This article is part of MI Mental Health, a new series highlighting the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from Genesee Health Systems, St. Clair Community Mental Health, Community Mental Health Association of Michigan, and its community mental health (CMH) agency members. 

Surf the internet and you can find a number of quotes that emphasize the importance of family. “Family unity begins with U-N-I.” “When you fall in life, your family catches you and stands you back up.” These quotes highlight the bonds between a child and their family.

Those bonds are why family engagement in a mental health treatment is vital, especially for children. The family is recognized as an important key in helping a child reach developmental and emotional milestones along with learning healthy social skills and how to cope with problems. 
Robert Sheehan.
“Our community mental health (CMH) system really believes that the families are the best tools to help recovery and help ensure that people function at their highest level,” says Robert Sheehan, executive director of the Community Mental Health Association of Michigan. “Sometimes families cannot be that and so our job is to help a family to become that.”

From cyberbullying to school shootings

According to the Annie E. Casey Foundation’s 2022 Kids Count Data Book, the share of Michigan children struggling to make it through the day rose nearly 26% from 5.8 million children in 2016 to 7.3 million children in 2020. From that same report, 13.5% of Michigan children ages 3 to 17 have been diagnosed with or reported anxiety or depression in 2020 compared to 11.9% in 2016. 

“It's a combination of things,” says Heidi Fogarty, assistant division director for Child and Families Services at St. Clair County Community Mental Health (CMH). 

According to Fogarty, St. Clair CMH went from serving about 540 children a year and half ago to 800 currently. The pandemic has played a role but Fogarty pointed to other factors such as social media that have had a big impact as well. 

“There is a lot of bullying that occurs through social media,” she says. “That wasn’t really a thing 20 years ago.” 

Check-in area of St. Clair Community Mental Health in Port Huron. Another factor has been school shootings. 

“It's hard to assure a child that they're going to be safe at school when they're constantly hearing about school shootings,” Fogarty says.

A parent’s mental health also impacts the child. According to an article in Adversity and Resilience Science, one in 14 children have a caregiver with poor mental health.

As children age, Sheehan says it is important for them to be involved with a parent’s treatment as they are part of the family and experiencing what is happening in the family nucleus. Once a child does understand the parent’s mental illness, they can be supportive, helping with medications or, if old enough, going to work. 

”We don't want to burden the children, but they're already feeling that their mom or dad is struggling,” Sheehan says. “Most kids see it way before the therapist or the employer or anyone else does.”

Genesee Health System Center for Children’s Integrated Services. Supporting the child and the family

In the past, it was common practice to treat only the child because they were the one exhibiting challenging behaviors. However, this can, at times, create an unbalanced family dynamic with the child as the most powerful person in a family or get in the way of parents parenting, Sheehan notes.

Back in the ‘80s, under the system of care model, a family-driven, youth-guided approach, became the agreed-upon model among community mental health organizations. This approach supports and treats the child as well as the family. Another model, the ecological approach gives support beyond treatment, by providing respite, support groups for youth and parents, and guidance. That guidance may extend into other environments such as school — helping teachers and coaches or even Girl Scout and Boy Scout leaders learn how to work with the child.

“It's kind of like the metaphor we've learned with surgery,” Sheehan says. “It's good to get physical therapy after having surgery. It's the same idea. You want a holistic, not a silver bullet, mentality.”

St. Clair Community Mental Health recognizes the family's role in their children's mental health. Building upon the strengths of the family

That family-driven, youth-focused approach is easily seen at St. Clair County CMH.

Like many community mental health organizations, St. Clair offers a broad range of services for families. Services are based on medical necessity. The team considers several factors such as length of the child’s symptomatology and whether the child has been treated before. Using an assessment tool, they determine the level the child is functioning at, which includes mood, any self-harm behavior, and issues in the community or at school.

“We may start a family out with traditional outpatient services that they haven’t received previously. Then, hopefully, the child’s symptoms decrease and the behavior improves,” Fogarty says. “But if it doesn’t, then we have the option to increase their service intensity to something like home-based services, or we could make a wraparound referral at that time.” 

Wraparound services address all needs of the family by connecting them not only with mental health and other health care services but also with community organizations and government services that can address social determinants of health such as food, housing, employment, education, and transportation needs.

According to Fogarty, the key is meeting families where they are at. When the family is actively involved throughout the whole treatment process, St. Clair CMH team members does not push them to do something that they’re not comfortable doing.

“Sometimes, we can offer a family home-based services and they feel like that may be too intrusive or too intense,” Fogarty says. “They don't really want a service provider in their home. So, we would start out with outpatient services at that point.”

St. Clair provides a number of ancillary services such as occupational therapy, dietary counseling, personal trainers, respite providers, and community living support. 

“We utilize a strength-based approach with our families to highlight what those strengths are and how we can build on those strengths to address some of the areas that need to be addressed,” Fogarty says.

Making care easy and accessible
Tabatha Bassey, Genesee Health System clinical supervisor.
“We're just trying to make services in Genesee County easily available,” says Tabatha Bassey, clinical supervisor for Genesee Health System (GHS). 

After establishing a Behavioral Health Emergency Care about two years ago, GHS expanded this fall with the opening of the Genesee Health System Center for Children’s Integrated Health Services. The new facility is a “one-stop” facility that hosts all GHS family programs for children from birth through age 18 and soon will include a health clinic. 

“Mental health is a huge world,” Bassey says. “Families don't really know what they need. That's why they're coming here. It is nice that they can get all the services, medication, ABA therapy, and case management all in one place.”

GHS offers a range of programs. Simple case management can involve checking in with the youth and family, providing resources, and helping to advocate for the child’s and family’s needs. At the other end of the spectrum, intense, home-based services can involve four hours or more of service per month in addition to doctor and psychotherapy visits.

A child and family goes through a lengthy intake process, which is designed to help staff determine the best treatment options. By having everything housed in one building, a staff member with a question about autism testing can now simply go down the hall. Also families need only go to one location for a variety of programs instead of having to take several days off work to go to different locations..

While GHS has a new building, most of its services are provided in the community. Expanded programs in the schools help with crisis situations. All programs focus on giving families tools to help them and their children be successful.

“I might be biased, but we have seen awesome results of evidence-based practices that we use, which are very, very data driven,” Bassey says. “It's amazing when you see the results — like when foster families [who were] thinking about putting in their notices because kids have high behaviors and then they end up adopting. It's the absolute best feeling.”

Joanne Bailey-Boorsma has 30-plus years of writing experience having served as a reporter and editor for several West Michigan publications, covering a variety of topics from local news to arts and entertainment. 

St. Clair CMH photos by Nick Hagen.
Robert Sheehan photo by Roxanne Frith.
Tabatha Bassey and Genesee Health Systems photos courtesy Genesee Health System.

The MI Mental Health series highlights the opportunities that Michigan's children, teens and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, Genesee Health System, Mental Health Foundation of West Michigan, North Country CMH, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, St. Clair County CMH, Summit Pointe, and Washtenaw County CMH.