psychiatry in our schools: how a city and a health center created access to behavioral health...
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Psychiatry In Our Schools:How A City And A Health Center Created
Access To Behavioral Health Services
WEITZMAN SYMPOISUMNo Time to Waste: Primary Care Innovations in Acton
June 4, 2009
R. Timothy Kearney, Ph.D.Director, Behavioral Health, CHC Inc.
Jane Hylan, MPH, CHESDirector, School Based Services, CHC Inc.
Megan Giesen, LCSWSchool Based Health Center, CHC Inc.
Today’s Presentation
• Challenges associated with providing children’s behavioral health services
• Some characteristics of the children of Meriden
• The implementation of the Meriden program
• The daily work in the school
• What we have learned
• Points to ponder
• Discussion
June 4, 2009 2Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Program Description: Meriden School Based Health Center Behavioral Health Services
The Community Health Center (CHC) has partnered with the City of Meriden to bring behavioral health services provided by master’s level social workers into all municipal public schools (eight elementary schools and four middle and high schools).
Effective, efficient, consumer driven, culturally competent individual, group, and family therapy is provided on site at all schools with clinic based psychiatric back-up for medication evaluations, prescription of psychotropic medications, and ongoing medication management.
Consultation with the schools, the Department of Children and Families, and other community resources impacting a student’s life is an integral part of the service. Coordinated care with medical providers is provided.
June 4, 2009 3Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
The Challenge: Children’s Behavioral Health Services In CT
A crisis of access:
• Children’s outpatient behavioral health services are hard to find : limited number of treatment slots limited access due to payment issues language barriers. shortage in child psychiatry
• Limitations of clinic based outpatient services hours available transportation issues no show rates
• System of care issues IOP/PHP availability limited hospital beds
June 4, 2009 4Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Meriden’s Child Well-Being Data From CT Voices For Children
• Children below Federal Poverty level (2000): 18%
• Children Eligible for Reduced and Free Meals (2007-08) 55.8%
• Unemployment rate (March 2009) 9.8%
• Cumulative High School Drop Out Rate (2007): 5.8%
• Children Enrolled in HUSKY (April 2009): 7376
• Children Substantiated as Abused or Neglected (2007): 393
June 4, 2009 5Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Children And Mental Health
• According to the US Surgeon General’s 1999 report on mental health:
– 20% of children younger than 18 have diagnosable mental illness – 10% have a serious impairment– fewer than 20% of these receive treatment
• NASBHC’s web page
–“schools have become the de facto provider of most mental health services”–“SBHCs bring dedicated experts into the setting.”
June 4, 2009 6Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
In The Beginning
June 4, 2009 7Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Only one traditional model to offer Meriden
Challenges
•Staff•Space•Funding•Maintenance
“The thing that bothered me about this case so greatly was that the child was in full view of everyone for so long.” - CT State Rep. Mary Mushinsky
June 4, 2009 8Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Suicide Rates In Young Americans
• After falling 28% between 1990–2003, rates of suicide for 10-24 year olds climbed 8% (MMWR) – biggest climb in 15 years – 7.32 suicides per 100,000 people
• 4500 young lives lost each year to suicide –3rd leading cause of death
• Nationwide survey of youth in grades 9-12– 15% reported considering suicide– 11% had a plan– 7% had tried to take their own life
June 4, 2009 9Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Partnerships – New and existing• Health Department• Area Child Guidance Clinics• Board of Education• School Administration• School Staff• Families/Students
Time To RECONNECT And INNOVATE
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The Meriden Model
Priorities
• Even playing field• Nip it in the bud• Territories• ESL• Mastered and licensed• Sustainability
Challenges
• 8 openings • Parental involvement• Academics vs.
