Expanding mental health support in Pediatric Complex Care Clinic

When families are caring for children with complex medical needs, the demands are constant and often overwhelming. Multiple specialists. Frequent appointments. Lifelong conditions. And layered on top of it all, the emotional toll.

Against the backdrop of advocating for and caring for children, “there’s just so much trauma that families endure on top of chronic stress, depression and anxiety,”  said Courtney Holmes, Ph.D., associate professor in VCU’s Department of Rehabilitation Counseling.

And she saw an opportunity to make a difference.

Working alongside Tiffany Kimbrough, M.D., at VCU Health, Holmes is launching a pilot project that brings mental health support directly into the Complex Care Clinic, housed at Children’s Hospital of Richmond at VCU. This project includes Heather Jones, Ph.D., and Marcia Winter, Ph.D., of the Department of Psychology.

Now, mental health providers are able to provide services to directly reduce barriers to care. VCU’s Complex Care Clinic operates as a “patient-centered medical home,” designed to reduce the logistical burden on families whose children often see five or more specialists. These are children who might rely on ventilators, feeding tubes or other assistive technologies, and whose care requires a high level of coordination.

While the clinic addresses children's complex medical needs, families – primary caregivers in particular – struggled with a parallel need for mental health care. “Because of the stressors and barriers to accessing mental health care outside of their child’s treatment, our thinking was that if we embed it in the clinic, families are going to be more likely to use it,” Holmes said.

The resulting integrated behavioral health model offers counseling primarily for caregivers, often at the same time the child is receiving treatment or via later telehealth appointments.

From research to real-world impact

To better understand family experiences and what types of support would be most helpful, Holmes and her collaborators conducted qualitative interviews with parents. That work expanded into a larger research effort, combining qualitative insights with quantitative data to examine trauma symptoms, coping strategies and resilience among caregivers.

“We are creating a model to understand how we can promote resilience and wellness,” Holmes said.

A $50,000 Commonwealth Health Research Institute grant is allowing the team to move from concept to implementation. This pilot project builds on Holmes’ earlier VCU Quest grant, which was a multidisciplinary study focused on the support needs and well-being of parental caregivers for children with complex medical treatment requirements, as well as a HRSA-funded integrated behavioral health interprofessional training grant, with Jones as the principal investigator/project director.

Today, graduate students from VCU’s nationally-ranked Rehabilitation Counseling and Clinical Mental Health programs are part of Jones’ Integrated Primary Care Training Collaborative and embedded in the clinic, providing brief, trauma-informed counseling and support to families.

For Becca Gregory of Stafford, the opportunity allows her to combine her passion for working with children and families with a collaborative health care environment. “A gap in services was identified in the clinic for parents and caregivers of medically complex children, and this is a gap that we have begun to narrow as we have piloted this program,” Gregory said. “I became involved for the possibility of growing an essential service.”

Lyndsey Lawrence, a student from Alexandria, was drawn to the project for its emphasis on caring for historically underserved populations, which she gained experience within a medical setting. “This experience has given me a foundation of not only clinical skills, but a new understanding of how to best serve clients whose life circumstances are generally unchanging,” Lawrence said. “It requires a level of understanding and empathy for our clients, to meet them where they are.”

Care that extends beyond the patient

One of the project’s defining features is its family-based approach.

Not every child is able to participate in traditional therapy. But supporting parents, caregivers – and even siblings – can have a direct impact on the child’s well-being.

“When stress is down, they’re better caregivers,” Holmes said. “That child’s health outcomes are going to be better.”

Services are offered at no cost to families in the clinic, removing another barrier to care.

Since launching in fall 2025, demand has been strong. Dozens of families have already engaged with services, and an active caseload continues to grow.

Students say the work has reinforced the importance of supporting caregivers alongside pediatric patients.

“I hope that the parents and families that we work with take away that their mental health can be a priority alongside all of the roles and responsibilities that they take on as caregivers,” Gregory said. “By supporting and taking care of their own mental health, they are pouring back into themselves and supporting the needs and development of their children.”

Lawrence echoed that perspective. “The mental health and self-care of the parent is just as important to the child’s well-being as any other medical intervention or level of caregiving,” she said.

Now that services are in place, the project is starting to track the program’s effectiveness by collecting baseline and follow-up data on caregiver mental health.

Early feedback shows that family-centered mental health care is working.

“Anecdotally, it’s been amazing,” Holmes said. “Families are grateful for the opportunity. It’s been a positive addition to the clinic.”

by Kyra Newman