Moving Childhood Mental Health Interventions Upstream
Post Date: May 2, 2025 | Publish Date:
Mental and Behavioral Health
Research Annual Report 2024
As the nation grapples with a childhood mental health crisis made more severe by the COVID-19 pandemic, leaders at Cincinnati Children’s are investing in research efforts and structural improvements that can move diagnosis and treatment further “upstream” to help more children receive support before their problems become severe.
Several of these efforts were summarized in a report published online in The Journal of Pediatrics, including more than $100 million in facility improvements, sweeping practice changes affecting dozens of community pediatric offices, school health services and primary care clinics, plus tapping into the power of one of the world’s largest supercomputers to create a novel mental health early warning system.
“Our blue-sky goal is to eliminate pediatric suicides by 2033,” says the study’s corresponding author Tina Cheng MD, MPH. “To achieve that goal, we are moving away from a primarily reactive approach to care to a much more proactive approach. The work started here more than six years ago is building a strongly integrated system of care that focuses on early prevention while providing truly innovative ways to serve children and families in crisis.”
Cheng is director of the Cincinnati Children’s Research Foundation, chair of the Department of Pediatrics, and chief medical officer of the health system. Co-authors of this study include several leaders who have worked for several years to launch the transformation: Lori Stark, PhD, former director of Behavioral Medicine and Clinical Psychology; Michael Sorter, MD, former director of Child and Adolescent Psychiatry; Tracy Glauser, MD, associate director of the Research Foundation; Jessica McClure, PsyD, medical director for population behavioral health; Katherine Junger, PhD, associate medical director for population behavioral health; and John Pestian, PhD, MBA, director of the Computational Medicine Center.
Ongoing systemic transformation is building on four foundational changes:
- The Project ECHO virtual training program for front-line caregivers
- Embedding psychologists and other professionals within clinics and practices
- Rethinking crisis care by creating a Bridge Clinic and an Intensive Outpatient Program that help divert patients from the emergency care to more appropriate settings
- Investing more than $10 million in an artificial intelligence-enhanced early detection system to help more children at the highest risks for anxiety, depression and suicide.
Ambitious Goals for New Mental and Behavioral Health Institute
To carry out these and other changes, Cincinnati Children’s also has launched its new Mental and Behavioral Health Institute, supported with a generous $15 million gift from The James J. and Joan A. Gardner Family Foundation.
The institute will drive a deeper integration of three divisions at Cincinnati Children’s: Behavioral Medicine and Clinical Psychology, Child and Adolescent Psychiatry, and Developmental and Behavioral Pediatrics. It also will encourage enhanced collaboration with all clinical divisions and many research divisions at Cincinnati Children’s.
Combined, the three mental and behavioral care-focused divisions include more than 1,000 care professionals who work throughout the community, including schools, neighborhood primary care clinics and emergency departments, and a state-of-the-art care center opening in October at Cincinnati Children’s College Hill campus.
“It is no secret that our children and teens are struggling like never before and have an unprecedented need for anxiety and depression care,” says Steve Davis, MD, MMM, president and CEO, at Cincinnati Children’s.
New Leader for New Institute
On Feb. 24, 2025, Laurel K. Leslie, MD, MPH, previously vice president of research at the American Board of Pediatrics (ABP), became the inaugural director of the new Cincinnati Children’s Mental and Behavioral Health Institute (MBHI).
“Dr. Leslie’s extensive pediatric leadership and proven experience in pediatric mental, behavioral and developmental health makes her the ideal choice to direct our Mental and Behavioral Health Institute,” says Tina Cheng, MD, MPH. “Her expertise and passion for improving pediatric mental health care will help us advance our aspirations as the leader in improving child health.”
State-of-the-Art Mental Health Facility Up and Running
The William K. Schubert, MD, Mental Health Center at our College Hill campus opened to patients in October 2023. The five-story, 160,000-square-foot building makes Cincinnati Children’s the largest inpatient mental health provider of any children’s hospital in the United States.
