Sunday, August 17, 2008

More Ideas: Lots of Ways to Spin Mental Health Care.

I am just back from Chicago on Saturday, where I got to deliver 2 workshops, 2 roundtables and an introduction at the semi-annual (by which I mean every other year-did I get that right?) meeting of the CATCH facilitators of the AAP and the Healthy Tomorrows grant recipients, sponsored by the AAP's Community Pediatrics program.  I met people from Idaho and Montana and Texas and North Carolina, all trying to develop systems through which they are able to care for children with mental illness.  The good and the bad news is that they are ALL experiencing the problems with we have, such as stigma, poor morale, lack of child psychiatrists and poor follow-up.  Here are a few of the many solutions that have been proposed.

Connecting The Dots
City, State: Chapel Hill, NC
Year (start of the project): 2005 (5 Year Grant Period)
Program Description: Connecting the Dots takes advantage of existing relationships among the Local Health Departments, community-based out-of-home childcare providers, and the local childcare health consultant. Connecting the Dots will establish a hierarchy of services to prevent problem behaviors among children in out-of-home childcare from becoming behavioral and psychosocial health conditions. Child Care Health Consultants will offer consultation and technical assistance to out-of-home childcare providers to improve their response to challenging behaviors. Children needing medical services will be screened and referred to their medical homes for primary health services, and those with more serious needs will be referred on to pediatric mental health services.
Projects Goals & Objectives: The goals of the project are (1) to implement and integrated community-wide, pyshcosocial/behavioral health system for young children that will link child care, primary health care, and mental health providers, (2) to create a well-trained cultrually diverse workforce trained to prevent minor behavioral issues from escalating into major behavioral problems, and (3) to assure that all children in out of home child care have medical coverage and a medical home to address their psychosocial/behavioral health needs.
Project Title: Project EAGLE - Central Intake and Referral System
Grant ID: 727
City, State: Kansas City, KS
Year (start of the project): 2004 (5 Year Grant Period)
Program Description: The Project EAGLE Central Intake and Referral System is a mechanism for screening multiple risks in families with children zero to 5 years of age and for providing referrals to address multiple needs. The Central Intake and Referral System is based on the idea that early identification and timely access to appropriate services leads to healthy development and children entering school ready to succeed. The goals of CIRS are to identify immediate family needs via a collaborative relationship that includes multiple risks screening; to provide appropriate referrals and problem-solving support to improve parents' self-advocacy in accessing services; and to improve utilization of community resources.
Projects Goals & Objectives: The goals of this project are: 1) To identify immediate family needs via a collaborative relationship that includes multiple risks screening, 2) To provide appropriate referrals and problem-solving support to improve parents

Project Title: West Virginia CARES (Coordinating Access to Resources and Emergency Services) Project
City, State: Huntington, WV
Year (start of the project): 2007 (5 Year Grant Period)

Program Description: Homeless and foster care children are a complex and especially vulnerable group of children with special health care needs. The West Virginia CARES project will improve access to a medical home for Appalachian children who are homeless or in foster care. The project will select and train two parents of children with special health care needs to serve as parent care coordinators. These coordinators will become an integral part of the medical home improvement team and will create a Medical Passport and Education Passport for all families in the program. The coordinators will also be responsible for screening for developmental delays and school issues, including ADHD.
Projects Goals & Objectives: The overall goal of this project is to improve the health status of homeless and foster care children by establishing a model for coordination of health care and improvement of the medical home led by trained parent care coordinators.

So, are you noticing that the core of all of these initiatives is care coordination, either through trained parent advocates, a professional care coordinator or co-location?  Really drove home two points, in my mind:
1)  It will take more than access to make this work.  After we open access, whether through insurance mandates or the Rosie D. remedy, families won't use the system unless we help them to do so.  We can build it, but they won't come unless we walk with them through our new system of care.
2)  Communication between the various members of the team is even more important that I thought.  I understand that there are barriers, including time, compensation, HIPPA and fear that keep that from happening, but we need to address it square on or we are just spinning our wheels.

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