Tuesday, October 26, 2010

Keynoting a System for a Medical Home: Some Joy Out There in Muddville

Today, I had the privilege of keynoting the kickoff of a learning collaborative for pediatric practices that want to enhance the care that they provide for children with mental illness. The Boston Public Health Commission led a consortium that successfully got 2 grants from SAMSHA to address issues of early childhood mental health problems in the context of a community health care. It is a noble effort. One program, Boston LAUNCH, is targeting children from 0-8 with an assortment of mental health prevention approaches and the other, a Systems of Care effort that really focuses on younger children with more severe behavioral problems. What's really cool is that the BPHC convinced HRSA to allow the programs to integrate, and that they are "braiding" the funding, which be allow both programs the opportunity to work off of each other in very different circumstances. Very cool initiative. Maybe they will be able to tell us how to "fill in the blanks" in health reform.

So what did I say to them, you may ask? Really three things:
  • States have much say in how health reform plays out, and they are in various degrees of understanding their role in the process. All of them will need to implement new programs that intertwine behavioral services with routine primary care.
  • You can do the coolest program in the world, but if is not well evaluated, it will not change policy.
  • With Massachusetts health reform, CHIPRA and the Affordable Care all mean that the system is vulnerable to change. These programs, properly evaluated, will be what informs the choices that lawmakers have to make over the next few years.
After that, we team built, talked, laughed and bonded. Overall, a good use of my time.

Monday, October 25, 2010

Save the Date: CMHC Supporters Meeting

November 23, 9:30-11am

The next CMHC Supporters Group Meeting will be on Tuesday, November 23 from 9:30-11am in the 9th Floor Conference Room at 30 Winter Street in Boston.

This will be an important meeting where we will finalize the Campaign's policy and advocacy agenda for the upcoming legislative session.

We need everyone's input and help to be successful.

Also, if you or your organization have legislative priorities or upcoming events you would like to share with the group, the November meeting is a great chance for this.

See you on November 23!


Show the world your support of Children's Mental Health

Cut and paste the html code below into your website for a button that will direct users to the CMHC website.

A Proud Member of the Children's Mental Health Campaign

When you put it on your organization's website, let Matt know at mnoyes@hcfama.org.

Saturday, October 9, 2010

Thought on Returning from Sabbatical

It is both wonderful and weird to be back.

Wonderful because I really enjoy working with patients. For those of you who don't want to go back into ancient blogging history, I left Massachusetts last September to go to Washington and work in the Federal Government as a Robert Wood Johnson Health Policy Fellow. As part of that deal, I too a year off of patient care, and left my practice, where I had worked for 18 years. One of the things that surprised me in DC was that I didn't seem to miss the day-to-day doings of seeing patients. So I was concerned that, when I got back to Massachusetts, I wouldn't either remember how or enjoy doing that anymore.

Turns out I needn't have worried. The give and take of the clinical encounter really grounds me in reality, in a way that detached policy discussions don't. Now, I am not back in my old practice in Webster- South County has continued to flourish in my absence and has recently added a third doctor to its group. I couldn't ask those patients to put their lives on hold while I was away. Since I am now working on policy stuff within UMass Medical School's Commonwealth Medicine, a great organization that lets us bring clinical and analytic expertise to the service of state government, I need to be in Worcester more. So I am working in another practice within our clinical system. And, it turns out, I really do like seeing patients.

In my new role, mental health has not been as large a part as it was in my old practice. We are screening for behavioral health issues, as one would expect from in these days of the Rosie D rollout. I am still not finding the screening terribly useful. Most of the kids I've been seeing are pretty well plugged into services, and have already been diagnosed. The system continues to work for them in its own creaky way, and I am incredibly conscious that we in Massachusetts have a lot more in our system than does any other State in the Union. Despite all that we do, it is not yet enough to calm the feeling of dread that course through a parent's heart whenever they take one step forward and two steps back. Much work to do.

What is weird about being back is that I have now travelled over the whole landscape of 90,000 foot high grand policy decisions (like mental health parity and children's mental health reform) at the Federal and State levels, seen the agencies where they are implemented (like HHS and SAMSHA and the CBHI) and been to the meetings where decisions are made that affect the lives of millions of children (no, I didn't make any of the decisions, and I don't think that I influenced them much- but I have seen the process). So now, when I am seeing a patient, and trying to figure out how to make that system work for them, I sometimes visualize it as the end of a long web of decisions that stretch from the halls of Congress to my examining room. It is an odd and vertiginous perspective, but I am getting used to it.

I did manage to attend the MCAAP Mental Health Task Force meeting a few weeks back. There is still much energy in that group, and they continue to focus on early childhood mental health. There was talk of aligning that work with the push for early childhood education, which I think is important. More on that in another post.

Not sure how often I will post in the future, but I will try to post things that are useful.

FEEDJIT Live Traffic Map