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Becker’s Healthcare Podcast
How Children’s Nebraska is Advancing Pediatric Mental Health Through Caring Contacts
00:18:53
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- [00:00]
Mariah Muhammad
Welcome everyone to the Beckers Healthcare Podcast series. I'm Mariah Muhammad, writer and moderator with Becker's Healthcare. I'm thrilled to have with me today Renee Rafferty, Senior Vice President of Behavioral Health and Wellness is Sabrina Shally, Director of Behavioral Health Integration and Program Coordinator at Children's Nebraska. Renee and Sabrina, welcome to the podcast. We're very excited to have you join us today. To get a start, would you mind please introducing yourself and telling us a bit about your background?
- [00:24]
Renee Rafferty
Yes. Thanks so much, Mariah. Renee I'm Renee Rafferty, Senior Vice President of Behavioral Health and Wellness. I am a therapist by trade and have been in a leadership role for over 20 years. I have worked in the full continuum of care, outpatient, inpatient, residential crisis services, as well as integrated behavioral health. And just I'm very excited to talk.
- [00:47]
Sabrina Shally
With you today and yes, it's lovely to meet you, Mariah and get a chance to share about our program. My name is Sabrina Shally. I'm a licensed clinical social worker by discipline and this is actually my 30th year in the field. I began as a clinical counselor and therapist for adolescents and working with kids and their families has remained my passion throughout my career and have also really been excited to lead Children Nebraska's efforts for suicide prevention in hopes that we can accomplish zero suicides. So excited to talk more about our efforts in that space today.
- [01:26]
Mariah Muhammad
Yes, yes. Thank you both for giving us that background and obviously amazing work that you are doing in that field. Sabrina, going to you for my first question. How did the idea for implementing caring context in a pediatric setting originate and what made Children's Nebraska decide to adopt this historically adult focused intervention and lead its utilization for children and teens?
- [01:50]
Sabrina Shally
Well, thank you so much for giving us a chance to tell this part of our story. I am celebrating eight years here at Children's Nebraska and prior to the role I'm in now, I had the great opportunity to support and lead the medical social workers, which included our emergency department social workers who in our continuum of care provided the mental health assessments for kids who were coming in for suicide ideation or suicidal behaviors. And when I joined children's in 2017, it was right as we really began to see a ramp up in the number of kids needing to come in for those services. And as I was supporting those social workers, I was hearing about how difficult it was for them, you know, in a 8 or 12 hour shift to be working with child after child after child. And so we were doing some things to try and support them. The Medical team that surrounded them was amazing, but that was on my brain at the same time as a leader continuing to hear about. We were, we were nearly doubling our rates of kids needing these services. And I'll be honest, it was fall season because I was watching Kansas City Chiefs football game. We are in our glory years, I readily admit that. But during commercials is when I like to catch up on magazines. And there was a Time magazine article in the fall of 2019 all about these handwritten note cards that were used in adult substance use and misuse recovery. And I thought, oh, I don't really want to read this article right now. It's a Sunday, I'm watching football. And I thought, no, I probably really need to read this. And I read it and I just thought that magic of that personal touch of when you get to meet someone in their most vulnerable moments and they tell you their story and then you help them make recommendations of what the next step on their journey is, but then you don't have contact with them again, potentially forever, how that must feel to the patient, let alone how that was feeling to the social workers. So I brought it to our emergency department social work team and I said, what would you think if we tried something like this? And they all immediately got on board and were really excited about the opportunity. So we really dove in. We learned about zero suicide. We traced the history of these handwritten carrying contacts note cards. We did some benchmarking with the Children's Hospital association and found out this wasn't being utilized in any sort of environment that we could uncover. We had an amazing practicum student that helped us roll it out. And I want to bring back to attention the timeline that we started this, which was fall of 2019. We had no idea what coming in March of 2020. We had set a go live date of May 1, 2020. It took us about six months to develop the program to create what we thought would be an effective clinical intervention. And I'm really proud to say that despite the COVID pandemic happening, we did go live on May 1st. And since that time, we just celebrated five years. We have enrolled nearly 1,200 patients into the program. And the best news of all is we have zero deaths by suicide in our patient population in this space. So that's how it came about. A random article being read that was used in the adult space.
- [05:09]
Mariah Muhammad
Wow, that's absolutely amazing. Thank you so much for sharing that. And you're now five years into the program, and obviously it's going really well, but what outcomes or trends have surprised you the most, especially in terms of patient response and impact.
