October 20, 2021 by Carolyn Campbell Nugent Good News
Where can families turn when their very young children need help with mental or emotional issues? For nearly 60 years, The Children’s Center, a nonprofit organization in Salt Lake City, has provided mental health care to enhance the well-being of infants, toddlers, preschoolers, and their families and caregivers—regardless of their ability to pay.
When toddler Ezra Blackham exhibited behaviors that his mother, Sonja Blackham, felt were “more than something he would just grow out of,” she followed the suggestions of two preschool teachers and a pediatrician. She took Ezra for an assessment at The Children’s Center, where he later began mental health and family therapy.
Ezra’s therapy started when he was 3. years old and continued until he was 7. And the coping skills that Ezra, now age 9, learned at The Children’s Center continue to help him navigate life today.
Blackham explains, “My family has a history of mental health issues, including suicide. As a mother, it was important to me to help our son know how to care for his mental health. I knew that I was okay with therapy and wanted to seek it out.”
Blackham explained that Ezra has a lot of anxiety and gets scared easily. “The thought of getting into trouble puts him in a tailspin,” she shares. Once, Ezra said, “I don’t want to be on this earth because I make everyone else miserable.” Another time, he told his mother, “I’m afraid Jesus doesn’t want me.”
Ezra’s temper flared when things didn’t go his way at preschool, and he became extremely uncooperative. “Little kids grow out of biting and hitting, and he continued those behaviors longer than we thought was normal,” says Blackham. She and her husband observed that they could reason with Ezra’s older sister if she lost her temper. “We could talk her out of it eventually and let her play it out, but Ezra would just stay in it the whole day.”
Because Ezra’s behavior affected the whole family, the Blackhams chose to begin family therapy. “We went once a week and then twice a month. Our daughter went with us, and my husband came sometimes,” says Blackham. “We learned how to incorporate coping tools into our daily lives.”
HELPING THOUSANDS OF UTAH FAMILIES
Founded in 1962 by Dr. Agnes M. Plenk, The Children’s Center began as a nursery school in a community church. One little boy was quite disruptive there. Plenk felt compelled to explain to his parents that he could no longer attend. His mother was highly distressed. She said, “You are the one person in the community who has the training to help us, and you’re turning us away?”
This conversation was transformational—it inspired Plenk to create The Children’s Center. Often known by her nickname of Agi, Plenk was “a woman ahead of her time,” says Rebecca Dutson, president and CEO of The Children’s Center. “She understood that the benefits of going upstream (beginning therapy at a young age) could change the trajectory of children’s lives.”
The Children’s Center has been a fixture in Utah for 58 years and provides care for more than 2,000 children, families, and caregivers each year. The organization has grown to employ a staff of more than 100 people who are dedicated to helping Utah families.
“The Children’s Center is a living, breathing agency that is committed to finding new and creative ways to help our community and the families living in it,” says Jennifer Mitchell, vice president of clinical strategy and innovation. She explains, “We see many behaviors that are considered typical for young children, such as anxiety around separation or challenges in meeting typical milestones or daily tasks such as eating or toileting.”
On the surface, these might seem like average challenges. But there could be other complicating layers that are more intense than a child knows how to handle. Some families bring children with behavioral intensities such as “anxiety so severe that a child can’t ever separate and cries in childcare for hours,” says Mitchell. “We don’t want parents to become stuck in a cycle of wondering, ‘Is it bad enough to ask for help?’ We would rather that they go ahead and ask for the help.”
She explains that fewer diagnoses are appropriate for young children than for older children or adults since young children cannot articulate their internal experiences in ways that older children and adults can. They also have little control over their environment. “As a result, many young children present with similar challenges or behavioral concerns, including eating, toileting, sleeping, tantrums, defiance, and delays with reaching developmental milestones,” says Mitchell. “They have limited ability to speak for themselves, if they even have words at all, so much of the evaluation comes from direct observations and reports from parents and caregivers.”
Many early experiences can affect a child’s development and functioning, including development in utero, delivery, and their caregivers’ well-being in the first few years of life (the most critical period of brain development). “The challenge in diagnosing young children is to look beneath the surface and get as much information as possible about the child’s environment and prior history,” says Mitchell.
Are there signs that a parent can look for that may indicate that seeking a mental health diagnosis might be a good idea? Mitchell suggests that caregivers can seek support when they are worried or unsure about anything related to their child’s well-being, rather than initially focusing on seeking a mental health diagnosis. “Talking with a trusted healthcare provider, such as a pediatrician, is a great place to start if caregivers are wondering about their child’s behavior or development.” She says that the healthcare provider can offer context for typical development and suggest resources and referrals if needed.
