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Jody Levison-Johnson

Assistant Vice President, Practice Improvement

High-Tech, High-Touch, Integrated Care for Children

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Children are the living messages we send to a time we will not see. – Neil Postman

Childhood should be a time of innocence and security, of learning through play. Sadly, one in five children age 13 to 18 have or will have a mental illness, and suicide is the third leading cause of death for youth ages 10 to 24. For females, increasing suicide rates are highest for those ages 10 to 14.

Children from minority communities are especially vulnerable, often receiving fewer and inferior mental health services compared to their non-Latino white peers. Socioeconomic factors, childhood adversity and family and community structure all play a role in disparities in child and adolescent mental health and receipt of mental health services.

When Tumaini Coker, M.D., MBA, began her PCORI-funded project designed to improve access to behavioral health care for children in underserved areas, she knew that multiple barriers stand between children from low-income families and needed mental health services. What she didn’t know was that the barriers vary from stakeholder to stakeholder.

“Pediatricians, parents and mental health care providers all had different ideas of what the barriers were,” says Coker, who is the principal investigator of the project at Seattle Children’s Hospital and Research Center, a member of the National Council for Behavioral Health.

Coker and her team discovered that pediatricians were uncomfortable managing mental health problems, and mental health providers felt they had little support in transferring children’s care back to pediatricians. Parents expressed concerns about the mental health clinics and difficulties in completing the enrollment process.

“I was shocked and scared when I was told that my daughter needed [mental health] services,” says Claudia Sweener. “To make matters worse, I didn’t know anything about the mental health clinic, and the intake process took about six hours. They asked a lot of personal questions, and filling out all the paperwork was difficult.”

In collaboration with pediatricians and staff at six primary care sites of the Northeast Valley Health Corporation, and mental health specialists at two community mental health centers, the study team developed a two-pronged approach. The first addresses the intake process at mental health clinics by comparing the current process – which starts with a phone interview with no support – to a novel process in which parents are guided by a coordinator using videoconferencing.

The second part of the project is geared to pediatricians, with the research team and clinic partners developing an online course led by a psychiatrist on best practices in treating children with mental health issues.

Coker’s PCORI study is a perfect example of the high-tech, high-touch care that defines integrated care for physical and behavioral health conditions. Using video technology, the mental health team creates a personal connection to each family. The parents can see the person asking the questions, which increases their comfort level in providing personal information and engaging their child in therapy. Online courses help pediatricians learn how to provide ongoing care.

Engagement, ongoing education and provider training on different models of integrated care are all key elements of the Center for Integrated Health Solutions (CIHS), run by the National Council with support from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). Integration isn’t just a concept – it’s a philosophy of whole-health care and a way of doing business.

CIHS provides technical assistance (TA) and training to SAMHSA’s Promoting Integration of Primary and Behavioral Health Care (PIPBHC) grants awarded in September to Kentucky, New York and Vermont. State agencies will work with provider organizations in PIPBHC states to promote full integration and collaboration in clinical practice between primary and behavioral health care across the lifespan, from children to older adults. CIHS also provides support to other SAMHSA grantees throughout the U.S. that are working on integrated care.

In addition, CIHS provides support to HRSA-funded safety net clinics with a focus on maternal and child health programs. The sooner we reach children and their families, who often interact with multiple health and social service systems, the sooner we can prevent or forestall mental, emotional and behavioral health problems. CIHS staff provide intensive TA in evidence-based practices, including Screening, Brief Intervention and Referral to Treatment (SBIRT) and run a nine-month learning collaborative, the Pediatric Innovation Community.

To ensure that children and family members in need of mental health and addiction treatment aren’t told to “come back when we have an opening,” the National Council promotes same-day access and just-in-time prescriber scheduling. We sponsor a robust program of health care practice improvement initiatives designed to help behavioral health leaders grow their clinical knowledge and management expertise to meet their patients’ needs. This includes our Addressing Health Disparities Leadership Program.

Health and behavioral health care in the 21st century demand an emphasis on patient-centered values, whole-person care and customer satisfaction. We must raise the bar because the children and families we serve deserve nothing less.