Agencies help teens, families in behavioral health crisis
Pittsburgh Post-Gazette - 3/7/2017
March 07--When parents discover their teenager is using drugs, or they find that a change in behavior is caused by depression, it's a crisis in the family. But there are often gaps in finding treatment that will lead to the young person being safe and in a stable condition. Problems can occur every step of the way.
"I once got a call from a family member at 10 p.m.," said Christine Michaels, executive director of NAMI Southwestern Pennsylvania, an advocacy group for people with mental illness and their families.
"They were admitting their son to an inpatient psychiatric unit voluntarily. He was very depressed, had a lot of insight and had just turned 18 years old. The mom assumed she would accompany him to his room and get him settled in. She was stopped cold, not permitted past the ER and no one would talk with her or explain to her what was going on. Her son had been hospitalized for asthma a couple of different times, [but] that admission process was a totally different experience."
Expanding mental health services for teens is the goal of a multiyear effort by the Adolescent Behavioral Health Initiative in Allegheny County. It was created last year by the Jewish Healthcare Foundation, and this past January the initiative convened a gathering of more than 50 people -- behavioral health service providers, health plan representatives, nonprofit leaders, funders, family and patient advocates, and state and county officials -- to make an action plan for 2017-18.
"I kept hearing stories and narratives from families about their experience about accessing behavioral services, especially in a crisis," said Robert Ferguson, director of government grants and policy for the foundation. "That prompted us to also look at the data about access and quality of care."
Taking the initiative
The Allegheny County effort has a 40-member advisory group and is supported by JHF, the Staunton Farm Foundation and The Pittsburgh Foundation. JHF has committed $500,000 to the project; Staunton Farm, $150,000 over three years; and Pittsburgh Foundation, $75,000 for one year. Mr. Ferguson oversees the initiative.
"We're hoping to divert people and catch them much earlier than inpatient admission," said Joni Schwager, Staunton Farm executive director. "It may be developing services. There's never enough services for the people that need them. There are complications to get access to services."
After brainstorming and setting priorities, the Adolescent Behavioral Health Initiative group last month awarded a $20,000 grant to the nonprofit advocacy group Patients' View Institute to gather stories from families with teenagers in need of mental health and substance use services.
Through late April, at the website goPVI.org/ABHI people can submit stories in written, spoken or visual formats with the goal of sharing the patient's point of view.
Patients' View spokeswoman Denise Acker said the focus is to collect stories specific to Allegheny County.
"It's really about creating a conversation to inform community health care planning," Ms. Acker said. The stories in turn will be coded according to research-based points that are important to patients, she added. For example, a story may be identified with the theme of safety if it involves concerns about up-to-date treatment, if treatment is consistent with best practices, or about unwanted prescription side effects.
The stories will help JHF understand the perspective of families, Mr. Ferguson said. He said the initiative gave priority to expanding evaluation and crisis response services in the community -- such as deploying paramedics for mental health care -- and developing a system to help families navigate the services.
"The mental health system is a complex, multidimensional entity that at certain stages requires a personal guide," Ms. Michaels of NAMI said in a recent email. One issue, she said, is that teenagers may not yet be in the public, community mental health system, where the services they need are found. Another is the different way that mental health care is provided compared with physical health care, in how patients are both diagnosed and treated.
"We worked with a family who had a child in a residential treatment facility and had not lived at home for nearly a year and a half," Ms. Michaels said. "It was September and they had been told that their child would be discharged at the beginning of November. They called us because now, their child was being discharged within the week, had just received a new diagnosis and everywhere they called no one could stop the discharge. They did not understand what was being told to them, they did not understand how the system worked, nor did they know whether they or their child were being treated correctly or not."
Ms. Schwager of Staunton Farm said an added problem is that public and private insurance experiences differ.
While she believes Allegheny County has some of the best services in the country, there still are not enough psychiatrists in the county, and the situation is much worse outside the county. "The lack of child psychiatrists is critical."
Integrating primary care and behavioral health is important to fill gaps in care, she said, praising the model of some pediatrics practices and federally qualified health centers in the county that have integrated care, with social workers and part-time psychiatrists on staff.
Pilot project planning
Mr. Ferguson said the initiative is in the middle of its early phases. A pilot project to reduce the time from the onset of a crisis to recovery could start this summer.
"We're looking at models called recovery response centers," Mr. Ferguson said. "We are also looking at how to expand the types of crisis and stabilization services that exist in Allegheny County already." He said re:solve Crisis Network is an example.
"With this model we want to fill the cracks in the system ... In this pilot we want a very effective follow-up and follow-through. So a person is not let go until a satisfactory resolution is achieved."
Ms. Michaels said NAMI advocates a model that breaks down the barrier between the children's system and the adult system so that families aren't held at arm's length once the child turns 18.
With better education about treatment and services and navigation help and advocacy for teens and their families, she said, the family who wanted to stop the discharge of their child from a facility might have been better informed -- perhaps the new diagnosis was more accurate and a different treatment was needed.
"Rather than the family be upset and fearful of bringing their child home, this could have been a really positive, celebratory homecoming," she said. "Families need navigators and translators to understand both the system and the treatment."
Jill Daly: firstname.lastname@example.org, 412-263-1596.
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