November 12, 2020
Operation of The University of Alabama Brewer-Porch Children’s Center transitioned October 1 from the University’s College of Arts and Sciences to its College of Community Health Sciences. Brewer-Porch provides behavioral health care and educational services for children, adolescents and their families both locally and from across Alabama.
The CCHS Department of Psychiatry and Behavioral Medicine will be directing day-to-day operations of Brewer-Porch. Department faculty include psychiatrists, psychologists and other providers with experience and expertise in child and adolescent mental health care, and who also practice at University Medical Center, which the College operates.
With the transition, Brewer-Porch also stands to expand its role as a teaching and research site for UA students and as a venue for developing innovative approaches to clinical practice in children’s mental health, with the potential of becoming a national leader in the care of children with behavioral health needs and their families.
Dr. Thad Ulzen, chair of the Department of Psychiatry and Behavioral Medicine, sat down recently with CCHS dean, Dr. Richard Friend, to talk about the transition and future plans for Brewer-Porch.
RF: Tell us a little bit about what you do for the College of Community Health Sciences and University Medical Center.
TU: I am the chair of the Department of Psychiatry and Behavioral Medicine, and I am the associate dean for Academic Affairs for the College of Community Health Sciences.
RF: Your expertise is in mental health care. What areas of mental health care do you specialize in?
TU: I’m trained as a child and adolescent psychiatrist, so that’s my subspecialty interest. I also have a lot of interest in telemedicine and global mental health. Within the population of children, most of my clinical interests have been in the area of ADHD (Attention Deficit Hyperactivity Disorder) and disruptive behavior disorders.
RF: How has COVID-19 impacted your department and our psychiatry clinic at UMC?
TU: When the pandemic hit, our first response was to set up a crisis response team so that front-line workers and first responders had a place they could call for support in this new and evolving situation. We had already been doing telehealth, and when the pandemic came it became clear that we had to do a lot more. We’ve ended up seeing more patients now during the pandemic than we did before because we ramped up our telemedicine response.
RF: Brewer-Porch Children’s Center has transitioned from UA’s College of Arts and Sciences to CCHS and will be part of your department. Tell us about Brewer-Porch.
TU: Brewer-Porch is a full-service children’s mental health center. There are very few in the country, so it’s very special that we actually have a program like this within The University of Alabama. We are very gratified that it is now in the College of Community Health Sciences because it is essentially a health-care facility for children. We expect that we will be providing a lot of services that maybe were not previously available, particularly direct psychiatric care for the children, and we will also have access to other disciplines from CCHS, like psychology and social work, and we will be putting together a lot of synergy between what we have in the College and what Brewer-Porch will need.
RF: What is the mission of Brewer-Porch?
TU: Brewer-Porch is a facility that is best described as a tertiary center for children’s mental health. It’s not a walk-in place, but it’s a place that is set up to support children who have serious mental problems, and their families, that are not often able to be supported on an outpatient basis. It’s also not a hospital because you want children, even though they’re away from home, not to feel like they’re in a place where they’re being kept. You want them to thrive in an environment that is essentially a home away from home where they can get better.
RF: Brewer-Porch has been around for 30 or 40 years, hasn’t it?
TU: I believe it was founded sometime in the 1970s, and it’s always been part of (the College of) Arts and Sciences. During the last 10 years or so, our College (CCHS) has been involved and providing psychiatric services on a contractual basis.
RF: What about COVID-19 and Brewer-Porch and keeping the children safe? What kind of special protocols are in place there?
TU: Because we were already working there, when the pandemic started, there were medical personnel on the scene. Together with the director of mental health for the state, they put together a COVID-19 Crisis Task Force that met regularly right from the beginning, set up the protocols and made sure that the center was in compliance with Alabama Department of Public Health requirements. They set up screening and improved sanitation. Children are allowed to visit their families, but they get tested at University Medical Center before they go back (to Brewer-Porch). It has been very safe for the children at Brewer-Porch.
RF: Talk about the services offered there and why they’re so important.
TU: Mostly mental health services – mental health care spanning outpatient day treatment programs, shorter-term residential stay and longer-term residential stay as needed by the child and family. Children have had their primary health-care needs met, usually outside the center, but with UMC and CCHS taking over, we will be providing primary-care services at the center, so the children won’t have to travel out for those services.
RF: What are the age groups of children that Brewer-Porch serves, and what kinds of mental health issues are they dealing with?
TU: Generally, children ages 6 to 18 are served at Brewer-Porch. Clinically speaking, children who need Brewer-Porch services are children who have had fairly significant adversity in their lives and in the lives of their families. Often, they have issues related to exposure to trauma, or being traumatized, or other deprivations because of family disillusion. They’re often children who need nurturing and a lot of stability. A place like Brewer-Porch allows children to be in a stable place long enough so that a comprehensive treatment plan is formulated for them to help them get to their next stage of development safely.
RF: And Brewer-Porch is not just for children from this region but for children from all over the state.
TU: That’s right.
RF: Are there other faculty and mental health care providers in your department who have expertise in child psychiatry?
TU: Yes. We have four child psychiatrists. Our plans include having them be engaged with Brewer-Porch through different programs there over time. So, we’re going to be able to offer more direct care.
RF: Tell us how our College has been involved with Brewer-Porch in the past.
