Written by Emily A. Cheslock

Texas Hospitals Tackle Pediatric Mental Health, Vaping and Rising Uninsured Rates

Today’s children are tomorrow’s leaders, so ensuring that they are healthy and thriving is critical to the future of Texas. Access to quality health care, socioeconomic status and environmental factors often influence a child’s health. Texas hospitals are in a unique position to address the various health issues facing today’s children and ensure they are receiving the primary care they need.

Hospitals across the state are working with community partners to prevent and treat illnesses and encourage healthy lifestyles, while also advocating for necessary policy changes that would improve children’s access to quality health care.

Closing the Behavioral Health Gap

According to the U.S. Centers for Disease Control and Prevention, one in six children between the ages of 2 and 8 has a behavioral health disorder. Untreated, childhood behavioral health disorders can impact how children learn, react to situations and handle their emotions — even when they become adults. Severe cases can lead to risk factors like substance abuse, self-harm and even suicide.

Brian Payne

“The earlier children can learn to cope with symptoms of anxiety and depression, the less likely it is that their symptoms will worsen and escalate over time,” said Brian Payne, M.D., chief medical officer at University Medical Center Children’s Hospital in Lubbock. “It’s important to start working with adolescents at a young age in order to teach them how to emotionally care for themselves, deal with social pressures and find coping strategies for stressful situations.”

In recent years, behavioral health has become a highly discussed topic but, while the many of the stigmas previously surrounding mental illness have been debunked, many children and adolescents do not receive adequate treatment for mental illness. Physician shortages, limited funding and other barriers create obstacles to accessing care. Children with behavioral health needs are increasingly reliant on inadequate settings, such as emergency departments, to receive treatment.

Texas hospitals are working toward solutions to close the pediatric behavioral health care gap.

“We saw a need for a clinic that focused on children and families, particularly after suffering a traumatic injury. We created a collaborative group that included ER doctors, clinical psychologists, drug and addiction counselors and a few marriage and family counselors from UMC and Texas Tech University,” said Dr. Payne. “The Children’s Behavioral Health Clinic evolved from focusing on the aftermath of a traumatic injury into a place where children and families can come and get individualized treatment — whether the child needs an individual focus from a child psychologist or the whole family needs counseling from a marriage and family counselor.”

UMC’s clinic utilizes a telemedicine aspect to facilitate continuation of care. According to the Academy of American Child and Adolescent Psychiatry, moving to a new area can be one of the most stress-inducing events a child may face. A move can trigger anxiety and depression. Continuing behavioral health care can help to mitigate some of these symptoms. “We wanted to focus on the telemedicine aspect of care, especially if the family leaves Lubbock. So when we saw several patients moving to New Mexico, some of our providers obtained their license there in order to continue providing care across state lines via telemedicine,” said Dr. Payne.

In addition to providing a space for children and families to seek care and using technology to expand their reach, UMC is working to make behavioral health care affordable to families in West Texas. They’ve been able to lower costs by using telemedicine, and they also work with families to set rates for care based on what the family can afford to pay.

Curbing the Vaping Epidemic

Vaping, which is the inhalation of vapor from e-cigarettes, was once seen as a healthier alternative to smoking traditional cigarettes. However, a recent outbreak of vaping-related lung injuries, specifically amongst young people, has changed the narrative. According to the Texas Department of State Health Services, there have been more than 200 reported cases of vaping-related lung injuries in Texas. Of those cases, nearly a quarter were teenagers.

Suman Sinha

Teens suffering from a vaping-related lung injury can exhibit an array of respiratory symptoms, including coughing, shortness of breath and chest pain. In severe cases, blood oxygen levels can drop, requiring hospitalization. Those with pre-existing conditions, such as asthma, are at a much higher risk for vaping-related injuries and any existing respiratory symptoms could be made worse. Vaping can also weaken the lungs, making vape users more susceptible to other respiratory illnesses. Suman Sinha, M.D., chief of pulmonary medicine at CHRISTUS Trinity Mother Frances in Tyler, is warning patients to be especially cautious of vaping during flu season.

“I would recommend avoiding vaping at all costs as it could impair the immunologic function of the lungs,” said Dr. Sinha. “Vape users could be at much higher risk for the flu, and they should take extra precautions to prevent the flu such as getting the vaccine and thoroughly washing their hands.”

While vaping is an issue that is impacting Texans of all ages, it is becoming increasingly popular among teenagers. “Vaping has become a social activity; it’s trendy. Vaping is gadget-oriented, which appeals to teenagers,” said Dr. Sinha. “It’s also highly addictive due to the high levels of nicotine found in many vaping formulas.”

Lawmakers in Texas have been working on legislation to curb the outbreak of teen vaping. The 86th Legislature passed a bill that raised the legal age to purchase tobacco, including many vaping products, from 18 to 21. The new law went into effect in September 2019.

