Opportunities to Promote Children's Behavioral Health Health Care Reform and Beyond: Workshop Summary (2015) / Chapter Skim
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4 Implementing Innovations at the State and Local Levels
4 Implementing Innovations at the State and Local Levels
Pages 33-40
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From page 33... ...
About 26 percent of the state's population, or around one million people, are covered by the plan. These coordinated care organizations have sought to improve the integration of primary care and behavioral health, and they have resources to do so, said Anthony Biglan, senior scientist at Oregon Research Institute and author of the recent book The Nurture Effect: How the Science of Human Behavior Can Improve Our Lives and the World (New Harbinger, 2015)
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From page 34... ...
One of the most important challenges is ensuring that every young child who has a medical home is being screened for developmental readiness and is getting the services of appropriate behavioral health or developmental specialists when screening indicates that they are needed, said Biglan. He noted that the coordinated care organizations and hubs are collaborating to make this happen and that the most difficult part is getting behavioral health effectively integrated with primary care.
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From page 35... ...
In the past few years, the alliance has made a major effort to integrate mental health services in the primary care setting, but virtually all this effort has gone toward adults, not toward children and families. Recently, the state Medicaid program has been rolling out a primary care payment reform that is forging much stronger connections between primary care and mental health providers, noted Gregory Hagan, chief of pediatrics at the Cambridge Health Alliance and clinical instructor in pediatrics at Massachusetts General Hospital and Harvard Medical School.
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From page 36... ...
We should be clear about that to all of our training programs, to all of our universities, and to everybody who thinks they can still hang out a shingle by themselves." Second, data and metrics have become driving forces. "When you start to look at data, you suddenly find where the emergencies are and where you should focus your priorities." For example, school data revealed that the largest high school near the hospital where Kelleher works had 6,500 days of children absent in the previous school year because of juvenile justice involvement, which Kelleher termed a "mental health crisis." The metrics demanded by organizations such as the National Committee for Quality Assurance and the state Medicaid agency are at the claims level and need to be gathered, he said, but data are also needed from schools, foster care, juvenile justice, and other systems that involve children and families, as are data on unemployment, school readiness, high school graduation, teen pregnancy, and other characteristics outside of the traditional health domain.
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From page 37... ...
"If we do not measure our savings, then we cannot show how to make the business argument for these programs going forward." INTEGRATING PSYCHOLOGISTS WITH MEDICAL TEAMS IN CINCINNATI When Lori Stark, division director of behavioral medicine and clinical psychology at Cincinnati Children's Hospital Medical Center, was hired in 1998, there were four psychologists at Cincinnati Children's. Today there are more than 70, many of whom are providing services for children with chronic illnesses.
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From page 38... ...
In the area of community prevention, a program called Moving Beyond Depression has been targeting maternal depression in first-time mothers and has been attracting interest from other states that want to integrate these services into primary care.1 In general, the ACA has created a much stronger commitment among organizations to their communities, said Stark. Stark indicated that they have also started incorporating the collection 1 Additional information about the Moving Beyond Depression Program can be found at: http://www.movingbeyonddepression.org (accessed September 29, 2015)
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From page 39... ...
Biglan called attention to the larger context, such as children in the juvenile justice or foster care systems. As they age out of these systems, they can find themselves on the streets without health insurance, family support, or other help.
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From page 40... ...
"Not only do we need the policies but we need the leadership and the vision within our own organizations to push for implementing those policies." Health care 3.0 requires breaking down barriers, said Hagan, "and the only way we are going to do that is if we are fully integrated with these community organizations." However, Kelleher also pointed out that community organizations are numerous and can disagree with each other in fundamental ways. For example, in many neighborhoods, long-term homeowners dominate the civic associations, and they tend not to include families with young children.
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