as e d . “ It w as t h e f ir s t t im e sin ce si x t h gr a d e t hat I w as n ot ove r t a ke n by my dis o rd e r,” s h e re c a lls . S h e has b e e n in re cove r y fo r ove r t h re e ye a r s a n d at te n ds t h e U ni ve r sit y of N ev a d a , Re n o, w h e re s h e is n ow a ju nio r majo r ing in p u b lic h e a lt h . A n na s ays s h e is a ls o wo r k in g towa rd a min o r in su bs t a n ce a b us e. “ I p la n to f u r t h e r my e d u c at io n af te r gr a d u at io n by goin g to P. A . s ch o o l a n d re cei v ing a sp e cia liz at io n in N e u ro l og y. O n e d ay I h o p e to s t u d y e at ing dis o rd e r s a n d a d dic t io n in t h e b r ain .” SINCE HER RECOVERY, A nna has shared a passion for breaking ment al health s tigmas. S h e has wo r ke d t h ro ugh h e r s o ro r it y to d eve l o p p rogr a ms p ro m ot in g h e a lt hy b o d y ima ge awa re n e ss a n d maint ains s t ro n g t ie s w it h t h e h os pit a l . “ My re lat io ns hip w it h R a d y C hil d re n’s co nt in u e s to s t ay s t ro n g . I l ove h e lpin g t h e h os pit a l t hat p laye d a huge role in who I have become today. In the future, I hope to work at Rady Children’s a n d b e a p a r t o f t h e i r m i s s i o n t o m a ke f a m i l i e s f e e l t h a t t h e i r c h i l d i s o n e o f t h eir ow n ."


Rethinking Healthy

ONE DOOR

MANY PATHS R a d y C hil d re nâ&#x20AC;&#x2122;s has d evote d ye a r s to d eve l o pin g b e s t-in-class f a cilit ie s a n d p rogr a ms fo r id e nt if y ing a n d t re at in g b r ain a n d b e hav io r a l h e a lt h issu e s . A s we l e a r n f ro m o u r p at ie nt s a n d f a milie s , o u r k n ow l e dge a n d re s o u rce s co nt in u e to evo l ve a n d grow. A s a re sult , chil dre n a n d f a milie s have a n im p re ssi ve a r r ay of ass et s at t h eir dis p os a l , f ro m init ia l ass e ss m e nt t h ro ugh co nt in uing c a re.

W E B E L I E V E O U R A P P R OAC H O F I N T E G R AT I N G R E S E A R C H , C L I N I C A L S T R E N G T H S A N D A G U I D E D T R E AT M E N T P L A N FO R E A C H C H I L D A N D F A M I LY S H O U L D B E C O M E T H E S TA N D A R D OF C ARE ACROSS THE COUNTRY AND BE YOND.


SPECIALTY SERVICES

RESEARCH • UCSD Research Center for Childhood and Adolescent Behavior

• Chadwick Center for Children and Families • Eating Disorders Therapy Program • Gender Dysphoria Clinic • Sleep Center • Cross-cutting Research Programs

INPATIENT • Child and Adolescent Psychiatry Services • Medical Behavioral Unit/ Eating Disorders

AUTISM • Autism Discovery Institute • Alexa’s PLAYC

EMERGENCY • Sam S. and Rose Stein Emergency Care Center • Rady Children’s Behavioral Health Urgent Care Clinic (Mid-City) • Crisis Stabilization Unit

OUTPATIENT • Psychiatry Outpatient Services (For county-funded patients only) • Psychiatry Outpatient Services (For Rady Children’s funded patients) • Developmental Behavioral Pediatrics • Children’s Care Connection • Developmental Screening and Enhancement Program • Developmental Evaluation Clinic • KidSTART

BY PUTTING OUR F A M I L I E S AT T H E CENTER OF OUR O R G A N I Z AT I O N , A L L THE RESOURCES AND SUPPORT THEY NEED OVER TIME REMAIN WITHIN RE ACH.


Rethinking Healthy

IS ALREADY

HAPPENING A D V O C A C Y. E D U C AT I O N . A C C E S S F O R A L L . W h e n a ll is s aid a n d d o n e , p e o p l e d o nâ&#x20AC;&#x2122; t t u r n to b uil din g s a n d m a chin e s fo r h e lp. T h ey t u r n to ot h e r p e o p l e. L e a d e r s at R a d y C hil dre nâ&#x20AC;&#x2122;s a n d t h ro ugh o u t t h e S a n D iego co m m u nit y have a lre a d y d e dic ate d t h e ms e l ve s to cha n gin g t h e w ay we t hin k a b o u t b r ain bio l og y a n d b e hav io r al h e alt h . T h eir ef fo r t s a re n ot o n l y fo cus e d o n f in din g b et te r t re at m e nt s b u t als o o n cre at in g a b et te r u n d e r s t a n din g of t h e s e issu e s t h ro u g h o u t o u r co m m u nit y s o all p at ie nt s c a n re cei ve t h e at te nt io n a n d h e lp t h ey d e s e r ve.