clinical • Bi-lingual therapists• Recruitment• Sustainability
June 4, 2009 11Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Meriden School-Based Behavioral Health Services
June 4, 2009 12Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
The Daily Work In The Schools
Megan Giesen, LCSW School Based Health clinician
June 4, 2009 13Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
• Total clients seen through April 30: 423 total for treatment by school based social worker, of these 175 also seen by child psychiatric team at CHC Meriden State Street site
• Total sessions provided at school sites through April 30: 4517
• Sessions provided by type of service:
• Psychiatric Services at Clinic site 613
• Clients also seen by CHC Meriden Medical: 156 (37%)
June 4, 2009 14Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Meriden School Based Services: Clients Seen School Year 2008-09
Meriden School Based Services: Clients Seen School Year 2008-09
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368
1295
1572
99255
Sessions
Initial
Individual
Group
Family
PPT
Summary Data Meriden School Based Health: School Year 2008-09
Facility
School Population
08-09Enrolle
d
% enrolle
d
Total Visits 7/1/08 - Current Patients Avg Visits
Barry 640 77 12 733 73 10.00
Franklin 464 78 17 520 47 11.00
Hale 625 84 12 261 43 6.00
Hanover 592 87 15 587 53 11.00
Hooker 510 44 8 135 26 5.00
Pulaski 700 88 12 862 61 14.00
Putnam 650 86 13 681 62 11.00
Sherman 656 72 11 738 58 12.00
Total 4837 616 12.5 4517 423 11.14
June 4, 2009 16Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Summary Data Sites with Medical Services: School Year 2008-09
Facility
School Population
08-09 Enrolled%
Enrolled
ISAAC 180 92 50
Keigwin 374 171 46
Wilson 731 414 56
Macdonough 224 114 50
Roosevelt 580 190 33
June 4, 2009 17Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
What We Have Learned
• Access to behavioral health care has been increased for the children of Meriden:
Total unduplicated children seen since start of program: 698
Total number of unduplicated visits delivered: 13,177 Average number of sessions received by each child:
18.88
June 4, 2009 18Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Meriden Residents Ages 4 - 11 Emergency Room Visits at Connecticut Children's Medical Center & MidState Medical Center for Behavioral Health* Related Primary Diagnoses, FY 2003-08
CCMC
2003 2004 2005 2006 2007 2008
Total <6 <6 <6 <6 <6 6
MidState Medical Center
2003 2004 2005 2006 2007 2008Total 57 36 21 28 9 11
Other+2003 2004 2005 2006 2007 2008
6 7 14 7 6 8
Total
2003 2004 2005 2006 2007 2008
67 45 38 38 16 25
Source: CT Hospital Association Chime, Inc. Emergency Department Data
+ Other : The William W. Backus Hospital, Middlesex Hospital, Saint Francis Hospital and Medical Center, Hospital of Saint Raphael, Waterbury Hospital and Yale-New Haven Hospital
Entries that are less than six have been replaced with "<6" to ensure patient confidentiality. Entries that would allow calculation of the exact number of observations under six have been excluded to ensure patient confidentiality.
June 4, 2009 19Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Meriden Residents Ages 4 - 11 Emergency Room Visits at Connecticut Children's Medical Center & MidState Medical Center for Behavioral Health* Related Primary Diagnoses, FY 2003-08
67
45
38 38
16
25
0
10
20
30
40
50
60
70
80
2003 2004 2005 2006 2007 2008
June 4, 2009 20Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Top Ten Diagnosis in the Meriden Schools 2006-09
June 4, 2009 21Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Top Ten Diagnoses In Child Outpatient Clinic 2006-09
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• The population seen is in addition to those previously seen: 76% of those seen report this is first BH treatment Child Guidance Clinic of Central Connecticut (Meriden
based community clinic) reports that children seen rose during time since SBHCs started
Clients seen are very similar to outpatient clinic clients in diagnosis with some tendency toward less intense diagnosis
• Utilization of sessions is higher in SBHC Average outpatient no show rate 14.4 vs average SBHC
rate of 2.0 (January to March 2009)
What We Have Learned
June 4, 2009 23Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Previously Identified Markers Of Success
•Researchers have identified markers for success for School Based Health Care, among them:
– Increased delivery of service to children– Reduction in stigma surrounding access to service– Reduction in absences from school– Reduction in hospital ER usage– Improved utilization of service– Early identification of BH issues– Improved coordination with schools
Thank you to Roy Chung and Tanya Moss, Wesleyan ’09 students in “Health of Communities” with Dr. Peggy Carey Best
June 4, 2009 24Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services
Points To Ponder
• Directions for ongoing program development and future research
• Measures of therapy outcome:
–Ohio Scales
–DCF measures for child treatment clinics
• Tele-psychiatry for medication follow-ups
• Model for mobile psychiatric care
• Need to update data collection practices through electronic health record
• Ongoing work with Wesleyan students
• Training social work students in the model
June 4, 2009 25Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services