Wednesday, June 10, 2009

PCCs and Rosie D: A meeting in Springfield

This morning, I had the privilege of talking to a group of 25 doctors (mostly pediatricians), nurse practitioners and clinical administrators in West Springfield about the new services about to be rolled out in the CBHI.  I may post the slides at some point, but they are long and many and it would take a while to do so;  perhaps I will post them after I do the Eastern Massachusetts version of this talk (as noted in the "upcoming events" part of the blog).  The session went really well;  these folks have a good sense of the clinical load with which they are dealing, the resources currently available in their area and the difficulty of engaging a system in change.  They were simultaneously engaged in understanding the system and thinking creatively about how to overcome the barriers likely to pop up in such a system, while voicing their concerns over lack of resources and waiting lists within the current system (or non-system of care) of care.  A few highlights:
  • Acronym overload:  The folks at the Massachusetts Behavioral Health Partnership put together a great packet of information about the program as it seems to be evolving and included a glossary of selected CBHI terms.  33 of them, starting with APRN and ending with SOC.  (The Free Dictionary lists 123 possibilities for that one).  There is a lot of detail in this proposed system, and it will be confusing to many.  I tried to focus on 4 key bits of jargon: SED,  CANS, CSA,  and "wraparound" in an effort to keep it simple.
  • Capacity underload:  People get the model, people understood the sorts of patients that we are trying to manage, but it was very clear that they thought that we were opening Pandora's box, that the number of children eligible for services would quickly overload the new CSAs.  Perhaps, but we have to start somewhere....
  • Desire for change: This was a group of people like me, who have been banging their heads against the "wall" of mental health services for many years.   They are eager to engage the new system, but wary of get getting their hopes up.

All of this means that we need to continue to engage primary care providers in the next phase of the CBHI, if we are ever going to address the access issues raised in the Rosie D. lawsuit.  Hope to see some of you at the next session in Waltham.

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