Name of Innovative Program:
ASPIRE Program: Mental Health Program/Schools Integration
El Camino Hospital (Mountain View and Los Gatos, CA)
Name of Innovative Program Lead:
Michael Fitzgerald, Executive Director Behavioral Health Services
E-mail Address of Innovative Program Lead:
ASPIRE (After School Program Interventions and Resiliency Education) is a mental health program that was developed with extensive community engagement by a hospital in the Silicon Valley region of Central California, following the tragic cluster-case suicides of several youth who stepped in front of moving trains. Because of the high-stress environment of youth in this community, who are often in households of extremely successful parents and who have high expectations for their own acheivements, there was recognized that many youth lack the skills needed to cope with this stress and were responding with behaviors including suicidal behaviors, self-mutilation , substance abuse, etc. Unlike traditonal services, ASPIRE is an 8-week program teaching DBT skills to kids so that they learn to manage crisis more effectively. Linked with schools, ASPIRE graduates receive 5 semester credit hours for program completion, applied towards their high school graduation requirements. The goal is to stress mental health treatment as Education, not as Illness.
Creativity and Innovation:
Traditional youth mental health acute programs require ongoing insurance review and demands that youth "step down" or discharge from services once they are improved in symptoms, i.e. "the crisis has passed". ASPIRE has turned this upside-down. We work with kids coming out of a crisis, referred by a hospital or others following significant risk behaviors. The goal is for studnets to learn/apply skills that help them manage crisis, focused on the areas of Emotional Regulation, Distress Tolerance, Interpersonal Effectiveness, and Walking the Middle Path. Parents attend mandated classes as well, focused on these areas (particuarly the skill of "validation"). Insurane companies must fund 8-weeks of after-school sessions, four days per week. We rarely receive an insurance denail, and if we do the youth is sponsored and completes for free.
El Camino Hospital is a community hospital in every sense of the word. We looked at a community concern (cluster suicide of youth) and put together a community task force to address the issue. The "buy-in" from schools who participated in this process included the awarding of school credit, recognizes that this not only rewards the hard work that students do in the program (including extensive homework that involves practicing the use of these skills and recording of these on diary cards), but destigmatizes mental health treatment.
The true innovation, in addition to the integration of this program with schools, is in the efforts with payors, families, and others to recognize that the experience of mental health symptoms is at-risk for all people, and that youth experiencing these symptoms can learn effective strategies to manage. The emphasis is continualy on gaining wellness, not on identifying illness. Michael Fitzgerald has given several talks on this program, including the Calfornia Healthcare Association annual meeting, and at the Leadership Institute in Santa Fe (attended by non-profit community hopsital leaders from around the country) and has received many requests to teach this program/approach. El Camino Hospital is looking at licensing this highly strucutred program so that data can be received and contiuned improvement made, across the region and beyond.
We've been approahced by middle-school administrators to expand the program (currently high school based) to that population, and are also working with local community colleges to bring this program to these sites in an integrated manner, again by offering college credit for completion of the challenging program. This innovation and the activities required to bring to a larger market require funding as "seed"--- it is our belief that once up/running, these programs (as they are now at two sites) can be self-sustaining via a combination of insurance reimbursement and donor support. We continue to engage with many partners so that there is a sense of community "ownership" of the program, as it was created by a community task force group.
Currently, we have this progam at two community hospitals owned by El Camino (the campuses at Mountain View and Los Gatos respectively). The measure that we have used to identify the success of ASPIRE has been 3 and 6 month surveys to both parents and the youth who've graduated from the program. These surveys indicate that most youth continue to utilize the skills learned, that communication within the family has been improved, and that symptoms are well managed. Average survey score is 3.5 to 4 (out of 5) on use of skills. We've received several letters from parents indicating success of their children. The majority of ASPIRE graduates were referred after hospitalization or significant suicidal or other high-risk behavior, this has been very gradifying. Ofter, it is the former patient who refers a troubled friend to the program---these youth have in some cases become ambassadors.