TU: Dr. Marisa Giggie, assistant professor in our Department of Psychiatry and Behavioral Medicine, has been the core contact with Brewer-Porch, and it’s been an important one because it’s allowed us to have a good sense of what has been needed by the center over the last few years. Now, with the center coming within CCHS, we already know that it has been doing a lot of good work but could do even more with the resources of our College.
RF: Now that Brewer-Porch is officially under CCHS, what changes do you anticipate, and what safety precautions will continue because of COVID-19?
TU: With respect to COVID, I think things are well under control. A good task force has been established, they meet regularly, and the results have been very good. The way I view child psychiatry is that it is the public health arm of psychiatry; it is preventive psychiatry. Those of us who see children are very interested in finding out what’s wrong as quickly as possible and build supports around children as quickly as possible. Even though Brewer-Porch is a residential center, now that it is within our College, we are going to look at ways to expand outpatient services at Brewer-Porch, and also look at reaching out into the community to offer preventive programs so that we don’t have to wait until children get into a really bad place before we have contact with them. We will definitely preserve what’s at Brewer-Porch, but we want to build more community connections. We would like to see families more involved when their children are there, using telemedicine so that they can keep in touch with their children, and children can keep in touch with their parents even though they’re not at home. We want to enrich what’s going on there and have more community involvement as well.
RF: Tell us what you’d like to see at Brewer-Porch in the long term.
TU: For the children you get at a place like Brewer-Porch, trauma is very much their life experience. One of our main interests is to offer consistent and continuous training in evidence-based trauma interventions for children. We want to have everybody on the same page around trauma theory, about the best way to nurture and treat children who have experienced trauma. We’re hoping to bring in an outside consultant to help us, in consultation with staff and folks already at Brewer-Porch, to develop such a program for the center.
RF: With COVID, we’ve seen a lot of depression and anxiety. Have children also been affected and are you seeing more of that in your private practice and at Brewer-Porch?
TU: Yes. This has been very difficult for children. A lot of children have presented with more anxiety and more uncertainty about what the future looks like for them. And children like to be with other children but because of COVID they can’t. Even though children love their families they love their friends more. Not being able to be with their friends has made it difficult for children and, particularly, for adolescents whose lives are often outside the home. It’s a challenge across the board and that’s become evident to mental health practitioners since the pandemic started.
RF: You’ve seen global pandemics and political unrest in other countries and the impact this has on children. What kind of long-term consequences can children have from these experiences?
TU: What’s happening now reminds me of what happened to a lot of children during the Iraq War because it was the first war that was televised. Everyone had it on television and children were watching and getting nightmares. We know now that large-scale changes around the world affect children, even though they may not talk about it. They are conscious of what’s going on and worry about what’s going to happen next. Finding ways of talking with children about COVID in ways that reduce their anxiety and offer them hope for the possibility of returning to normal as soon as possible is really our goal.
RF: Do you expect to see more ADHD with interactive learning at home? I imagine there are some children who aren’t good learners in that setting and really need a face-to-face setting. What kinds of things can we expect there?
TU: A lot of parents have discovered that they’re not teachers and they are with helping their children at home. We’re also diagnosing new cases (of ADHD in children) because of this.
RF: Do children with ADHD respond better, in general, to Zoom-type interactions, or to person-to-person interactions?
TU: It really depends on how that is structured. A lot of children with ADHD like interactive video formats, but they like that in play, which is very different from using that for work or education. And even though they like that, parents still have to be around to keep them on task. It’s new for all of us and parents are talking about it a lot, actually, and we’re learning a lot from them.
RF: Tell us more about plans for Brewer-Porch moving forward now that the transition has occurred.
TU: We’ve started by meeting with staff at Brewer-Porch and learning from their experiences has been helpful. We’re learning what things have been challenging, and seeing how best we, as a College, can bring our resources to bear on those issues – enriching the positive things and trying to help solve the problems. It’s going to be a period of learning for all of us, and the staff at Brewer-Porch will also learn how our College approaches issues. It’s going to be learning from each other and setting a path forward together.
RF: What do you see are the short-term and long-term goals for Brewer-Porch?
TU: Short-term goals will be mostly around training everybody in evidence-based trauma interventions for the children and doing that as soon as we can so that we have a philosophy to guide our work in treating and supporting the children. Long term, it’s going to be expanding our community outreach with schools. Brewer-Porch already has relationships with schools, and we hope to expand those. Some programs that have disappeared, like the autism program, we’re trying to see if we can get some of those back. Then there’s adding more evidence-based screening tools and approaches so that we can measure outcomes at the end, so we’ll know what we have achieved for these children. The staff at Brewer-Porch will have input into these ideas as well. In addition, we hope to attract research funding for community-based intervention research. CCHS has experts in community medicine and population health who will help us bring Brewer-Porch to its potential as a research center.
RF: CCHS has learners at the undergraduate, graduate and post-graduate levels. We have medical students, residents, fellows. Tell us about learning opportunities that might be available for learners at CCHS and across campus.
TU: I trained at a center like Brewer-Porch as a psychiatry fellow, so it brings back good memories for me. There are opportunities for learners in all kinds of health disciplines – pharmacy, psychology, social work, nutrition. Brewer-Porch is really going to expand opportunities for learners in formal programs and also for young people who want to get into health care and who want to shadow and learn about health care in a different setting. I think that the sky is really the limit.
