Wednesday, July 22, 2009

The Word is Getting Out There: At Least Among My Patients

Another summer day of physicals;  more positive screens on kids that I already knew had problems.  The difference this year, it seems, is that many of them have already been contacted by the CBHI and are in the process of getting into "wraparound".  

None of them called it that-  it seems that the "brand" of our particular kind of health reform has not been well marketed.  But as I talk to the families, it becomes clear that this is the CBHI that we are working with.  The family that was in crisis last week was in yesterday- things are moving along to get that child into a diagnosis.  Another family, one that has been through heck and back over the years, was in.  The boy, an articulate teenager with Asperger's and bipolar disorder,  spoke with remarkable frankness about his mental illness and is busy organizing their big team meeting.  I asked to be invited, and perhaps I will be able to go.  I got a call from DCF about a family that I wrote about in 2007; he is now doing OK, in a therapeutic day care setting,  with a psychiatrist and under treatment with only a few  psychotropics.  THe DCF worker is setting about getting that family hooked up with the CBHI.   I actually haven't seen them in a year- they will be coming back for a physical before I leave the practice.

Oh, I guess I hadn't written about that yet.  I will be leaving the practice in about 6 weeks, and heading off on a new adventure.  Each year, the Robert Wood Johnson Foundation selects up to 10 health professionals to be Health Policy Fellows at the Institute of Medicine, and to work directly with Congress on the implementation of health policy.  I mentioned last February that I had an interview in Washington- turns out that interview was successful, and that I am to be of the 10 in 2009-10.  This means that I have to leave my current practice, (South County Pediatrics in Webster) and many families with which I have worked for the last 18 years.  While all of my patients acknowledge that this is great for me and possibly even good for the country (they know what is going on down in DC right now), I am also having a hard time saying good-bye.  It is good to know that the work that we have all put into the mental health system over the past 3 years is benefitting a significant number of my patients;  it will be hard not to be here to find out what happens next.

I was worried when we started this whole thing that we would be making a system too complex for people to engage.  So far, that doesn't seem to be the case.  The larger issue is why should this system only be available to those on the "public plan"?  Why are the private insurers not engaged in supporting the establishment of systems of care?  That would be the next big thing.

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