Kaweah Health bridges gap for adolescent mental health services

Kaweah Health receives $8.7 million in grant funding, builds 22-bed wing at the mental hospital for children and adolescents

VISALIA – As medical professionals continue to see an increase in the need for adolescent mental health services, Kaweah Health received a grant to build a 22 bed hospital wing for youth, including children under the age of 12.

Kaweah Health Hospital was awarded $8.7 million to create the county’s first mental health hospital for children. The grant will allow youth to receive inpatient psychiatric services closer to home than Fresno, Bakersfield or even San Jose or Los Angeles. The grant will fully fund the construction of a 22-bed wing to Kaweah Health’s Mental Health Hospital. 

According to Cory D. Jaques, MD, a child and adolescent psychiatrist at Kaweah Health, there has been an increase in adolescent anxiety and depression, substance abuse, eating disorders and more since the pandemic. The addition to the hospital will help children have better behavioral health outcomes close to home, which will also save patient families time and money.

“I can tell you clinically, I have seen a huge increase in the number of children coming in for mental health services, and for the types of problems we typically didn’t see. [They] are things that used to be a little bit more uncommon,” Dr. Jaques said. 

Kaweah Health expects to break ground at the end of 2023 or beginning of 2024 with an anticipated opening date in 2025. The new building will be an 8,200 square foot addition to the already existing mental hospital at Akers Street and West Tulare Avenue. The current hospital was built with three wings and was designed for a fourth wing to be added in the future if need be. Inside the new wing of the 22-bed expansion, 14 beds will be for adolescents, while eight will be for children.

“There is a huge need for child mental health services in the valley. Now we will be able to provide these services right here in our own backyard,” Dr. Jaques said.

This addition to Kaweah makes them one of a few hospitals that have the ability to admit children for mental health reasons under the age of 12 according to Dr. Jaques. He said the most common reasons children under 12 would need to be hospitalized is typically for behavioral aggression related to autism or other developmental disabilities.

According to Kaweah Health, in Tulare County, there are about 110,000 residents who are between ages 5-18 and about 20% of those children experience a mental health crisis a year; 1 in 3 of those youth in crisis go without care. Once the doors of the new wing are opened, as many as 684 youth could receive care there in the first year, with that number growing to nearly 1,100 young people in three years.

Currently, options for children in the Central Valley include a smaller hospital in Fresno, as well as one in Bakersfield. The one in Bakersfield does take children under 12, but does not have a lot of bed space according to Dr. Jaques. He said Kaweah typically sends children to the greater Los Angeles area or San Jose for further treatment. He continued to say most California hospitals only have 14 beds or less. In addition to Kaweah, a new development near Valley Children’s Hospital is projected to have 23 beds available, extending the Valley’s reach even more.  

Together, we will have 45 additional beds that didn’t exist in our community, enabling our young patients and their families to stay close to home for care,” Dr. Jaques said. 

Being that there is a lack of resources in the adolescent mental and behavioral health department nationwide, Kaweah’s new facility will be open to anyone. At the new facility, care will be given regardless of insurance status or ability to pay. But in light of demand for such services across the Central Valley, children who live in Tulare County will receive preferential access.

“Sadly, one of the downfalls of the pandemic was that it brought an exponential rise in the need for mental health services for both children and adults,” Gary Herbst, Kaweah Health chief executive officer said. “There are very few inpatient adolescent psychiatric hospitals in the valley so it is wonderful that we will have this for our community.”

Inside the hospital, adolescent patients will receive 24/7 nursing care and work with psychiatrists and licensed therapists like social workers, marriage/family counselors or clinical counselors. They will undergo complete psychosocial assessments, multidisciplinary treatment and individual, group and family therapy. Additionally, patients will work with recreational therapists, registered nurses or licensed psychiatric technicians to receive health education. They will also have the opportunity to work with a special education teacher to ensure that education time is not lost while hospitalized.

Kaweah Health will be responsible for staffing the mental health hospital for youth as well as the new Crisis Stabilization Unit (CSU). They will be able to staff these operations thanks in part to its Graduate Medical Education Psychiatry Residency program, added in 2013, and the new Kaweah Health’s Child and Adolescent Psychiatry Fellowship added to the program created in 2021. Dr. Jaques is also the program director of the child and adolescent fellowship.

Dr. Jaques said the new hospital will require a higher nurse to patient ratio because of its specialty. As Kaweah Health is struggling to find nurses for the general hospital, they don’t have a plan quite yet to make sure they will have enough staff as the project is still two years out.  Currently the hospital’s focus is recruiting nurses in general and as positions open up. 

“It’s not an immediate need. I think right now, we’re really focused on [hiring] critical care [nurses],” Maria Rodriguez Ornelas, Kaweah Health public information officer said. “Definitely in the future, we’ll look into hiring and how we will hire these more trained nurses for the mental health hospital.”

The Child and Adolescent Psychiatry Fellowship Training Program’s mission is to train child and adolescent psychiatrists who will positively impact the health of youth and their families in the Central Valley.  It currently has three fellows and will bring on three more within the next year. Six is its maximum operating capacity according to Dr. Jaques. 

“There’s really nowhere in the country that isn’t underserved in terms of adolescent psychiatry, and certainly here in the Central Valley, it’s very difficult to recruit physicians to come here. And given this is a subspecialty, it makes it even more difficult,” Dr.  Jaques said.

According to Kaweah Health, their psychiatry residency has been successful, with about half of its graduates remaining in the area to practice or get further training. Kaweah Health also offers adolescent therapy at its clinics in Exeter, Lindsay and Dinuba, as well as adolescent and child psychiatry at its Lindsay clinic.

Kaweah Health will contract with Tulare County Mental Health Services for the admission of children and adolescents. The hospital expects the service will be profitable by the end of the second year due to demand for child mental health services in the valley. 

This $8.7 million was awarded to Kaweah Health by the Department of Health Care Services’ through the Behavioral Health Continuum Infrastructure Program. This was the fourth round of funding to improve California’s behavioral health infrastructure for children and youth. Kaweah Health was one of 54 projects to receive funding, totaling $480.5 million granted. 

“Children who need care are currently brought to the emergency room when they are in crisis. The ER can be a relatively chaotic place and relatively scary especially for younger children,” Dr. Jaques said. “These two projects will change child mental health here in Tulare County.”

This is not the first grant Kaweah Health has received in accordance with broadening youth access to  mental health services. Earlier this year Tulare County Health and Human Services Agency (HHSA) and Kaweah Health were awarded a $4.9 million grant from California Health Facilities Financing Authority. The grant was to be used for the creation of a child and adolescent CSU. The 12-bed CSU is expected to open this summer in Visalia and will provide crisis intervention services for children and youth under 21-years-old, 24 hours a day, 365 days a year.

“Eventually [patients from] our crisis stabilization unit will be able to feed right into the inpatient hospital [and those] two things will work together synergistically,” Dr. Jaques said.

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