“This building is a giant step forward in what we are able to do for children and families. It will house an expanding group of programs that will provide the most advanced evidence-based care for children and adolescents,” said Michael Sorter, MD, former director of the Division of Child and Adolescent Psychiatry. “These programs will reach far beyond the walls of the hospital and throughout our community to improve outcomes for children and families.”
Mental Health Progress Highlighted by White House
Cincinnati Children’s leadership in improving childhood mental health outcomes also has been recognized at the highest levels.
In June 2024, the White House Office of Science and Technology Policy collected and shared a collection of actions being taken by government agencies, the private sector, nonprofit organizations, and academia to respond to America’s mental health crisis. The communication specifically praised the integrated behavioral health care training program at Cincinnati Children’s.
“These actions address key research priorities and move us closer to a future where every American has access to the best available care when and where they need it,” the White House communication states.
AACAP 2023 Showcases Cincinnati Children’s Expertise
A small army of Cincinnati Children’s experts traveled to New York City in October 2023 to share their knowledge at the American Academy of Child and Adolescent Psychiatry (AACAP) meeting.
Topics ranged from updates on bipolar disorder, ADHD, medication adherence and pediatric catatonia to preventing violent behavior at schools. Cincinnati Children’s experts at the meeting included Ashley Marie Berry, MD, Melissa DelBello, MD, MS, Ernest Pedapati, MD, MS, Suzanne Sampang, MD, Craig Erickson, MD, Brian Kurtz, MD, Kelli Dominick, MD, PhD, Almeria Decker, MD, Katherine Soe, MD, Jeffrey Strawn, MD, Tanya Froehlich, MD, MS, and Sam Vaughn, MD, PhD.
Early Behavioral Health Problems Need Earlier Interventions
Further underpinning the need to move care “upstream,” data from more than 15,000 lower-income children ages 2 to 6 reveals higher-than-expected levels of significant behavioral dysfunction, according to a six-year study led by Robert Ammerman, PhD, and colleagues.
Experts have long reported an association between family stresses and
child behavioral problems. Even so, the early ages of onset and severity of
behavioral problems were unexpected, findings published in JAMA Pediatrics.
Study Reviews School-Based Suicide Prevention Programs
Many experts see school environments as vital settings for both detecting and addressing the needs of children at high risk for suicide. A study led by Landon Krantz, MD, published in the Archives of Suicide Research, evaluated 12 school-based suicide prevention programs across several factors, including cost, resources needed for implementation, age appropriateness and other demographics.
The research team evaluated the programs using the Let Evidence
Guide Every New Decision system (LEGEND), developed by the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s.
The findings show that one size does not fit all. A key concern: once schools start a program, do they have the capacity to sustain it?
“Many of these programs are feasible to implement and have been implemented in the U.S. and other countries,” Krantz says. “Schools wanting to start suicide prevention programs should assess their capacity to handle an increase in students needing resources and establish formal policies for suicide prevention.”
Improving Hospital and Clinic-Based Suicide Risk Screening
At Cincinnati Children’s, leaders began rolling out a two-tiered screening process for assessing suicide risk in July 2023.
The first step: using the National Institute of Mental Health’s screening tool, Ask Suicide-Screening Questions (ASQ). When positive results occur, teams then use the Columbia-Suicide Severity Rating Scale (C-SSRS) to conduct a more detailed risk determination.
The results, including updated safety plans, then become integrated into electronic medical records that can be shared securely among care providers and families via MyChart.
“With the recent rollout of screening for suicide in children 8 and older
across all our levels and sites of mental health care, and tools within the
medical record to help facilitate safety planning, we are increasingly able to ascertain and respond to the needs of our patients and families,” says Brian Kurtz, MD, who led efforts to implement this process improvement.
Learn more about our latest research in mental and behavioral health
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About this blog
The Research Horizons blog features news and insights about the latest discoveries and innovations developed by the scientists of Cincinnati Children's. This blog does not provide medical advice, diagnosis, or treatment.
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