Transcript Virginia Treatment Center for Children

www.mentalhealth4kids.org
New Approaches to Meeting Children’s
Mental Health Needs
Robert Cohen, Ph.D.
Alli Ventura, Ph.D.
Virginia Treatment Center for Children
Department of Psychiatry
Virginia Commonwealth University
History
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Grew out of Program Review of VTCC Services
Recognition of Lack of Access to Services & Inefficient
Use of Mental Health Providers
Planning Group of 13 Individuals/Organizations Interested
in Child Mental Health
2.5 years Planning and Development
Mission
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To serve as the community’s go-to resource for accurate,
essential information on children’s mental health and evidencebased practices
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To provide parents, professionals and other interested
individuals with the assistance and support they need to
navigate the complex child mental health system and access
appropriate services
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To play a leadership role in bringing together key stakeholders
interested in improving and developing the child mental health
system in Virginia
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To provide limited services, including assessment and support,
when these resources are not available in the community
Goals
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Education
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Resources
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Provide information and materials that promote greater understanding of the causes,
diagnosis and appropriate treatment of children’s mental health problems through print
and web-based media, educational forums, and consultation and technical assistance for
providers.
Establish a referral database of mental health care providers who meet the Center’s quality
criteria.
Link individuals to appropriate resources, including child and family support, education,
assessment and treatment, and financial and other resources.
Integrate primary and behavioral healthcare.
System Improvement and Development
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Provide education to families, practitioners and policy makers on the needs and strengths
of the child mental health service system, as well as evidence-based practices that should
be made available.
Advocate and work collaboratively with other stakeholders for additional resources for
children’s mental health.
Funding
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Support for the Center comes from a variety of sources, including private
donors, foundations, local government, and revenue from fee-based
services.
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Virginia Health Care Foundation
Richmond Memorial Health Foundation
Jackson Foundation
Jenkins Foundation
City of Richmond
Virginia Premier
CMHRC Programs
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Educational Resources
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Family Education and Support
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an on-site library with materials in both English and Spanish,
a website with in-depth information on childhood disorders, available
treatments, and community resources
one-on-one assistance and group trainings that help families navigate
the child mental health system and build upon their natural strengths
Referral Assistance and Pediatric Consultation Services
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a pilot project with pediatric primary care providers in the City of
Richmond that connects families with appropriate specialty services
and increases pediatricians’ capacity to care for their patients with
mental health needs
a referral network of providers willing to provide timely care for
children with behavioral challenges and their families
Family Education and Support
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Train and deploy cadre of experienced families to serve as
navigators/mentors for families entering child mental health system
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Provide workshops/presentations to families on subjects related to
obtaining appropriate services for their children
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Offer information through website and individual consultation
Referral Assistance &
Pediatric Consultation Services
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Working with a target group of pediatricians (~5) within the City of
Richmond to offer referral assistance services to families.
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When a family contacts CMHRC, the staff interviews the parent/guardian
to identify the specific needs of the child so that an appropriate referral can
be made for diagnostic or therapeutic mental health services.
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The CMHRC has developed agreements with a network of quality service
providers (~16) to offer referrals for outpatient and intensive in-home
services.
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The goal is to facilitate appointments within 10 business days.
Flow chart for Referral Assistance
Pediatrician refers family for
Referral Assistance services
Pediatrician sends
referral request form to
Resource Center via
TrustFax
Family initiates contact with the Resource Center
(Pediatrician provides family with Resource Center contact information)
Resource Center staff conducts screening
If family is not able to do screening at time of initial call, or
trained staff is not available to conduct screening,
times/preferences are obtained for a follow-up call. Staff
follows up with family and conducts screening.
Referral to network provider
Report of referral sent
to network provider.
Report of referral sent
to referring pediatrician.
Resource Center staff makes
appointment with network provider (goal
is within 10 business days). Family is
asked to follow up with provider within 24
hours. Information on other
programs/supports is provided.
Staff utilizes screening
tool to gather pertinent
patient/family data.