- [05:23]
Sabrina Shally
Oh, my goodness. You know, our biggest hope as we went into this is that we really wanted to reduce our kids that were returning to us for repeat suicide ideation or suicidal behavior. We also thought that it might give us a chance to decrease the number of kids who died by suicide. We thought it would help normalize mental health and needing to come in for support with our pediatric healthcare team. But also we thought there was potential for it to impact our community in a positive way and just showing a token of support for these individuals. I want to be really clear that we never intended to replace the needed steps for kids after they come in for suicidal ideation or behaviors. We always needed to encourage them on to go into inpatient care or to connect with an outpatient or intensive outpatient team. These were really like, we've met you, we care about you, and we're gonna continue to cheer you on in your journey. So the cards are written really carefully so that they speak to that component. But really, magic started to happen and it started happening right away when the kids started writing back to us. And I have some cards I could read you some quotes from. We had no idea that the kids unprovoked would choose to write. We've had kids that have called our children's Nebraska agency line and say, hey, we're trying to track down a social worker you. And we don't. We only remember her first name was this. And they literally like ping pong through our system and are leaving messages for those social workers. We had no idea that we would hear from their families, that families were writing us and sending us pictures of their child. We got one picture where it was the child on their. On their bed with their comfort cat. And all of the handwritten note cards we send, six in that year were all hanging by the side of her bed. And the mom was saying, this is the most amazing thing. They're concrete, they're tangible. She reads them over and over. And I just wanted you to see this picture of my happier and healthier child than when you first met her. We also then really didn't know that we would begin to see our social workers who were doing this work no longer felt like it was a turn and burn or a one and done environment. They actually felt that empowerment to continue to support the patients in this really profound way. The retention rate improved for us with our emergency department social workers. I think since we started, we've lost only one or two to Moving out of state or different positions in our organization. And so it's really stabilized that team. And then as we began to share successes, after we'd run the program for one year, we heard from our division chief of our emergency department. He said, hey, none of my peers are hearing any. You know, they're not doing anything like this. We need to start telling people about the results. And so we've done a bit of that. We created a replication kit, and we've been able to share that with over 70 different healthcare systems so far. So that's been. Been really exciting. Yeah.
- [08:45]
Mariah Muhammad
Yeah, that definitely sounds exciting. And you answered my next question a little bit. But obviously the program has expanded significantly with over 1000 patients enrolled in replication kits shared with hospitals and schools nationwide. Can you explain what the adoption process looks like? And you say you have over 70 institutions that have adopted the model?
- [09:08]
Sabrina Shally
We've shared with over 70 institutions, Mariah. And we're really pleased to do that. We're happy. We've presented on this program to conferences, to larger groups, but we also get thrilled to meet with healthcare institutions one on one and really talk through how we've lifted the program here. I mean, you've got things like HIPAA and compliance, right? We need to get guardian permission to be sending these note cards. We need to ensure that the patient expects that these cards are coming. And so we have a 90%, 98% of our patients that we offer this program to choose to enroll. So that's really amazing. But I will say I don't know how many have chosen to adopt the handwritten part. We're really grateful to Children's Nebraska that we are able to allocate our social workers time to writing these cards. I know there are some other healthcare institutions that are doing some really neat things with regard to texting and those components, but we haven't been able to argue with the results of zero suicide. We also have a substantial decrease in kids that are in the program that return to the emergency department with regard to any sort of suicidal thoughts or gestures. And actually, we begin to see more and more of our kids that we are seeing, if they do come back, are able to discharge home with a safety plan and lethal means counseling as opposed to going into a higher level of care. So all of those things have told us we've really that we aren't at this time going to change our process and we're going to stick with the handwritten cards.
- [10:46]
Mariah Muhammad
Got it? Got it. Thank you so much for explaining that. And Renee, how do you Maintain the personal and meaningful nature of the handwritten notes, especially as the program scales. Can you share any memorable stories or feedback that really illustrate the program's emotional impact?
- [11:02]
Renee Rafferty
I think Sabrina spoke beautifully to the importance. Using innovation and text is great, and those things are wonderful tools. And I think what we've realized through this program, when you send that card and that child is able to connect with the person that they sat with during their most difficult moment, they're able to recognize that this connection is a sign of hope and healing. And they get these multiple reminders of that courage it took to reach out, the ability to trust their own inner wisdom and work with the person that's share their story. So I think those cards themselves are really a testament to the importance of connection. And that however we heal is usually through connection with our caring team. And I think that the I'll have Sabrina read a card to you of what is said because I think that just is is that one card from a child touches hundreds of caregivers because we do share the exciting words and not sharing the identity of the child, but just the healing that happens. And that, like Sabrina says, is so healing for our team to remember that this treatment actually works. People do heal from mental health conditions, and they do really respond to powerful visits, and that can be trajectory changing. Sabrina, you want to go ahead and read one for us?
