This article has been edited since it first appeared in print.
(From left) Faith Ghivizzani, Jean Todd and Mercedes Ashworth at the partial hospitalization program in Bon Secours St. Mary’s Hospital
Adolescents are special — just ask any parent who’s lived with a child through puberty and the teenage years. Emotions can run high or be curiously flat. Conversations range from logical and reasoned to bafflingly nonlinear. Friend groups either are superior to parents in every way or present a minefield of social interactions.
Here’s the often overlooked truth: Just as adolescents’ bodies are changing, so are their brains. The difference is that many physical developments are outwardly visible, while the brain’s evolution is hidden, revealed in behavior and emotion.
It’s during this time when behavioral health care needs can be greatest. The U.S. Centers for Disease Control and Prevention regularly assesses the well-being of teens through its annual, nationwide Youth Risk Behavior Survey. Looking at students in high school —grades 9 through 12 — the CDC found that 30% of teens had “persistent feelings of sadness or hopelessness” in 2013; the prevalence rose to 40% in 2023. In 2023, the CDC also found that 20% of students surveyed had “seriously” considered attempting suicide, while 9% had attempted it. “These data bring into focus the level of distress many students are experiencing,” the report states.
But where there’s cause for concern, there’s also care to be found. Locally, adolescents experiencing serious mental health issues have more options for care than they did just a year ago, thanks to new services around the region including a partial hospitalization program at Bon Secours St. Mary’s Hospital in Richmond’s West End, an adolescent Crisis Receiving Center at St. Joseph’s Villa in Henrico County and an adolescent assessment center at Tucker Pavilion, home of HCA Chippenham Hospital’s mental health services. Another adolescent PHP, via VCU Health’s division of child and adolescent psychiatry, will open this month, with a second unit set for a summer 2025 opening.
Taking Stock
“Behavioral health is learning how to be human, simply understanding how our behaviors and emotions impact us,” says Mercedes Ashworth, manager of Bon Secours’ Adolescent Behavioral Health Partial Hospitalization Program. “It sounds obvious, but we’re not always taught how to think about how we’re feeling and how to effectively communicate that.”
Mental health support for teens can look similar to that for adults: visits with clinical providers such as therapists, counselors and psychiatrists who can prescribe medication, if deemed necessary. If extensive treatment is needed, a hospital stay might be recommended. In the middle of the care spectrum fall PHPs, which allow participants to attend intensive therapy Monday through Friday, following hours that roughly mimic a work or school day. The benefit of PHPs, experts agree, is that they allow participants the chance to feel present in their “normal” lives.
“A partial hospitalization program is a beautiful [treatment] hybrid,” says Jean Todd, Bon Secours’ clinical director for behavioral health. “As a parent, you want to do anything to not hospitalize your child. [With the PHP], we can get kids treatment and let them go home at night safely.”
Bon Secours’ program launched in January 2024, welcoming youth ages 12 through 17 in cohort groups of no more than eight who agree to stay at least four weeks. Participants meet at the St. Mary’s unit — which is filled with handpainted murals, colorful artwork and “Chillville,” a room for quiet retreat — Monday through Friday, 8:30 a.m. to 3:30 p.m., with lunch and snacks provided. Teens have group therapy sessions daily; one-on-one and family therapy sessions are held weekly. A psychiatrist helps manage medications, and homebound educators assist with school assignment coordination.
(From left) Employees Faith Ghivizzani, Patrick Nicolas and Gianna Barone in “Chillville,” a room at the youth hospitalization program in St. Mary’s Hospital
Participants may come to the program via a therapist’s recommendation, an inpatient hospitalization or a visit to the emergency room where the right amount of help is determined. “We offer wraparound support with a program that provides structure and mimics the school day,” Ashworth says. “We do a lot of work to prepare patients for their return to home [full time].”
“Kids get support from one another,” says Faith Ghivizzani, a therapist within the program. “They can struggle [individually] and still support one another at the same time. It does wonders for them. They also see how someone else can be carrying a lot and is still able to support them.”
Expanding Options
Conversations about adding an adolescent PHP at Bon Secours began at least four years ago. “We had been referring [patients] to PHP programs that had wait lists,” Ashworth says. “After COVID, we really started brainstorming [about starting our own PHP].”
Seeing the same need, in 2021 VCU Health began to hire additional staff to expand its mental services for teens.