“ Technology offers new opportunities to spot trouble signs early . We can learn a lot from a kid’s use of social media . There needs to be a national conversation about weighing the roles of privacy against the importance of early intervention .” JAY GIEDD, MD is the Chair of Child Psychiatry at Rady Children’s and director of child and adolescent psychology and professor of psychiatry at UC San Diego School of Medicine. Dr. Giedd is one of the world’s leading researchers in the field of pediatric brain development.


“ Our new knowledge of the relationship between the brain and behavior represents a huge change in the

RETHINKING HEALTHY IS ALREADY HAPPENING

field of psychology . Better understanding of the causes is leading us to better treatments , and ultimately , cures .” WALTER KAYE, MD, is a professor of psychiatry at UC San Diego and the Founder and Director of Rady Children’s Eating Disorders Program. Dr. Kaye is a globally recognized leader in the treatment of childhood eating disorders.

“ Treating the whole child is critically important because physical and mental health and development are fundamentally intertwined . We have created a pathway that makes it easy and effective for every pediatrician and specialist to connect children to the behavioral health services they need .” KRISTIN GIST, MS, is Senior Director of Rady Children’s Division of Developmental Services, which addresses the behavioral and developmental needs of children and families in 14 departments and 8 locations across San Diego and Southern Riverside Counties.


“ We can expect major breakthroughs as science unravels the mystery of the human genome and how environmental factors , such as the release of stress hormones resulting from child abuse and family violence , interact in ways that shape long -term behavioral health . As we gain more understanding , we will be able to more effectively tailor our mental health interventions to meet the unique needs of each individual child .” CHARLES WILSON, MSSW, is Senior Director of the Chadwick Center for Children and Families, which provides care and treatment to abused and traumatized children, and oversees Rady Children’s behavioral health functions including outpatient psychiatry and medical social work.

“ Increasing access to quality care would represent a huge breakthrough in our field . Too many kids never receive proper attention and treatment , which is tragic , because the right kind of early intervention can change the whole life trajectory of a child .” BENJAMIN MAXWELL, MD, is Medical Director of Rady Children’s Inpatient Psychiatry, overseeing Child and Adolescent Psychiatry Services (CAPS), our Medical Behavioral Unit (MBU), Crisis Stabilization Unit (CSU) and Liaison Service to the medical programs.


Rady Childrenâ&#x20AC;&#x2122;s is committed Rethinking Healthy to changing the way we, as a community, think about DEPENDS ONbrain and behavioral health. Our successes serve as evidence that this can be done. But so much remains before us. Despite our advancing scientific knowledge, the wonders of technology and the promise of genomic medicine, millions of people

YOU

R a d y C hil d re nâ&#x20AC;&#x2122;s is co m mit te d to cha n gin g t h e w ay we t hin k a b o u t b r ain a n d b e hav io r a l h e alt h . O u r su cce ss e s p rove t hat t his c a n b e d o n e . B u t s o m u ch wo r k re m ains .

D e spite o u r a d v a n cing s cie nt if ic k n ow l e dge , t h e wo n d e r s of te ch n o l og y a n d t h e p ro mis e of ge n o mic m e dicin e , millio ns of p e o p l e in A m e r ic a s t ill f a ce m e nt a l

h e a lt h issu e s eve r y d ay, b u t l e ss t ha n 10 % re cei ve t re at m e nt . T his has a dire c t im p a c t o n t h e h e alt h of o u r chil dre n , f a milie s a n d co m m u nit ie s .

Er asing s t ig ma a n d b r inging p e o p l e w h o a re s t r ug glin g o u t of t h e s ha d ows to

re cei ve t h e h e lp t h ey d e s e r ve is J o b O n e . A n d t hat â&#x20AC;&#x2122;s w h e re yo u c a n h e lp. Yo u r

p hila nt h ro pic su p p o r t w ill all ow us to e n la r ge o u r s e r v ice of fe r in g s , p rov id e v it al e d u c at io n a n d h e lp p ush fo r cr u cial p o lic y cha n ge .


CHILDREN AND FAMILIES DONâ&#x20AC;&#x2122;T NEED TO SUFFER ANY MORE. TOGETHER, W E C A N H E L P T H E M , A N D C R E AT E A MODEL FOR THE REST OF THE WORLD.


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