Trauma-Informed Approaches and Motivational Interviewing

Elevate Health Engineers a Bridge of Hope: Delivering Integrated Physical and Behavioral Health for Children and Families

There is an interdependent relationship between physical and mental health, and this relationship exists for children, just as it does for adults. Traditionally, behavioral and physical health have been siloed, and while those silos are breaking down for adults, they have not been breaking down as quickly for children.

There's an interdependent relationship between physical and mental health, and this relationship exists for children just as it does for adults. Traditionally, behavioral and physical health live in silos, and while those silos are breaking down for adults, they have not broken down as quickly for children.

Catalyst Funding, created in 2018, aims at supporting the connection and integration of organizations to improve the health and well-being of people in our community. Today, we’re pleased to share details about the Bridge to Hope partnership, the first of several partnerships to unite organizations with a shared vision so together they can achieve the greatest impact.

The Bridge of Hope partnership, informed by Elevate Health’s insights and data, links Pediatrics Northwest and HopeSparks Family Services through a binding agreement to integrate primary care and behavioral health care for pediatric patients in what is the first collaborative care model of its kind in the state of Washington. By partnering these two organizations, Elevate Health projects their combined impact will positively affect more than 15,000 pediatric Medicaid lives.

A model to deliver collaborative care for children, as opposed to co-located, previously didn't exist. Catalyst funds allocated for this partnership support the delivery of integrated, collaborative, and co-located behavioral health care for pediatric patients. The partnership is underway, and each partner is demonstrating a commitment to complete its projected integration within the next three years.

Meeting Patients with Appropriate Care

When visiting a Primary Care Physician, a child receives an initial screening for any mental or behavioral health concerns. Many PCPs have limited time and if they determine additional care is needed, they’ll provide the parent with a list of contacts to call in order to access proper care for the child. Too often accessing behavioral care is difficult and families are reluctant to go to through the screening process again in a new, foreign environment. Many individuals in the health care industry understand that the structure of how families access care needs to be rebuilt.

HopeSparks’ President & Chief Executive Officer Joe LeRoy understands very well how children and families do not receive proper mental health services. Whether it be due to stigma, lack of appropriate clinicians in the region, or the access to clinicians is laborious and creates fatigue. In some cases, it takes multiple attempts to reach a mental health professional in order to make an appointment. It’s hardly surprising families with children in crisis head to the emergency room even though they understand it’s not the best venue for treatment.

“Imagine a mental health system that is coordinated and effective. This is a system that doesn’t fully exist for families and children, and this is why we’re excited to be part of the process to create such a system for kids and their families,” said Joe LeRoy.

High Demand for High Levels of Care

Conceptually, bringing physical and mental health care together is not new. But how to bring the two together effectively has posed a challenge to providers. Co-locating mental health professionals in the same office building lacks the key component of collaboration. In a true collaboration, both physical and mental health providers offer an atmosphere of trust where patients receive care in an environment supported by both providers.

In 2018, HopeSparks provided more than 26,000 visits to 3,550 children and their families. During a well child visit at HopeSparks, a clinician will screen the child for behavioral and mental health issues. If care is needed, a behavioral health therapist on-site will guide the child and family toward a suitable course of care. In addition, a clinical psychiatrist will be available to coordinate with the child’s physician and oversee prescription medication.

This process provides the family with actionable steps and alleviates the parent from repeatedly calling for an appointment. However, even with this process in place many were not able to receive the level of care needed, especially those with a myriad of behavioral and mental health challenges ranging from depression, anxiety, and ADHD, to PTSD and psychosis. The demand for services is very high, with clinics receiving over 100 phone calls a week for support with their clinicians already operating at maximum capacity. For instance, HopeSparks’ program for children who are raised by individuals other than their biological parents serves only 1,200 of the 25,000 children who fall into this category.

Catalyzing the Health of Children and Families

The magic of the partnership between HopeSparks and Pediatrics NW centers on their shared mission and dedicated clinicians. Their service model to provide care to families is embedded within their operations, and together they can begin to restructure an entire system of care.

Through the Bridge of Hope partnership clinicians will now screen children and accompanying parents. This is a brand-new approach that’s never been attempted at scale, nor as a practice policy for the teams at either organization. In its groundbreaking attempt, participants are aiming to rebuild the format of how families access care.

Scheduling plays a central role in building an improved process to integrate a collaborative care model. This means keeping no more than 50 percent of a mental health care provider’s time scheduled leaving more times open for critical patients. If a mental health intervention must take place, it’s also critical to place a time cap on that intervention so time is available for other patients in need.

Within the collaborative care model, a mental health intervention produces both short- and long-term action. During the week of a young patient’s initial screening and intervention, clinicians and care providers will follow up with the family to ensure every next step and recommendation is acted upon and tracked accordingly. Upon the patient’s return visit, their action items are reviewed, and they are given an additional mental health screening. This follow-up screening allows the care providers to note of any changes, enforce positive steps taken, and course correct where needed. This coordinated follow up and tracking allows clinicians, therapists and PCPs to have connected data and a dialogue about the patient’s well-being in order to provide wraparound care and increase the patient’s chances of success.

Immediate Impact of Partnership

Already the Bridge of Hope program is in high demand. Appointments are filling up for all the patients who pediatricians and PCPs wish to enroll.

Outside of the clinic, there are other opportunities to increase capacity, and we anticipate success to take on many forms. One such metric is the decrease in emergency room utilization. There was a 400 percent increase of emergency room visits in 2012 with 70 percent of those visits attributed to addressing the mental health of children. Another measurement is an increase in the number of patients served through the program made possible through referral partners. HopeSparks can support a numerous patients and Elevate Health will extend the Bridge to Hope patient capacity through additional mental health service providers via its extensive community network.

Elevate Health’s Catalyst Funding furthers the collaboration care model through to fruition. Through its execution HopeSparks and Pediatrics NW were given not only the funding, but also the necessary time, space, partnership, and project expertise to improve health outcomes for children and families.

Case Snapshots

Charmaine is two years old. She was born with rare skin condition that makes her high risk and one that can lead to excessive bleeding. She is not expected to have a long-life span and her mother has accepted a far too early fate. However, through an early intervention program referred by Charmaine’s pediatrician her family was educated on how to treat her in the home, from walking and wound care to knowing how to hug her without causing damage. She also receives physical therapy in the home and has a mental health therapist. Now this family is on a trajectory toward success.

Linda is a single mom with an abusive past. One of her children has been removed from her home, and the second who remains is autistic, doesn’t speak, and inflicts self-violence. To address her needs, she came to maternal services. Through the supportive service she received her autistic child can now communicate with her via a tablet, and she is dealing with the trauma of her past to become a better parent.

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