Johns Hopkins All Children's president on pediatric mental health: 'We're just beginning to scratch the surface'

Alicia Schulhof is the first female president to lead St. Petersburg, Fla.-based Johns Hopkins All Children's Hospital, a role she assumed July 26. Ms. Schulhof spoke to Becker's in September about her goals for the hospital and how she prepared for the position.

Editor's note: This interview has been lightly edited for clarity and cohesion.

Question: What are some of the trends you're noticing among pediatric patients as far as the delta variant is concerned?

Alicia Schulhof: As you might imagine, the delta variant is the predominant strain in our community. Since the beginning of July, we've really seen a dramatic increase in overall pediatric patients presenting to the hospital and testing positive for COVID-19. In August alone, 516 children tested positive for COVID-19, and there were just over 180 positive tests in July. So while many of those children are diagnosed in the emergency center and discharged to manage symptoms at home, the hospital still has about 20 patients on average with COVID-19 on hospital beds each day, with half of those cases in ICU. So while most children we see through our emergency center that are testing positive can manage those symptoms at home, we continue to see an increase in the number of children being hospitalized for COVID-19 as well as those in intensive care. We're seeing both healthy children and those with underlying conditions being admitted. Almost all of the children being hospitalized for this disease in our hospital are not able to be vaccinated since they are under 12, and therefore not eligible to receive a vaccine. So that's why we continue to encourage those 12 and up to get that vaccine. We also encourage everyone in our community to wear masks at school and anywhere else indoors to help prevent the spread of this really terrible disease.

Q: What do you think are the top three challenges children's hospitals are facing at this time? 

AS: I think, first and foremost, all of us are facing this pandemic together. And so we have to work together to help one another through it. But as we've seen in the state of Florida, and as we've also seen nationally, there's a real staffing challenge for everyone across the country, and it's not unique to healthcare. So I think [we have] to come together and continue to help one another think creatively to draw more people to healthcare. [Addressing] burnout and the well-being of our staff is equally important.

We are still in this pandemic, and I think that we're just beginning to see how the mental health crisis is affecting our staff and our patients. We were already in a situation where mental health was a top priority for our pediatric patients, but I think the pandemic has certainly highlighted that as another significant challenge that we're all facing.

And then third, I think, is how we continue to reimagine medicine as it will be delivered into the next decade. And so again, very highly influenced by the pandemic, but I think of how we continue to leverage technology to serve more patients and meet patients where they are. So I think about avenues like telemedicine and I think about other technological advances and how we can bring healthcare closer to our patients and work with our community to best serve our patients and our families.

Q: Arkansas Children's Hospital CEO Marcy Doderer told Becker's she is noticing a disturbing rise in pediatric patients with mental illnesses brought on and exacerbated by the pandemic, as well as a disturbing rise in eating disorders among pediatric patients. Are you seeing that as well among teenagers and young people who come to your hospital?

AS: We are, and what I'd say I'm even more concerned about, frankly, is those that we're not seeing. I think that it is even more prevalent than what we are seeing. We're seeing it, the rates are increasing, but I am concerned by the number of patients that haven't even knocked on our doors yet because we're still in the midst of a pandemic. I think that's why it's so important from a mask and vaccination standpoint, but then also on top of that, to get kids into their primary care, to keep up on vaccinations and keep those well-checks going, because that's where we're going to begin to identify their mental health and behavioral health needs. And again, I think we're just beginning to scratch the surface. I think this is an area that we're all going to have to partner on into the future, but I share her concern and her passion for saying, we've got to elevate this as an area of national attention.

Q: What are some of your biggest goals over the next year as president of All Children's?

AS: I got here at the end of July, so I've spent the first few months at Johns Hopkins All Children's really focused on meeting and getting to know our incredible team, observing what's happening in the hospital and in our clinics, and listening to our team. I spent the first week on the job staying at the hospital, sleeping there so that I could experience the environment as a family member does, and spend time with our night shift team. I'm awed by how hard these team members have been working and also responding to the global pandemic. That really gave me a great sense of priority. I think for those reasons, my very top priority is focusing on the care of our team.

We know that there are staffing challenges across the country due to the rise in COVID-19, and we recognize that our team members are feeling those high levels of burnout and stress caused by the pandemic and the unique toll it's really taken on our healthcare workers, especially here in Florida. So we at Johns Hopkins All Children's offer many resources for well-being and are currently encouraging staff to take time to care for themselves. But we'll continue to work with the team to address the challenges. Our leadership team is actively working on focused areas. So we have teams focused on recruitment and retention and well-being activities along with identifying some long-term solutions to staffing. So that's one kind of big bucket, if you will. 

In my short time here, it's been evident that our team consistently provides exceptional and compassionate care to our children and families. And I want to continue to enhance our strong operations with a heavy focus on access. It's important to ensure that we're not only providing the best care possible, but families can access care where they are and when it's convenient for them, and get the right care for their child. 

And then the third goal, as we look to prepare for the future, is to develop the vision for our next five years. So we've started a listening tour around the organization, which is helping our team brainstorm ideas to kick off the new strategic planning process. It's essential that I take the time, and that our team takes the time to hear from staff and patients and families what's working well and how, and where we can improve in order to provide that best care to our children and communities. Our mission is to expand our mission, which is treatment, education, research and advocacy.

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