“All children have periods in their development where they struggle, so it is important to note the duration and intensity,” says Mitchell. It’s also important to consider the child’s quality of life. For example, are they enjoying typical activities such as age-appropriate play and peer interactions, sleeping and eating as expected? It’s valuable to consider whether the child’s challenges impact the family’s quality of life. (Do they avoid activities due to the child’s behavior?) She advises, “I encourage all caregivers to listen to their gut. They are the experts on their child. If something worries you or seems off, ask a healthcare professional.”
A young child’s sense of safety and well-being comes from their caregivers, says Mitchell. “They take their cues from them. If a caregiver is struggling, distressed, or worried, that may impact their interactions with their child and potentially their relationship. It’s important that caregivers not feel alone in parenting. There are providers available to answer their questions and offer support if needed.”
Sometimes it’s a new concept for people to think that such young children have mental health needs.
“Once they stop and think about this, they realize that it’s true, just like we all have physical health needs,” says Dutson. “I will say that not every child and family needs our services. People come in for an assessment to make sure that we can provide them with the help they need.”
The center’s team of clinicians, psychologists, and psychiatrists are extremely skilled in using evidence-based treatment and trauma-informed practices. “It is very individualized and tailored to each child,” says Dutson. “Science tells us that when we work with very young children, they are highly resilient. When you give children the tools that they need to express themselves appropriately to advocate for their needs and interact with their peers, all of those skills go with them throughout their lives.”
The services are “wrap-around” and include caregivers and siblings. All participating children and their families and caregivers are engaged in outpatient therapy; clinicians refer children who need additional assistance to the Therapeutic Preschool Program, which provides intensive daily treatment.
During family therapy, Ezra and his family received a toolbox filled with coping tools. “It was a physical box, made from a shoebox, filled with little cards. We learned how to incorporate these tools into our daily lives,” Blackham recalls. One card depicted rainbow therapy, where Ezra imagined placing his feet in water, then envisioned a rainbow moving across his body. Another card represented a robot rag doll. When incorporating that tool, “Ezra would go really tense and squeeze his body (tight like a robot). Then he let his body relax (like a rag doll),” says Blackham. Ezra’s “special place” was a swimming pool with his sister, mom, and dad. “When he felt scared or anxious, he could think about this special place,” says Blackham. He also learned “cookie breathing,” in which the participant imagines the smell of fresh-baked cookies.
“You breathe in as you put them in the oven and then exhale or blow on them to cool them,” says Blackham. “Ezra called it ‘sausage breathing’ because he would rather have a sausage than a cookie.”
Blackham explains that while Ezra took a long time to utilize the coping skills consistently, as time passed, he began to recognize when he was becoming angry. “While I don’t think he consciously pulls out the robot/rag doll coping tool, I still see him tense up and then let his body relax.” She adds, “He doesn’t lash out the way he did when he was younger. He can talk about his feelings and recognize what he is feeling—angry, frustrated, or even just happy.” She says Ezra’s most significant takeaway from the therapy is that he can now put words to his feelings. “That helps with communication in the family. I think it is vital to talk about mental health—to not be ashamed of it. Mental health issues are more prevalent than we know. So many people are just afraid to talk about it.”
After Ezra aged out of The Children’s Center, he continued therapy “because he enjoyed it so much,” says Blackham. “He felt comforted by that support, that somebody outside of Mom and Dad talked to him about his feelings.”
CREATING A SENSE OF HOPE
Mitchell says, “At its core, the center focuses on supporting young children and their families by creating a sense of hope, no matter what their challenges are.” Speaking of The Children’s Center itself, Blackham says, “There is so much support and love that comes out of that building that it can benefit any child (for whom the assessment deems appropriate) from the smallest behavior such as anxiety. When families take advantage of the therapy when children are little, building that kind of support in a little person’s mind will only benefit them in the long term.”
Blackham says that she didn’t have a job when their family began therapy and that her husband was self-employed, so she is grateful that The Children’s Center operates on a sliding scale that made their participation possible.
“Therapy is expensive, and insurances don’t always cover it,” she says. Because the center is a nonprofit, they can subsidize costs for families who usually wouldn’t be able to afford traditional counseling.
“We do not turn away any child or family who needs our services,” says Dutson.
For her final MBA project at the University of Utah, Blackham completed a consulting project. She assembled a team that included data analysts, a financial professional, and a doctor. She served as a marketing specialist.
“We chose to do our project for The Children’s Center.” In the end, the four team members were “so touched by what The Children’s Center did and does for the community that we dedicated our graduation gifts from friends and family to them, raising just over $2,000.” She adds, “It gave our team a chance to give back to someone who could use it and provided me with a way to personally give back to The Children’s Center, who helped me so much with their sliding scale program.”
As for Ezra, “He kind of loved the pandemic. It gave him a chance to be at home, away from all of the crazy, anxiety-inducing things that happen at school,” says Blackham. “But he is back at school now. He recently made a great new friend and scored 100 percent on a spelling test. We need more organizations like The Children’s Center to support the mental health of children, starting at a young age.”