“Mental health, in general, over time, hasn’t been well funded,” says Dr. Jarrod Leffler, chair of the health network’s division of child and adolescent psychology. “That’s the starting point. Then you have an international pandemic. Kids are removed from their daily routines … then anxiety and depressive symptoms are enhanced, and [teens] are isolated; they don’t have a teacher, coach or counselor to turn to. And their parents are trying to work, too. For kids, it was extremely difficult.”
Dr. Ekaterina Stepanova, chair of child and adolescent psychiatry, says inpatient stays are designed for youth who may be at risk of hurting themselves or others. But once stabilized, those patients need other options. “As soon as they’re ready to step down to a lower level of service, that’s the goal,” she says. “Kids should not be in the hospital, because it’s really hard for them to be away from their families. There’s so much need in the community for these types of step-down programs.”
(From left) Drs. Jarrod Leffler and Ekaterina Stepanova are involved with bringing Children’s Hospital of Richmond at VCU’s adolescent PHPs online this year.
There’s indication that Children’s Hospital of Richmond at VCU’s adolescent PHP, which will be housed at the Virginia Treatment Center for Children on Sherwood Avenue, will function similar to Bon Secours St. Mary’s program; the two providers have already been communicating. “This will help kids get out the hospital more quickly,” Stepanova says. “And for kids who come through the ER side, not all of them need to be admitted as inpatients but end up there because that’s all we have. [Once it opens,] they can go into the partial hospitalization program instead.”
Last summer, St. Joseph’s Villa in Lakeside added an adolescent Crisis Receiving Center alongside its adolescent Crisis Stabilization Unit, which opened in May 2012 — the first of its kind in the state. The CSU, which is operated in partnership with Richmond Behavioral Health Authority Region 4, has eight beds for youth ages 5 through 17 who are experiencing a mental health crisis. The maximum allowable stay is 15 days. Much like other PHP settings, the CSU is designed to keep kids out of hospitals.
“A hospital has a stigma attached, [sending the message] ‘I’m sick,’” notes Linda Saltonstall, St. Joseph’s Villa’s senior clinical director. “What has made us stand out is that we really do family work. ... We meet with families at least three times during the visit, with the goal of getting families to start communicating in a better way.”
The Crisis Receiving Center opened in April 2024 to offer emergency room services specifically targeted to adolescent mental health. “You can just go and walk in — like an ER — but you can only stay [at the CRC] for 23 hours,” Saltonstall says. “I always say that CRC is like CSU but on steroids, because they do all the same things — clinical, nursing and psychiatric assessments — but faster.”
Most often, youth who come to the CRC for help are able to return home with a plan to find additional community resources and support, Saltonstall says. “In the worst-case scenario, where a kid needs a hospital, at least we can give them immediate intervention responding to the crisis,” Saltonstall says, noting that research indicates teens benefit most from intervention when a response to a mental health crisis is swift. “There’s no wrong door,” she adds.
Saltonstall credits a previous St. Joseph’s Villa staffer for initially proposing the CRC, which is now operated in a fiscal partnership with Henrico County with additional support from the state. “I’m a big believer in public-private partnerships; they’re win-win,” Saltonstall says. “Henrico County and RBHA Region 4 are great to work with.”
St. Joseph’s Villa also refers patients to HCA Chippenham’s Tucker Pavilion, which has adolescent partial hospitalization and intensive outpatient programs. The Tucker Assessment Center opened in October, offering evaluation to determine the best level of care needed.
According to Joy Singh, director of outpatient behavioral health services for HCA Chippenham Hospital, referrals are coming from community health and wellness providers, as well as local schools, crisis centers and community service boards. Families may also call the center directly (804-483-1331).
Making the Call
The Richmond Behavioral Health Authority is a governmental agency licensed by the state to provide services for mental health, intellectual disabilities, and substance abuse and prevention services within the city of Richmond. Additionally, RBHA supports community service boards throughout Region 4, which includes the city of Richmond and counties of Chesterfield, Goochland, Hanover, Henrico and Powhatan, along with numerous other communities in Central and south-Central Virginia.
“Some people aren’t aware of what we can do here and all the services we can offer,” says Kristen Scott, program manager for RBHA’s Rapid Access program, outpatient therapy and psychological services. “Many times, it turns out we’re not the right spot, but we can reach out and connect [people] with all of those services,” Skapars adds.
Saltonstall of St. Joseph’s Villa acknowledges the challenges parents face in raising teens. “We all judge ourselves based on how our kids are doing,” she says, “But there’s no rule book, and there’s no shame in asking for help. For all the bravado that kids express, they’re terrified inside. They want somebody to be brave and wrap their arms around them, not to take control, but to help.”
