FARGO — A new way of delivering mental health treatment to child abuse victims in less populated parts of the state is underway.

Children’s Advocacy Centers of North Dakota have launched a telehealth method for treating kids dealing with trauma.

The centers, in Fargo, Bismarck and Minot, specialize in helping children who’ve been victims of sexual or physical abuse or neglect.

At Red River Children’s Advocacy Center in Fargo, more than half of those referred last year came from rural counties.

RRCAC mental health director Nicola Herting, who has a doctorate in psychology, said children whose families have longer travel times tend not to start or stay with treatment.

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“We have kids driving two hours . . . and we wanted to change that. We want to make sure kids have access and can get the treatment that they need,” Herting said.

Paula Condol, executive director at Dakota Children’s Advocacy Center in Bismarck, said telehealth levels the playing field for kids in rural counties.

“They can heal just as well as someone in a more populated area,” Condol said.

Jenn Faul, chief operating officer at Fargo psychiatric hospital Prairie St. John’s, called the approach clever.

“Incredibly well suited for our environment,” Faul said.

Heidi Tupa demonstrates how a telehealth sessions would be conducted at the Red River Children's Advocacy office in downtown Fargo.
David Samson / The Forum
Heidi Tupa demonstrates how a telehealth sessions would be conducted at the Red River Children's Advocacy office in downtown Fargo. David Samson / The Forum

Mental health shortages in most of ND

Almost all counties in the state, or 90 percent, have a shortage of mental health professionals, according to the Center for Rural Health.

Of North Dakota’s 53 counties, only five — Cass, Grand Forks, Burleigh, Morton and Ward — are considered not to be lacking in mental health services.

With the Telehealth Outreach Program or TOP, clinicians in larger cities can be connected to children in counties with limited, or no mental health professionals available.

The service is available, free of charge, for children ages seven to 18 who have experienced trauma, thanks to a grant from the North Dakota Department of Corrections' Victim of Crime Act funding.

Families receive an iPad on loan if they don’t have access to one otherwise, along with a charging cord and headphones.

The tablets are enabled with wifi and data, and are “locked down” to a secure video conferencing platform, so they can’t be used for games or web-surfing.

Families also receive a box of age-appropriate supplies specifically to be used during therapy, which could include a journal, colored pencils, positive affirmation cards, materials to make a stress-relieving ball and liquid to blow bubbles, which allows them to practice deep breathing for relaxation.

Herting said children who’ve experienced trauma through abuse are easily stressed, and their bodies often tense up.

Regular talk therapy isn’t very effective for kids, she said, so the more active they can be, the better.

Laminated cards are included in a box of supplies sent by Children's Advocacy Centers in North Dakota to families of child victims of sexual or physical abuse who take part in a new Telehealth Outreach Program.
David Samson / The Forum
Laminated cards are included in a box of supplies sent by Children's Advocacy Centers in North Dakota to families of child victims of sexual or physical abuse who take part in a new Telehealth Outreach Program. David Samson / The Forum

Just as good as 'in person'

Herting said Trauma-Focused Cognitive Behavior Therapy or TF-CBT is the gold standard for treating children and adolescents who have experienced trauma.

There are now 12 therapists at CAC’s in North Dakota, five each in Fargo and Bismarck and two in Grand Forks, who are trained to provide that therapy via telehealth under instruction from the Medical University of South Carolina.

The North Dakota clinicians were the first such group in the country to get that training, Herting said.

The university’s research shows TF-CBT done via telehealth is as effective as therapy done in person, she said.

Children can do the therapy at home, school or a community agency, and a designated adult must be available in case of emergency.

Part of each session is done only with the child’s caregiver, so they understand the objectives and can reinforce them through the course of treatment.

Anywhere from 16 to 25 sessions are recommended, and completion rates are better because of the consistency and convenience factors.

“You’re not having the parent missing work, the child missing school,” Herting said.

Nicola Herting, who has a doctorate in psychology, shows a box of supplies sent to families of child victims of sexual or physical abuse who take part in a new Telehealth Outreach Program.
David Samson / The Forum
Nicola Herting, who has a doctorate in psychology, shows a box of supplies sent to families of child victims of sexual or physical abuse who take part in a new Telehealth Outreach Program. David Samson / The Forum

The bad things that happened

One goal of the therapy is understanding the emotions related to trauma.

Herting said children who’ve been neglected, or abused sexually or physically, often suffer flashbacks, nightmares, and are sad, angry and irritable.

The majority of children served by the RRCAC are victims of sexual abuse.

Last year, 53 percent of its cases involved an allegation of sexual abuse, 18 percent involved neglect, 15 percent involved physical abuse and 6 percent of the children were a witness to violence.

“We don’t talk in detail about the trauma right away, but there’s a process of gradual exposure,” she said.

Avoiding it isn’t helpful, she said, because it only prolongs the level of stress, and having children learn to deal with the bad things that happened to them doesn’t “retraumatize” them.

“It helps kids get better,” she said.

Condol believes having mental treatment available for those children wherever they live, via electronic means, should offer them brighter futures.

“This is going to make a big difference for families,” she said.