Transcript Slide 1

Psychiatry In Our Schools:
How A City And A Health Center Created Access To
Behavioral Health Services
WEITZMAN SYMPOISUM
No Time to Waste: Primary Care Innovations in Acton
June 4, 2009
R. Timothy Kearney, Ph.D.
Director, Behavioral Health, CHC Inc.
Jane Hylan, MPH, CHES
Director, School Based Services, CHC Inc.
Megan Giesen, LCSW
School 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
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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.
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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
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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
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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.”
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In The Beginning
Only one traditional model to offer Meriden
Challenges
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Staff
Space
Funding
Maintenance
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“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
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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
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Time To RECONNECT And INNOVATE
Partnerships – New and existing
• Health Department
• Area Child Guidance Clinics
• Board of Education
• School Administration
• School Staff
• Families/Students
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The Meriden Model
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Priorities
Even playing field
Nip it in the bud
Territories
ESL
Mastered and licensed
Sustainability
Challenges
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8 openings
Parental involvement
Academics vs. clinical
Bi-lingual therapists
Recruitment
Sustainability
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Meriden School-Based Behavioral Health Services
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The Daily Work In The Schools
Megan Giesen, LCSW
School Based Health clinician
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Meriden School Based Services: Clients Seen School
Year 2008-09
• 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%)
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Meriden School Based Services: Clients Seen School
Year 2008-09
Sessions
55
992
368
1295
Initial
Individual
Group
Family
PPT
1572
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Summary Data Meriden School Based Health: School
Year 2008-09
Enrolled
%
enrolled
Total Visits
7/1/08 Current
Patients
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
4837
616
12.5
4517
423
11.14
School
Population
08-09
Barry
Facility
Total
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Avg Visits
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Summary Data Sites with Medical Services: School
Year 2008-09
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
Facility
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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
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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
Total
Total
2003
2004
2005
2006
2007
2008
<6
<6
<6
<6
<6
6
2003
2004
2005
2006
2007
2008
67
45
38
38
16
25
MidState Medical Center
Total
Other+
2003
6
2003
57
2004
36
2004
7
2006
28
2005
21
2005
14
2006
7
2007
9
2007
6
2008
11
2008
8
+ 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.
Source: CT Hospital Association Chime, Inc. Emergency Department Data
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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
80
70
67
60
50
45
38
40
38
30
25
20
16
10
0
2003
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2004
2005
2006
2007
2008
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Top Ten Diagnosis in the Meriden Schools 2006-09
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Top Ten Diagnoses In Child Outpatient Clinic 2006-09
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What We Have Learned
• 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)
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Previously Identified Markers Of Success
• Researchers have identified markers for success for School Based
Health Care, among them:
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–
–
–
–
–
–
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
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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
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