- [12:19]
Sabrina Shally
Yes, yes, I'm happy to. So, Mariah, here's a card we got back from one of our patients and she writes, thank you so much for sending that letter. I can't even begin to tell you how much it meant to me. I got the letter the day of my birthday and started sobbing in the car. I'm glad. I know I have someone rooting for me. It was so kind of you to reach out. I'll take a moment to read another one that I think is really impactful. This is someone who wrote back after all six cards had been sent for that first year. And she says, I have always meant to write back to you. The cards mean so much to me. Each one is hanging up in my room. I wanted to let you know how much of an impact the cards have and to know someone I met once cares so deeply for me. I'm doing the best I have been since a year ago. I never imagined this much happiness was waiting for me. There have been hard times, but I have been able to overcome them and become better in the end. I can never thank you enough for all you have done in my healing journey. And again, that's Just a reminder that that social worker met this patient once. And six handwritten note cards. I mean, again, just a bit of magic.
- [13:33]
Mariah Muhammad
Yeah, absolutely. Thank you so much for sharing those. And looking ahead, how do you envision care and contacts evolving with Children's Nebraska? Are there any plans at all to expand beyond behavioral health into other areas of care where connection might also improve outcomes?
- [13:50]
Renee Rafferty
Yes, I'll answer the beginning of that, Sabrina, you weigh in. But I think ultimately it's very important to say that, you know, interventions for kids experiencing mental health conditions happen across our continuum. We are training within Children's Nebraska. We have a program called cope, which is children's outreach and provider education. And we train pediatricians to treat mild to moderate conditions within primary care. And I think there's opportunities to expand, expand in those types of settings, to bring to outreach to other hospitals and to continue to talk about the importance of that personalized, deep trauma informed connection that allows for that sense of hope which we know is really the key to healing. So I think we plan to. You know, Sabrina is excellent at being able to support and to continue to provide that implementation. And we are going to be using it as we expand our services. We have used it in our behavioral health urgent care out in Kearney, Nebraska, and have found that the kids absolutely love it out there as well. And so it's just a very. It's a tool that we'll continue to support and offer to others as well as inside of our. Inside of our programs that are not just behavioral health programs or behavioral visits. They're treating behavioral health in other parts of the continuum.
- [15:04]
Sabrina Shally
Yeah, agree with that, Renee. We've really been on a robust journey with zero suicide and caring contacts falls under the transition arm of that. But what it's offered taught us is that ability to have a conversation with the family while they're with us in crisis and saying, hey, we're going to continue to support you and this is what it'll look like. And we've added some other tools to that. We've really created a robust lethal means counseling program where not only are we providing the concrete objects like lock boxes and gun locks and those sorts of things, we also teach them how to do a home sweep. We send them home with those materials so they know how to make their home safer for their child to return. We have adapte, the safety plan, and are using it in really unique ways across our entire continuum. We do universal screening for depression and suicide across our Children's Nebraska programs in units and clinics, which helps us identify Kids who are at risk. And just over last year, we identified well over 100 kids who actively had a suicidal plan. But we're here for some other reason besides mental health care. And I think those are the things that keep us motivated moving forward. Just like these really amazing responses we get from our patients in the caring contact program.
- [16:25]
Mariah Muhammad
Wonderful. Thank you so much for explaining that. And Sabrina, Renee, before I let you go, the last thing I wanted to ask is beyond caring context, how is Children's Nebraska leading excellence in pediatric behavioral health? What's on the horizon for bringing hope to children and families right now?
- [16:42]
Renee Rafferty
That's a great question. I love answering it. It's such an exciting time to be part of Children's Nebraska. In January of 2026, we will be opening a behavioral health and wellness center that's part of our hospital system, but provides a full continuum of care of behavioral health services. And this building as being part of our health care system is unique in that it is also no wrong door. So when kids have a behavioral health crisis, they can walk in our front door and they can receive behavioral health urgent care so they can meet with a therapist and work on a crisis that is occurring. But they can go back home and see be with their family if they're stable and can return back home. But we also have crisis stabilization that is 23 hours and 59 minutes. Kids can come in and stay for a while to provide more stabilization, be able to see a psychiatric nurse practitioner, psychiatrist, get therapy as peer support, and be able to receive those services that also can hopefully stabilize them back to go home. But if need be, they can also be admitted to an inpatient psychiatric unit that will help to offer that higher level of care. For acute services, we also will have a treatment program that provides mental health care, partial hospitalization. And then we have our eating disorder program that will also be expanding. It's a partial hospitalization we have, but we'll be expanding. So we have 10 patients that can be in that program. So just a really large continuum of care, behavioral health service as well as we'll have primary care located in our wellness center too. And the goal is to really help destigmatize care. Recognizing that, please reach out early, please come in the door. We'll help you navigate the system and really create that seamless transition depending on what the child needs. That families don't have to figure out where to go with excellent services right now. But it's just going to be so exciting to offer this full continuum.
- [18:34]
Mariah Muhammad
In January of 2026, wonderful, wonderful. Thank you both so much for those final thoughts. It's definitely been a very informative discussion. So again, I want to thank you so much for coming on Becker's Healthcare and explaining that, and I look forward to connecting again with you both soon.
- [18:49]
Renee Rafferty
Thank you.
- [18:50]
Sabrina Shally
Thank you so much, Brian.