Monday, June 1, 2009

Intensively Coordinating Care: A Few Kinks in the Process

So, as H.3546 rolls through the House with nary a glitch,  I wanted to talk a bit about the role of care coordination in the process of children's mental health care and in particular in the "Rosie D." remedy plan.  Throughout the lawsuit and the negotiations on the remedy, the plaintiffs have spoken of the difficulty of engaging the various systems (e.g. DCF workers, DYS staff, DMH managers, school personnel, pediatricians, mental health workers, psychiatrists and youth workers at the Boys Club, for example) and of the need to convene team meetings to allow the family to have all of the members of their team pulling together to benefit the child and family.  In the RFR, as part of Intensive Care Coordination, the Care Coordinators  will have
"Regular contact by  with the family, youth (where appropriate) and other relevant, persons in the youth’s life (collaterals),  Facilitation of CPT meetings  [and] Face-to-face contact with the youth and family, as determined by the youth and family and members of the CPT"

I have speculated before that this will be hard to do;  I have been trying to attend as many multi-agency team meetings as possible in the run-up to July 1 to see how this is going to work.

Last week, a patient of mine with serious emotional disturbance had such a meeting scheduled, and my care coordinator and I tried to attend.  Multiple e-mails were exchanged to assure that we wouldn't forget the meeting, as it was scheduled on the day after Memorial Day.  We were there at the appointed hour; the parents were there as well.  The agency, on the other hand, had cancelled the meeting, as the lead person was on vacation.  Assurances were given that we were all called;  neither my care coordinator or the parents can find any evidence that this happened.  Did all four of us, with e-mail, cell-phones and home answering machines miss the message?  Did it get caught on a SPAM filter?  Or was it never sent?  We don't know.  We do know that two professionals and two parents spent 2.5 hours going to a meeting in a distant location that didn't happen.

Please note that I did not name the agency involved;  this is not meant to be about them, or us.  
To their credit, a superb worker familiar with my patient's family met with us informally for 30 minutes and useful information was exchanged.  Not a full team meeting, but a piece of one.  Still, multiply this by a factor of 10,000 children with SED;  to paraphrase Apollo 13: "Boston, we may have a problem here".    So, if this isn't about an agency or a patient, what is it about?  This is a plea to all parties that, as we design a system as comprehensive and multimodal as the one that we are planning, we need to invest in a communication system that crosses lines that we are not used to crossing.  Otherwise, this thing doesn't have a chance.

It will be an adventure.

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