Friday, July 17, 2009

Report from the Front Line: System Performed (with a few creaky bits)

Back when people were envisioning the implementation of the Rosie D settlement, or inventing the CBHI, primary care was envisioned as a key player in the process by some, and as a potential roadblock by others.  Who should screen for mental health problems?  Who should initiate the referrals into the CBHI?  Who would trigger the Emergency Crisis response system?  In many ways, it made sense for primary care providers to be integrated into the system.  Frequently, we are the place to which people turn when they don't know where else to go.  Often, we know the families, and can tell when someone is at the breaking point.  And sometimes, families with whom we have a relationship trust us just enough to let a system into their lives.

That happened today, in my office.

A mother came in, with a child with one problem, and in the course of our discussion, spoke of another child, a five year being treated for ADHD by a psychiatric nurse practitioner who my partner suspected had a more involved diagnosis.  She was at the end of her rope, and she was worried that this other child could harm the child in front of me in the exam room.  "No one is listening to me", she said, "I am not sure what else I can do.".  I explained the mobile emergency services to her, and she thought that was a good idea.  She spoke with her therapist, who also thought that this was a good idea.  Fortunately, the family had MassHealth.  So off I went to activate the system.

First problem:  who to call?  I knew the agency that had the contract for our area, but could not find a place that listed the contact information for the various mobile emergency service providers.  Finally, my nurse practitioner found the agency in one of our resource directories, and I put in the call.  The agency bounced me around a bit, but after about 10 minutes, I was talking to the program coordinator, who collected information efficiently and then asked to talk to the mother.  The mother was upset, and the coordinator did her job beautifully;  she offered options, she got a sense of how to enter the family's home respectfully and she developed a plan that allowed the husband to get home to be there for the assessment.  The family left my office nervous, but a little hopeful.

I called the family at the end of the day.  The EMH person had been to the house, assessed risk, developed plans with the mother for the weekend and hooked the family up with FST, all in collaboration with the child's therapist.  I will call Monday to check on them, but things seemed to work relatively smoothly.

How can it run better?  Well, we need clear access to a list of phone numbers for this service.  And, I need to learn something of family centered care for that coordinator-  she was great.  But overall, I think that the system did what it was supposed to, and saved us a trip to the psych emergency room.  

Good work, everyone.  Keep it up.

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