Children's Mental Health and the Life Course Model: A Virtual Workshop Series Proceedings of a Workshop (2020) / Chapter Skim
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6 Transforming Children's Health Care to Improve Lifelong Behavioral Health
6 Transforming Children's Health Care to Improve Lifelong Behavioral Health
Pages 53-64
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From page 53... ...
This chapter discusses the severity and widespread nature of the problem, potential pediatric care settings for incorporating mental health, and the importance of family-focused approaches when working to transform pediatric care. In her opening remarks, Leslie reiterated the massive shift in epidemiology across the world in terms of increasing "deaths of despair" (also highlighted in Chapter 5)
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The current mental health system is not enough, she said. TRANSFORMING CHILDREN'S HEALTH CARE Leslie presented arguments both for and against utilizing pediatric care settings for improving the mental health system's care delivery.
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Figure 6-1 Health care model transformation. SOURCE: Halfon, Long, Chang, et al., 2014.
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For a state, county, or health system to BOX 6-1 Envisioning Integrated Health Care Training: • Psychologists, child developmental specialists, community health workers, and peer navigators embedded in training settings • Cross-training across different disciplines and professions for true integration of care • Shared competencies and curricula across disciplines, professions, and evaluation metrics • Child and family emotional health and resilience attended to no matter where the health care setting is • Patients and families integrated into care team Care: • Inclusion of nonmedical professionals, parent and young adult patient peers, community health workers, and office staff in the team • Supervision models • Cross-disciplinary records with evidence-based decision support • Cross-disciplinary mechanisms for payment • Cross-walk of different risk identification and treatment protocols, including the family • Network of medical and nonmedical resources to link with SOURCE: Laurel Leslie presentation, April 16, 2020.
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Casey Foundation Blueprint program, which performed a systematic review of interventions that meet rigorous standards, and the Washington State Institute for Public Policy (also discussed in Chapter 5) that allows policy makers to review cost analyses of programs.
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Unmet Needs of the Current Model Despite these improvements, the response to stresses from those implementing pediatric chronic care models has been partial at best, Boat stated, and there are many needs that still demand attention. He listed three overarching unmet needs that the current medical model has yet to address: the full integration of behavioral health into the care model, the promotion of child and family behavioral health, and the identification and mitigation of risks for behavioral health.
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Importance of a Family-Focused Approach Boat introduced CFWell, a program at Cincinnati Children's Hospital that uses a family-focused approach to promoting behavioral health and wellness when a child has a disabling or lifelong chronic illness. Key elements of the program include: • Attention to lifestyle factors that promote health and wellness • Managing stress • Encouraging moments of joy and satisfaction • Addressing adverse social and economic determinants • Surveillance for family behavioral disorders Paying particular attention to lifestyle factors, he discussed the importance of sleep, nutrition, exercise, and finding joy.
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School success is a critical precursor to successful independent adult life, Boat emphasized, so it's clear that thinking about holistic needs must go well beyond the hospital and physical health. Possible Recommendations for Subspecialty Programs Boat shared his recommendations for improving and protecting the mental, emotional, and behavioral health of children and families in these situations: • Address demands, stresses, and their behavioral consequences from the time of diagnosis.
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He stressed the urgent need to learn and test interventions designed to better support emotional health and resilience for families of children with chronic illness. CHALLENGING THE FIELD TO EMBRACE TRANSFORMATIONAL CHANGE Moving to health care model 3.0 will require us to completely disrupt the current system, Leslie said.
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ImproveCareNow has demonstrated how a learning health system can be created using learning networks to create a large community of people committed to testing, improving, and learning together in order to make bold transformative improvements in outcomes.1 These are huge problems with deep interconnected roots, and we need to do a better job of learning faster and developing solutions that are more transformative. Potential Future Research to Promote Mental, Emotional, and Behavioral Health for Children Throughout the six-part webinar series, numerous speakers and discussants presented their work across a diverse array of fields relating to mental, emotional, and behavioral health.
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Stephen Buka, professor of epidemiology at the Brown School of Public Health, pointed out the lack of long-term, longitudinal cohort data for children with mental disorders and disabilities, saying that new studies of this sort could allow for tracking development with interventions similar to the approach used by the GenV study in Melbourne described in Chapter 2. He also highlighted that there is no dedicated surveillance system for mental health in children.
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There were multiple examples of best practices and novel applications presented throughout the entire series. Taking those examples, applying them to local context, and continuing to push forward to learn more about some of the areas highlighted in this chapter can help the field continue to advance in achieving the goals of improving mental, emotional, and behavioral health for children and families.
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