Whole-Family Approach to Child Behavioral Health Care

Program Description

Over 100 years ago, Clifford Beers Clinic began delivering compassionate mental health care. Today, we focus on children’s behavioral health, and we believe that to address child’s mental health we must also address issues within the whole family. CBC has a three-part aim of service delivery: (1) the child/family’s exposure to adversity and stress, (2) how we can best address social determinants interfering with health, and (3) what we can do to address the physical and mental health needs of the whole family. This whole-family approach to care is not so much a program but a model of care to use across programs in unique, innovative settings. It assumes that if we work with only the child we will make some headway, but if we work with the whole family (e.g., address mom’s trauma history, help dad’s medical condition which is impacting his job performance, coordinate care for a sick sister, or provide an abusive uncle with therapy) we can make real progress. This whole-family approach starts with the family articulating their strengths (e.g., solid church ties, a great neighborhood network) and vulnerabilities (e.g., keeping doctor’s appointments, school engagement) so that the family can make meaningful strides toward wellness.

Creativity

Creatively, we are going well beyond the office setting to deliver behavioral health care for families. We are in schools, homes, and deep within the community. Recently, with community partners we opened a mental health “hub” for mothers in a large supermarket in New Haven. There we deliver stress management as well as workforce development, both of which involve teaching simple cognitive behavioral techniques. At this Moms “hub” and others like it, all services are co-delivered by a Masters-level therapist and a “Community Mental Health Ambassador” — a mother from the community who has been trained in mental health, trauma, and how to effectively address basic needs issues. CMHAs help draw out moms from the community who would not normally utilize mental health services, and they focus on building and using a comprehensive network of community resources to meet family needs (e.g., housing crisis, diaper bank access, school/head start program).

Leadership

We are routinely contacted from across the State and Nation about our whole family, trauma-informed model of care; others want to use it! For example, at their request we trained 2,000+ New Haven Public School employees staff about trauma, self care, emotional intelligence, de-escalation and wraparound services. We can do this because our whole-family approach programs have published outcomes, and the trainings are manualized. The model can — and is — easily replicated. Our belief in this model has us advocating for legislation to promote larger-scale adoption of it; we participate in commissions and task forces focused on mental health delivery for children toward that end. Finally, our receipt of a three-year federal CMS Innovation Grant also speaks to our leadership. We were asked to fiscally test the model alongside quality of care outcomes. Results confirm cost savings via decreases in inpatient and ED utilization while improving clinical symptomology.

Sustainability

In this changing healthcare environment we are clear there is no one path; therefore, we explore multiple funding streams and pay great attention to outcomes and impact. Our whole-family work with the Moms “hubs” is now part of a State of Connecticut/Yale University partnership that is a pay-for-success reimbursement model. Our whole-family work in schools is via a State contract as well as paid for through a private foundation that supports replicating the model in more schools. Our whole-family approach in the Innovation grant has multiple sustainability models: (1) CT Department of Social Services is an active partner and exploring Medicaid waivers to support the model; (2) CBC’s business leadership team is working with private payers to develop billing codes for care, and (3) CBC has secured a blended rate from one insurer to provide the care coordination element within the whole-family approach to care. Similar contracts are in development.

Replicability

We believe the whole-family approach to care will be widely replicated within the industry based on results as well as cost savings associated with where care can be delivered. The design of our model has been process evaluated. We have outcomes and impact data to indicate it works. It is also a framework that easily translates into a wide variety of settings: schools, pediatric offices, community locations (like the grocery store mentioned above), youth centers, and other mental health centers (including Federally Qualified Health Centers). We are fully manualizing the whole-family approach to care, including training and system integration. This includes sharing proposed financing models. We are developing a national training institute to help meet the demand of inquiries from organizations looking to replicate the whole-family approach. We expect that institute to be up and running within the next year.

Results/Outcomes

We use evidence-based assessments to track progress. In one home-based program where we use the whole-family approach we used the CES-DC assessment which indicated a clinically significant score of 15.7 for symptoms of depression. After six months of care the CES-DC results show significant decreases for all children (on average, between 3-point and 4.4-point improvement — these are clinically significant results). Using the whole-family approach in schools, we use attendance/unexcused absences to help quantify success. For children who received the CBITS group therapy intervention, over half improved their attendance rate, and over half had fewer unexcused absences. There was also a 40% reduction in chronic absenteeism. This means children were in school and in class more because of our intervention. Although we are still evaluating cost savings with our intervention, preliminary data shows a significant decrease in inpatient and ED utilization which means care moves from episodic to preventative.