Thursday, July 9, 2009

Musing on a CATCH Visiting Professor

My Academy has some very cool parts to it; my personal favorite is the CATCH program, which actively promotes the interaction of pediatricians and communities to create things of beauty- partnerships that glow, radiating hope to families without ACCESS (that's the A in CATCH) who want to improve their child's health. One part of their program is the CATCH Visiting Professor Program, which brings accomplished Community Pediatricians to academic medical centers in an effort to broaden their horizons. (*FULL DISCLOSURE: I hosted one of these many years ago and , as the District 1 CATCH Facilitator for the AAP, I have reviewed these applications for many years since. I was selected to be a Visiting Professor in Austin next fall*) Today, my colleagues at Children's Hospital invited me to hear Dr. Angela Diaz, a Professor and advocate for adolescent services describe her program in New York City, at Mount Sinai Hospital. ( See Robin Hood - Heroes - Dr. Angela Diaz, Shared via AddThis) I was representing the Academy and promoting the CATCH program, mostly to the Residents.

Dr. Diaz had a lot to say, and at the end of it all, we were speechless. How does anyone do what she had done? She works with adolescents in the City. Initially, I wasn’t sure that this was going to be relevant to this blog, but it turns out to be incredibly relevant; she opened by pointing out that 20% of adolescents have mental health issues, but only 4% of those actually get those needs get addresses. Her program is focused on the uninsured youth, using a positive youth development model rather than a deficit model to assure long term growth. What’s that mean? A lot of programs focus on risk behaviors- she adds the “lens” of the consumer and the strength/asset to more fully understand what is going on with the teenager and to build a relationship that is therapeutic and the key to long term follow-up. She has found that it is really useful to form partnerships with “every organization in New York” that works with children, with has aided them tremendously in their fund-raising.

The core of her program is that they give the patients what they need regardless of ability to pay. She’s been creative at engaging subspecialists as well as getting funding for mental health services, health education services and the other ancillary services that are needed to address all of the needs of adolescents.

Sounds great, no? And yet there is very little evaluation data to support any of these “best practices”- they were recently funded to conduct an external evaluation to look at the impact of all of these services. Overall, her program serves 10,000 youth of color, from all over the metropolitan area, on a budget of $14 million per year, all of which is generated through fundraising.

To me, the most interesting (and relevant) part of her talk was her discussion of the distinction between her funding sources, which are focused on specific parts of the problem of adolescent health, and her care, which she described as wholistic. I am paraphrasing, but I think that she said something like: "I do what they ask of me, then I do what needs to be done" in the care of her high risk adolescent population. That strikes me as an appropriate lesson for the CSAs going forward: the funder (MassHealth) is required by law to cover a number of services; the agencies implementing the program (the CSAs) will need to decide how to use this funding to supply wholistic care.

Nice way to think about the process through which we are currently living.

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