On the outside, seventh grader Cady was a regular, busy suburban kid. She played two musical instruments, had a stable home life and was getting good grades. But life wasn’t perfect –– Cady had just started at a new middle school and was having feelings that she couldn’t quite identify.
Then, at her annual checkup, Cady filled out a depression screening form, something her Children’s Hospital of Wisconsin pediatrician had recently started giving all her teen patients. Cady’s answers showed she was experiencing signs of depression.
Now 16, Cady reflects back. “I think I had been dealing with depression and anxiety since about fifth grade. But I didn’t know much about mental illness and I didn’t think it could affect me.”
Barbara Calkins, MD, Cady’s pediatrician at Westbrook Pediatrics, talked with Cady and her parents and they decided to pursue therapy. “Cady hadn’t been showing signs of depression or anxiety,” said her dad, Peter. “But once we started talking, we all realized she needed support.”
Cady’s story is far from uncommon. According to the Wisconsin Office of Children’s Mental Health, one in five Wisconsin kids had a mental health disorder in the last year. Teenagers’ self-reported levels of anxiety and depression are even higher, with nearly 40 percent of kids indicating high levels of anxiety, and nearly 30 percent reporting feeling depressed.
The impact of untreated childhood depression is not only decreased quality of life, but also potentially dangerous and even tragic behaviors including suicide. In fact, Wisconsin’s youth suicide rates continue to increase even more than national rates, part of a crisis that is getting more attention in the media, schools and communities.
Because kids’ mental health is critical to their overall health, Children’s Hospital of Wisconsin primary care clinics began screening kids ages 12 and up at well-child exams in 2016, after piloting the program in several clinics, including the one where Cady is seen.
Dr. Calkins says the simple screening, which is done on paper at the beginning of an appointment, is catching many kids with signs of depression and anxiety who might not otherwise discuss it during their checkup. “This tool helps us open up a conversation that lets kids expand on their feelings and gives us the opportunity to help,” she said.
Now, nearly all kids at Children’s Hospital of Wisconsin primary care clinics are screened for depression. “In 2018, our screening rate was 96.5 percent,” said Robert Rohloff, MD, director of quality and safety of primary care at Children’s Hospital of Wisconsin. “That’s a phenomenal rate.” Of the adolescents screened, doctors are finding significant depression in about 6 percent of kids. “Our pediatricians identified more than 100 kids last year alone who otherwise might not have gotten the care they need.”
That’s 100 other kids like Cady –– who otherwise carry on, or even excel in their daily lives while masking the fact that they are suffering from depression or anxiety.
Cady’s treatment helped. Regular talk therapy gradually gave her the tools she needed to handle her anxiety on a daily basis. “I learned techniques to calm myself, and how to talk to myself if a thought or worry I’m having doesn’t make sense.”
For Cady, one of the greatest gifts is simply recognizing that she has anxiety. “When I’m in a stressful situation, I can say to myself, ‘This is just my anxiety, it’s going to be okay.’”
At Cady’s school, all graduating eighth graders were expected to give a speech. At the tender age of 14, Cady decided to write hers about her journey through therapy and getting support for her mental health. “I wanted to talk about it, because it seemed like no one else was,” she said. “People don’t like to admit that mental health is a taboo subject, but it is.”
Cady wanted to help her peers understand what she was going through. “People with anxiety might be feeling bad or stressed not because there’s something wrong with them, but just because it’s just a condition they have,” she explained.
“As I was going up to do my speech, I was thinking to myself, ‘Hey, I’m kind of putting myself out there.’” Her speech went well, and Cady’s peers accepted it. “A few people even told me they were happy I was talking about it. It was nice to know I was being supported.”
Cady’s parents are also very supportive –– something Cady doesn’t take for granted. “I’m really lucky that my parents are willing to help,” she said. Not all of her peers are so fortunate. “I have a friend who struggles with anxiety, but her parents don’t want her to see a therapist,” she said. “It’s really hard to see that since I know how much it helps.”
Dr. Calkins remains a strong support for Cady, checking in with her at regular appointments about how life and therapy are going.
Cady sees her pediatrician as an important part of her team that supports her. “I’ve always had a lot of trust for Dr. Calkins,” said Cady. “I feel like she’s always looking out for my mental health.”
Since implementing depression screenings for all adolescent patients in 2016, Children’s Hospital of Wisconsin pediatricians like Calkins have also had additional training to help support patients who screen positive for depression or those with other mental health concerns. “Not only do we know how to effectively use the screening tool, but we have a wealth of resources available to us to help us respond. These include suicide prevention information, community resources and information to share with families,” said Dr. Calkins.
One of the most powerful tools is the ability to consult with a Children’s Hospital of Wisconsin psychiatrist on any aspect of a child’s care, including medication, lifestyle and wellness recommendations and diagnosis clarification. The Wisconsin Child Psychiatry Consultation Program started as a pilot program led by the Medical College of Wisconsin in partnership with Children’s Hospital of Wisconsin, and supported by philanthropy. It is now funded by the Wisconsin Department of Health Services and is available to doctors across the state –– and it’s impacting kids throughout Wisconsin.
“Being able to consult with psychiatrists on care for my patients, I’m much more comfortable caring for kids with a variety of mental and behavioral health issues and treating them now,” said Dr. Calkins. “It’s so important that pediatricians be empowered to care for kids’ total well-being, and that includes their physical, mental and social health.”
Despite getting help for her anxiety, life isn’t perfect for Cady. There are still times when, as she puts it, “something doesn’t get communicated well” with her parents. There are still moments of anxiety. But Cady is feeling fulfilled with her busy life as a student and teenager. She still plays the clarinet and the viola in two orchestras, she’s part of her school play, and on top of her schoolwork, she is following her passion for coding, animation and creative writing. She hopes to combine the two passions and become a video game writer or designer.
Her dad, Peter, wonders how Cady’s life might be different now if her anxiety and depression hadn’t been identified and addressed at a young age. “Getting Cady help and giving her the tools to handle her anxiety has been a very good thing,” he said.
As for Cady, she still sees a therapist once or twice a month, and she plans to keep doing it for as long as it’s useful. “It’s good to have someone you trust who knows what they’re doing. It’s been instrumental for me in changing the way I deal with my anxiety.”