The student most on Michael Horne’s mind — and most weighing on his heart — as he served as “principal for a day” at Dallas ISD’s Yvonne A. Ewell Townview Center was the one who wasn’t there — but who deserved to be.
Horne, a longtime educator and now Parkland Foundation president and CEO, met Brandon when the youngster was in middle school.
He sat in the family’s south Oak Cliff home as Brandon, alongside his supportive mother and grandmother, talked about how much school meant to him. How he wanted to go to college then come back to his community and make a difference for others.
But Brandon began to struggle with mental health challenges that he and his family had no idea how to navigate.
“Eventually he fell through the cracks in ways that were extremely tragic,” Horne recalled.
Last month, at Townview’s Rosie M. Collins Sorrells School of Education and Social Services, Horne heard from students with aspirations as big as Brandon’s — and he thought about how many of them may face the same untreated behavioral health problems.
“The reality of those exit ramps up ahead that will keep some of them from realizing those dreams is so great,” Horne told me Wednesday as he described that day at Townview.
“What happens if we don’t do something for them? They are desperate and eventually lost — and our society erodes,” he said. “That’s not hyperbole.”
Tragedies like Brandon’s are why Parkland Health and Hospital System has launched a new effort — with a powerful jump-start of $5 million from the Rees-Jones Foundation — to integrate mental health care into its pediatric primary care settings.
Equipping children’s doctors to be the front line in behavioral health — to treat mild and moderate mental health challenges and to refer more serious cases to the right source for help — is a best practice slowly taking hold across the country.
Parkland’s effort is particularly significant because, if successful, it will be a safety net for the tens of thousands of Dallas County kids who, like Brandon, are part of uninsured or underinsured families and whose life circumstances leave them most vulnerable to mental health challenges.
A year ago, Georgetown University’s Center for Children and Families found that half of the country’s 10 counties with the most children lacking health insurance are in Texas. Dallas County was in the top five, with 122,000 uninsured kids.
Annually, 1 in 3 school-age children living in Dallas County — about 180,000 total between the ages of 6 and 17 — experience needs that require clinical intervention, according to the North Texas Behavioral Health Authority.
Two-thirds, or 120,000, of those kids have conditions that fall into a mild or moderate range that could be handled in an integrated pediatric primary care setting — if the doctor was able and willing to do that.
Yet only 10% of these children get that help; the remainder go untreated unless their symptoms escalate to the point of them winding up in an emergency room.
If those numbers are too big for you to wrap your head around, let’s simplify it to a single classroom of 30 students, based on data from Dallas County Mental Health Systems for Children, Youth and Families:
Twelve of the 30 will experience a behavioral-health issue requiring clinical intervention within the year — but only three will actually receive treatment.
Seventeen of the students live in poverty — 11 Latino, four Black, one white and one from another group.
Sixteen of the kids are survivors of an adverse childhood experience, which includes abuse, neglect, an incarcerated parent, and witnessing intimate partner violence or substance misuse inside the home.
These facts, along with similar ones Parkland found in its most recent Community Health Needs Assessment, sparked this new initiative to work as quickly as possible to put universal mental health screening in place for the 50,000 kids who get primary care at its 12 community health centers and its 12 youth and family centers on DISD campuses.
“We want all these kids screened for mental health issues, just like they are screened for other vital signs,” Parkland’s lead psychologist, Dr. Rebecca Corona, told me Wednesday. “Make it just as normal as screening for hearing and vision.”
There are actually two storylines of innovation here. One is about saving children’s lives. But it’s also worth noting the private-public partnership fueling this mental health work.
The philanthropic gifts that so often get the big headlines are those made on behalf of new buildings that people can put their names on. Nothing against that — but kudos to Rees-Jones for supporting hardly flashy but vital programming that fills mental health gaps.
The effort comes at a time when the state of children’s psychiatry, both locally and across the nation, is in a crisis.
“Every single place is dying to get a child psychiatrist, a child psychologist, because there are so few available,” Dr. Fuad Khan, Parkland senior vice president and chief of integrated behavioral health, told me.
In addition to mental health issues generally associated with children — autism, ADHD and other learning disorders — many conditions we think of as adult illnesses — depression, anxiety disorder, schizophrenia and bipolar disorder — almost always can be spotted in the teen or even adolescent years.
Khan wants parents to remember this: Biology doesn’t ask for your choice for your child; it just delivers. This condition is not your fault. Don’t suffer alone.
He worries that today’s stretched-too-thin environment too often leaves providers “taking care of the ones who are really sick and ignoring the others until they become really bad off too.”
But early intervention and treatment by Parkland clinic pediatricians — the doctors whom families are most likely to trust — is the better way forward, Khan said.
Minnie Mathew, Parkland’s director of global behavioral health, agreed that parents feel less stigma with their pediatrician, with whom they already have a relationship.
“We must empower those pediatricians and serve in a consulting role as we provide education to make them feel comfortable to take care of those patients in the mild range of problems.”
Matthew also pointed to the behavioral operation that will soon open in the new RedBird Health Center as a hub designed to increase capacity and early detection, plus improve the navigation of care with community partners.
Corona said the new screenings being put in place — plus telehealth service expansions — will help doctors figure out what’s going on with kids before the condition escalates to suicidal ideation or self-harming behavior.
“That’s at the heart of what we’re trying to do here,” Corona said. “To get in as soon as possible, identify anybody at risk and help them not get to even the mild range.”
None of this happens overnight. Appropriate screenings for various age groups must be found, proper training done, support systems put in place and referral hubs established.
“We must build this service so that what we start, we take it to the finish line,” Khan said.
Horne joined the Parkland Foundation, the hospital’s fundraising arm, after serving as executive director of a local group of charter schools — work that stirred him to try to find ways to close gaps in the mental health safety net.
“A day doesn’t go by when I don’t think about what could have been had Brandon been able to access services closer to home, had trust in the system, someone to sit down with him, his mom and grandma,” Horne said.
Horne remembers Brandon each time the foundation sits down with Parkland, with philanthropists and, most importantly, with the people served by the public hospital to try to find ways to do things differently — to move into the community where patients reside, learn and work.
“That starts with not seeing people as broken,” Horne said. “Like Brandon’s family, they don’t have the tools. … but the desire is there. We need to help them along the way and give them that agency.”
