From one mother to another

By the time he was 4 years old, Norma Granados-Madrigale’s son had been kicked out of every preschool he’d attended. He got in trouble for things he said and his reactions to other children, leading to intense meltdowns that his teachers struggled to manage. The calls to please pick him up early would come in the middle of the workday, at least every week—sometimes every day. Eventually, the time away from work was too much, and Granados-Madrigale lost her job. When she sought professional help for her son’s behavioral symptoms, he received several diagnoses and a spot on a waiting list for specialized therapy. The estimated wait time for a first appointment? Four years.

“It’s kind of like you’re thrown out of the bus with a bunch of diagnoses, and you don’t know what to do,” Granados-Madrigale said of her journey through the pediatric mental health care system. “And in the meantime, you’re fighting—fighting insurance, fighting the school district, fighting for services. Then you come home, and you still don't know how to deal with the challenges that your child is facing. You don’t have any support, and you feel so lonely in the process.”

So when Granados-Madrigale reached out to Penn’s Pediatric Anxiety Treatment Center at Hall-Mercer (PATCH) earlier this year, she braced herself for another long wait.

Instead, she heard back almost immediately. The next day, she received a message from Marguerite Willis, PATCH’s Family Peer Specialist.

“Honestly, it felt like finding a friend,” Granados-Madrigale said. “Someone that also went through this. As soon as I read about the program, I thought: This is exactly what I need.”

PATCH is a specialty outpatient program within Pennsylvania Hospital’s Hall-Mercer Community Behavioral Health Center that evaluates and treats children with anxiety disorders and related conditions. As part of Hall-Mercer’s primary focus on supporting the mental health needs of Philadelphia’s underserved communities, PATCH predominantly serves families insured by Medicaid. Willis’ role supports parents navigating the often-overwhelming process of seeking mental health treatment for their children. She helps families get through these challenges by sharing her own experience.

Years before she joined PATCH as the center’s first Family Peer Specialist in November 2024, Willis was a mother desperately trying to help her own son, Laith, whose behavioral challenges began at age 2. He was eventually diagnosed with ADHD, depression, oppositional defiant disorder, and intermittent explosive disorder. He cycled through hospitalizations, was removed from multiple schools, and entered residential treatment when he was 7 years old, before ultimately beginning treatment at Hall-Mercer.

“I knew my child needed help, and I couldn’t fix it,” said Willis. “I was getting sent in circles, not knowing what to ask for or what to look for, not understanding these abbreviations people were using—it’s like everybody talks over your head.” She remembers being handed lists of psychiatrists to call, only to encounter months-long waitlists everywhere she turned.

“What I needed was somebody to advocate for me,” she said, “to stand in that gap and explain to me what was going on, what the next step should be, and how I should go about it.”

Over time, Willis learned how to navigate behavioral health systems, advocate for school supports like individualized education programs, and coordinate services for her son. Eventually, she began informally helping other parents facing similar challenges before receiving special training in peer advocacy. She also became a founding board member—and later vice president—of Philadelphia Family Voices, a family-led peer support organization for parents and caregivers of children and young adults with behavioral health challenges.

Now as part of the staff at PATCH, Willis uses that lived experience to support parents before treatment even begins. Families can meet with her virtually or in-person for up to six sessions, beginning before their child’s intake appointment. She helps parents understand what therapy will involve, answers practical questions, and provides emotional support during what is often a stressful and uncertain time.

Often, she tells families pieces of her own story. “I let them know: I’ve been there,” said Willis. “You’re talking to somebody who understands exactly where you are and what this feels like.”

That connection can be especially important because the leading treatment for anxiety-related disorders—exposure-based cognitive behavioral therapy (Ex-CBT)—can initially sound counterintuitive to parents. Rather than helping children avoid anxiety-provoking triggers, clinicians gradually guide them through hard or scary situations, like a crowded store or a play date, so they can learn to manage them more easily.

For Granados-Madrigale, having Willis explain the process ahead of time made a significant difference. “She prepared me for what therapy was going to look like,” she said. “By the time my son started, I already understood what was happening and why.”

