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  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  To serve as the community’s go-to resource for accurate, essential information on children’s mental health and evidence- based practices  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  To play a leadership role in bringing together key stakeholders interested in improving and developing the child mental health system in Virginia  To provide limited services, including assessment and support, when these resources are not available in the community

Goals  Education  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.  Resources  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  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  Support for the Center comes from a variety of sources, including private donors, foundations, local government, and revenue from fee-based services.  Virginia Health Care Foundation  Richmond Memorial Health Foundation  Jackson Foundation  Jenkins Foundation  City of Richmond  Virginia Premier

CMHRC Programs  Educational Resources  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  Family Education and Support  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  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  Train and deploy cadre of experienced families to serve as navigators/mentors for families entering child mental health system  Provide workshops/presentations to families on subjects related to obtaining appropriate services for their children  Offer information through website and individual consultation

Referral Assistance & Pediatric Consultation Services  Working with a target group of pediatricians (~5) within the City of Richmond to offer referral assistance services to families.  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.  The CMHRC has developed agreements with a network of quality service providers (~16) to offer referrals for outpatient and intensive in-home services.  The goal is to facilitate appointments within 10 business days.

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 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. Family initiates contact with the Resource Center (Pediatrician provides family with Resource Center contact information) Staff utilizes screening tool to gather pertinent patient/family data. Referral to CMHRC psychiatrist for further evaluation/short- term services Referral to network provider (as needed) Psychiatrist consults with pediatrician. Provides short-term services as needed. Report of referral sent to network provider. Report of referral sent to referring pediatrician. Pediatrician refers family for Referral Assistance services Pediatrician sends referral request form to Resource Center via TrustFax Report of referral sent to network provider. Report of referral sent to referring pediatrician. Resource Center staff conducts follow-up with family; administers satisfaction survey Flow chart for Referral Assistance

Outcomes for 1 st year  256 children were referred to the CMHRC; screenings were completed for 214 children  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  A total of 252 appointments were scheduled with psychiatry fellows and the nurse practitioner  116 children were referred to community mental health resources  Psychiatry fellows & Nurse Practitioner provided 162 consultations  Trained Initial Group of 4 Family Navigators

Initial Outcomes  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.  Family Education Specialist provided one-to-one assistance to families participating in referral assistance program.  Provided consultation to CSA staff.  Developed and put on line web-site with VCU School of Business (  Initiated long term strategic planning process.

Pediatrician Feedback  “It’s a quick and ready resource”  “This program increases my confidence in prescribing”  “This is a good model for teaching about medications ”  “It’s a hassle free program”  “Great wait time for patients”  “The feedback from CMHRC staff is helpful and fast. I like talking about medications by phone, s, and faxes ”  “My patients’ families say that they are happy to be properly evaluated and treated”  “I could send you more patients if the CMHRC had the capacity”  “We’d like to have the psychiatrists in our office”  “I hope this program doesn’t end…I’ll be sad if it’s ever over”

Challenges  Capacity issues  Educating patients on program parameters & returning to their PCP  Educating PCPs about program’s goals of taking patients back into care  Had to reevaluate pediatricians' readiness

This upcoming year…  Dr. Rosa Morales-Theodore began August 2012  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  Referral Assistance update (Sept-Nov 2012):  Two pediatric practices added  Referrals from PCPs  Prescriptions  Clinical Global Impression (CGI) scores

Short-term Goals/Plans  Train and deploy additional family navigators  Work with Richmond CSA to assist them to implement family oriented early intervention model  Formalize data base and program evaluation component  Work with Medicaid and other state policy makers to incorporate CMHRC functions into child behavioral health service system  Collaborate with Region IV to strengthen child psychiatry services and extend consultation/education services to primary care practitioners  Expand referral network partners

Long-term Vision  Expand pediatric collaboration to all practices; behavioral health should be routine component of health home.  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  Provide education to reduce stigma  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  United Methodist Family Services  Child Savers (Not for profit child mental health agency)  Voices for Virginia’s Children (advocacy group)  National Alliance for the Mentally Ill (NAMI) Advocacy Group  Richmond Behavioral Health Authority  Family Focus – private in-home service provider  Children’s Museum of Richmond  Medical Home Plus  City of Richmond Hispanic Liaison Office  City of Richmond Department of Social Services  5 pediatric practices in the city of Richmond  Jenkins Foundation  Jackson Foundation  Virginia Healthcare Foundation  Richmond Memorial Health Foundation  Executive and Steering Committees