Carrie Kroll

“Our state legislators are motivated to support policies that reduce the number of teenagers vaping in a way that I haven’t previously seen,” said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association. “Science shows us that the later in life someone is introduced to nicotine, the less likely they are to become a lifelong user. The intended outcome of raising the legal age to purchase tobacco products is to decrease the number of teenagers who are trying smoking and potentially beginning an addiction. Over time, the goal is to decrease the total number of tobacco users,” said Kroll.

Texas hospitals are working to educate their communities about the dangers of vaping. CHRISTUS Trinity Mother Frances is promoting a video that features local high school students encouraging their peers not to vape. They also offer smoking cessation classes and hold educational events about associated risks like lung cancer.

“We’ve been holding events around our community to spread the word about the dangers of vaping. We recently held an assembly for more than 600 high school students to encourage them to live healthy lifestyles and avoid both vaping and smoking traditional cigarettes,” said Dr. Sinha.

Addressing the Rising Uninsured Rate

Hospitals continue to struggle with the rising number of children without health insurance. According to data from the Georgetown University Center for Children and Families, 11% of Texas children — about 835,000 — had no health insurance coverage in 2018. This makes Texas the state with the highest rate of uninsured children.

Some children who are uninsured may be eligible for coverage through Medicaid or the Children’s Health Insurance Program. The amount of eligible but uninsured kids could be attributed to many factors, including language barriers and lack of information about Medicaid and CHIP services, among others.

THA is advocating for legislation that would create continuous eligibility for a full calendar year without periodic income checks for children receiving coverage under Medicaid or CHIP. With the current model, periodic income checks are conducted throughout the second six-month period in a child’s 12 months of coverage to ensure that enrollees are still eligible for coverage. If the system thinks that the family’s income has changed, the state sends paperwork in the mail to ask for verification. Often this paperwork is lost, missed or not filled out in time and children lose their coverage. Continuous eligibility would ensure these children have access to timely, comprehensive care.

In addition to continued advocacy efforts on the state and federal level, hospitals are playing a role in decreasing the uninsured rate by helping patients enroll for insurance when they come in for treatment.

Katherine Yoder

“Parkland’s mission is to care for individuals entrusted to our care regardless of their ability to pay and ensuring they receive care beyond an emergency setting is critical to not only their health, but the health of the community as well,” said Katherine Yoder, vice president of government relations for Parkland Health & Hospital System. “To that end, we have a robust team of financial counselors who work to help those individuals who qualify for assistance get enrolled in Medicaid, CHIP or other programs that might be available to them.”

The rising rate of uninsured children has many implications; not having coverage can mean skipping essential vaccines, not receiving proper medication for illnesses and many other issues. “When children don’t have preventive checkups or access to health care through primary care clinics, they risk missing milestones that could impact the rest of their lives,” said Yoder. “They may also wind up critically ill in an emergency department for something that a primary care physician could have caught and treated early on. We’re working to change that.”

Expanding Access to Care

Texas hospitals are finding innovative and technology-based solutions to transform access to pediatric care. Telemedicine is making strides across Texas to provide health care to thousands of children who may not have otherwise received it. Children’s Health in Dallas has partnered with 16 sites across 14 counties to offer telemedicine services to children.

Tamara Perry

“We have one of the largest and most active emergency departments in the country — with over 170,000 ED visits annually. Our pediatric emergency room providers are available 24/7 to hospitals that we’ve connected with,” said Tamara Perry, senior director of telehealth programs at Children’s Health. “Time is relevant in these situations. We want to ensure that children can be seen by a specialist quickly. Using video technology eliminates the need for long patient transports.”

Hospitals also are working on expanding access to care by working with schools in their communities. Children’s Health has expanded its school-based telehealth program to 159 schools across DFW and has an outreach team that attends PTA meetings,holds school nurse forums and assists parents in signing their children up for the school-based telehealth program.

“We can see and treat things like coughs, colds and asthma through the school-based telehealth program. This enables us to treat minor illnesses without the parent having to leave work to take the child to a traditional doctor’s office,” said Perry.

Telemedicine is saving money for both patients and hospitals, especially in the NICU. Many rural hospitals don’t have pediatric specialists, and this often leads to critically ill children and their families traveling across the state to see a specialist. Transportation and lodging can cost families a significant amount of money. Through the telespecialty program, newborns can receive treatment in their communities and parents don’t have to take extended time off work.

“Our neonatologists can video conference with attending doctors in rural hospitals to strengthen the diagnosis ability of the provider on-site. This is averting unnecessary transports, which leads to an average cost savings of up to $116,000 for the remote site as well as $15,000 in transport costs,” said Perry.

Through telemedicine, innovative treatments and advocacy efforts, hospitals across Texas are dedicating their time and efforts to addressing the varying and often complex health issues facing today’s children and tomorrow’s leaders.