Willis also works closely with clinicians to help strengthen engagement between parents and therapists. If families seem hesitant or uncertain, she may join sessions to help build trust and encourage collaboration. “The parent is the expert in the room when it comes to their child,” said Willis. “My goal is to empower them to feel confident speaking up and being part of the treatment.”

That support has helped families feel less isolated, said Granados-Madrigale: “Through all of this, my own anxiety often gets triggered; I remember going through one appointment just crying and very nervous about a recent insurance issue. Having Marguerite to talk to every other week has been so wonderful and extremely helpful.”

Willis’ position is part of a major expansion at PATCH, funded through a $250,000 grant from The Pew Charitable Trusts awarded in 2023. The grant enabled the clinic to hire two additional full-time clinicians and launch the Family Peer Specialist program.

It’s made all the difference in the world to families like Granados-Madrigale’s, whose numbers are only growing. Pediatrician visits for anxiety-related symptoms jumped more than 300 percent between 2014 and 2023, from 1.7 percent to 6.1 percent of all children’s primary care visits, according to research published this May.

The type of exposure-based therapy offered at PATCH has long been the leading treatment for anxiety and obsessive-compulsive disorder (OCD), but it can be difficult to access elsewhere, particularly for families with public insurance.

“We know that most kids who need specialty treatment for anxiety or OCD will not receive it. We also know there are major treatment disparities,” said PATCH Clinical Director Emily Becker-Haimes, PhD. “Therapists who do use Ex-CBT are often in private practice and may not accept insurance. It’s for this reason that we’ve made it our primary mission to serve kids with Medicaid.”

Bringing on more Ex-CBT–trained therapists has allowed PATCH to reach even more families. In 2018, the clinic served fewer than 50 children annually. This past year, it served nearly 300, and with dramatically shorter waiting lists.

“At the height of the pandemic, it was basically a full-year wait for our services—that’s an eternity for families who are seeing their child suffer day in and day out,” said Becker-Haimes. Now, families can book their first appointment in as little as two months, with further hiring underway at the clinic toward a goal of getting that down to one month or less.

The Family Peer Specialist program has also helped more children actually make it to that first session. Before its launch, about 70 percent of families who reached out to PATCH never attended their initial treatment appointment—a fairly average no-show rate for mental health services. Today, that number is down to 43 percent for the clinic overall, and only 19 percent among families that have engaged with Willis. The program has been so effective that PATCH will soon be bringing on additional family peer specialists, shifting Willis into a supervisory role.

While family peer specialists are increasingly used in some mental health settings, it’s rare to find them embedded within outpatient pediatric anxiety care. “We’re evaluating the program’s success with the goal of building a model where we can easily scale this to other programs, to really ensure that every kid who needs specialty anxiety or OCD treatment is able to receive it,” said Becker-Haimes.

The Pew funding also helped PATCH expand community outreach efforts and improve access for multilingual families by redesigning brochures and website materials in English, Spanish, and Mandarin. The clinic launched a Community Advisory Board made up of parents and community clinicians who help guide ongoing improvements. A new grant this year from the William Penn Foundation will support additional outreach and the hiring of bilingual therapists for children with selective mutism, an anxiety disorder that disproportionately affects multilingual households.

Finding what works

Treating childhood anxiety takes time, but for PATCH patients and their families, that time doesn’t have to be spent alone on a waiting list. “This is a slow process; I'm not expecting my son to not have anxiety in a month or two,” says Granados-Madrigale. But she has noticed that the topics he talks about with his therapist are starting to make their way into daily life, such as the pet names they use to frame anxious thoughts. “Like, he’ll say, ‘Oh, this is Negative Nancy telling me this,’ or, ‘Maybe this is Disaster Dan talking to me.’ I love that he uses it to express how he feels.”

For Willis, the work remains deeply personal. Today, her son is 18 years old, living independently nearby, and thriving. When she asks what made the biggest difference for him, he always gives the same answer: the time spent with his therapist at Hall-Mercer. “She heard him. She saw him. She let him be himself in that room,” said Willis. “That changed everything.”

She finds it’s what the parents she works with need most as well: validation and empathy. And Willis brings both in droves. The most common question parents ask her is: Will this help? Has she seen this therapy work?

“I’m able to tell them yes,” she said. “Yes, I have.”