$15M gift to expand services in East Bay
At UCSF Benioff Children’s Hospital Oakland alone, a team of about 60 mental health clinicians saw a record of nearly 60,000 patient visits in the fiscal year 2017, including approximately 5,000 visits with child psychiatrists, as well as early intervention services, school-based counseling, parent support and other services by psychologists and other therapists. However, specific access to a child psychiatrist has long been challenging in Oakland, part of a nationwide trend. With the team projecting a 23 percent increase in the fiscal year 2018, King is a strong advocate of designing and implementing new approaches to getting out in front of the growing service needs.
UCSF Health and the UCSF Department of Psychiatry Search Committee, with members from Benioff Children’s Hospitals in Oakland and San Francisco, UC Berkeley, and Zuckerberg San Francisco General Hospital (ZSFG) are leading a nationwide recruitment of psychiatrists to meet what King refers to as this “overwhelming need.”
In December 2018, the Oakland hospital received $15 million from Marc and Lynne Benioff to address this need and double the current capacity with an additional 5,000 psychiatric visits per year.
UCSF is recruiting six new child psychiatrists, two psychologists and one social worker. The hospital also will add two new child psychiatry training positions designed to attract top talent and encourage trainees to remain in the East Bay to practice medicine long-term. “This gift allows us to take a giant step forward in expanding our workforce, and the cascading effects of that are great,” says King, also UCSF professor of clinical psychiatry. “What invariably happens when you start to generate excitement and pull together a talented team to tackle enormous problems is that other people want to be part of it."
The gift funding also will be used to establish a new Child Psychiatry Access Portal, a model King successfully implemented at Seattle Children’s Hospital. The portal program is designed to train primary care physicians in the community — particularly those in more rural areas — to serve as the front line for early-stage mental health care management, with the support of a psychiatric hotline, referral management and continuing medical education.
To help address immediate service gaps, UCSF faculty child and adolescent psychiatrists based in San Francisco have been providing care at the Oakland hospital, and King envisions new hires providing care on both sides of the Bay and throughout the system of care, including the Benioff Children’s Hospitals and ZSFG.
Telehealth delivery for psych interventions
Efforts are also underway to increase telehealth delivery of psychiatric interventions, as well as to increase partnerships with county services and primary care providers to better manage mild to moderate mental health conditions.
UCSF Health, which includes UCSF Medical Center, Benioff Children’s Hospitals, and the Langley Porter Psychiatric Hospital and Clinics, is also growing partnerships with other hospitals and actively exploring ways to expand inpatient mental health capacity for the children in the region. This would help to meet the needs of children and adolescents who have more complex problems, such as autism or eating disorders, who often are turned away from existing psychiatric inpatient facilities.
“Through broader and deeper collaboration, and expanded use of various care models, including consultation and telehealth, we can see more kids and hopefully match them with the right provider, at the right time and place, for the right length of time,” says Petra Steinbuchel, MD, Medical Director of Psychiatry and Mental Health & Child Development at UCSF Benioff Children’s Hospital Oakland.
Collaborative efforts between Mission Bay and Oakland are underway not only in the areas of training, but also in clinical care, including suicide screening in the acute care setting, and treatment of specific disorders, including somatoform disorder, as well as chronic suicidal ideation and self-injurious behavior. Both Langley Porter Psychiatric Institute, and UCSF Benioff Children’s Hospital Oakland offer dialectal behavioral therapy (DBT), which Steinbuchel calls a “gold standard” treatment for young patients with chronic suicidal ideation and self-injurious behavior. The Oakland hospital has the only program in Alameda County offering comprehensive DBT to adolescents with Medi-Cal insurance.
Expansion of services
“Moving forward, in the next five years, we’re working toward a significant expansion of behavioral health intervention at Benioff Children's Hospitals,” Steinbuchel says. “And that would include in the areas of access, patient care, research, and advocacy as well as educational training efforts.”
The integration of the Oakland and San Francisco psychiatric services have helped address the demand, to “pool our resources together,” she says. “Looking at systems of care that we can develop together, that all focus on our unique strengths, has been really effective.”
For Steinbuchel, also a UCSF associate clinical professor, her continued work to serve such a diverse community in the Bay Area is what drew her to Oakland 11 years ago.
“I deeply value the social justice mission, and the diversity of the patient population here,” she says. “We see children of celebrated figures and children with really severe early deprivation and complex trauma. The rewards in treating such a diverse patient population are tremendous.”