Referral to CMHRC psychiatrist
Psychiatrist consults
for further evaluation/shortwith pediatrician.
term services
Provides short-term
services as needed.
Referral to network
provider
(as needed)
Resource Center staff
conducts follow-up with
family; administers
satisfaction survey
Report of referral sent to
network provider. Report
of referral sent to
referring pediatrician.
Outcomes for 1st year
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256 children were referred to the CMHRC; screenings were completed for
214 children
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NOTE: The # of screenings is lower than the # of referrals because some
parents did not contact the CMHRC after the pediatrician submitted a
referral request
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A total of 252 appointments were scheduled with psychiatry fellows and
the nurse practitioner
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116 children were referred to community mental health resources
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Psychiatry fellows & Nurse Practitioner provided 162 consultations
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Trained Initial Group of 4 Family Navigators
Initial Outcomes
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More than 100 parents and other caregivers participated in workshops on
variety of topics related to obtaining appropriate services for their children
in City of Richmond.
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Family Education Specialist provided one-to-one assistance to families
participating in referral assistance program.
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Provided consultation to CSA staff.
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Developed and put on line web-site with VCU School of Business
(www.mentalhealth4kids.org).
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Initiated long term strategic planning process.
Pediatrician Feedback
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“It’s a quick and ready resource”
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“This program increases my confidence in prescribing”
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“This is a good model for teaching about medications”
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“It’s a hassle free program”
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“Great wait time for patients”
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“The feedback from CMHRC staff is helpful and fast. I like talking about medications by
phone, emails, and faxes”
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“My patients’ families say that they are happy to be properly evaluated and treated”
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“I could send you more patients if the CMHRC had the capacity”
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“We’d like to have the psychiatrists in our office”
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“I hope this program doesn’t end…I’ll be sad if it’s ever over”
Challenges
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Capacity issues
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Educating patients on program parameters & returning to their PCP
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Educating PCPs about program’s goals of taking patients back into care
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to reevaluate pediatricians' readiness
This upcoming year…
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Dr. Rosa Morales-Theodore began August 2012
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Goals for Psychiatrist:
 Increase contact and networking with area agencies and associated
pediatric offices
 Reassess and modify guidelines for program with Pediatricians
 Increase in-office consultations
 Increase teaching via live session and/or on-line modules
 Increase accessibility of psychiatry for pediatricians in program
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Referral Assistance update (Sept-Nov 2012):
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Two pediatric practices added
Referrals from PCPs
Prescriptions
Clinical Global Impression (CGI) scores
Short-term Goals/Plans
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Train and deploy additional family navigators
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Work with Richmond CSA to assist them to implement family oriented
early intervention model
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Formalize data base and program evaluation component
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Work with Medicaid and other state policy makers to incorporate CMHRC
functions into child behavioral health service system
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Collaborate with Region IV to strengthen child psychiatry services and
extend consultation/education services to primary care practitioners
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Expand referral network partners
Long-term Vision
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Expand pediatric collaboration to all practices; behavioral health should be
routine component of health home.
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Integrate CMHRC functions into mainstream child serving system
 i.e. front door for entry into service system to include assessment,
referral, navigation, support for families
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Provide education to reduce stigma
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Participate in efforts to transform child mental health system
Partners
Children’s Mental Health Resource Center program designed to increase
timely access to appropriate services
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United Methodist Family Services
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Child Savers (Not for profit child mental health agency)
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Voices for Virginia’s Children (advocacy group)
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National Alliance for the Mentally Ill (NAMI) Advocacy Group
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Richmond Behavioral Health Authority
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Family Focus – private in-home service provider
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Children’s Museum of Richmond
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Medical Home Plus
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City of Richmond Hispanic Liaison Office
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City of Richmond Department of Social Services
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5 pediatric practices in the city of Richmond
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Jenkins Foundation
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Jackson Foundation
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Virginia Healthcare Foundation
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Richmond Memorial Health Foundation
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Executive and Steering Committees