SAMHSA grant: “Enhancing Systems of Care”

CHA’s Children’s Health Initiative (CHI), under the direction of PI, Dr. Katherine E. Grimes, was awarded a 4-year system-of-care grant from the federal Substance Abuse and Mental Health Services Agency. E-SOC ran from 9/30/16-9/30/20.

  • Pilot Experience: E-SOC built on 12 years of success with the Massachusetts MHSPY model for community-based, interagency strategies related to improving child outcomes, leveraging social determinants of health; as well as recent Windsor St. Collaborative Practice Model, CHA’s pilot for motivations in integrated care delivery within Pediatrics.
  • Population: Children, 3 – 18 years old, with PCP’s in CHA, who were referred from primary care having either screened positive for ‘serious emotional disturbance’ or where the PCP noted specific predisposing risk factors.
  • Sites: Primary Care clinic ‘hub’ sites Windsor and Broadway

Specific Goals of CHA’s E-SOC Project:

  • To improve access to child mental health and substance abuse (MH/SA) care – expand primary care screening and increase availability of timely evaluation and treatment, with a special focus on recognition and response to childhood trauma.
  • To improve youth and family engagement in MH/SA care – including greater communication between parents/caregivers and clinicians, and processes for outreach and tracking of referrals, as well as reduction of barriers such as language, culture, affordability and distance.
  • To improve clinical functioning – as reported by mental health providers, families, as well as self-report by youth with mental health needs.
  • To enhance integrated care delivery – including more real-time opportunities for collaboration; direct and indirect ways to “share care” between Primary Care Pediatrics, Family Medicine and Child Mental Health, with resulting increases in individualized treatment plans and adherence.
  • To improve community-linkages; with parent advocacy groups (PPAL, NAMI), school systems, and child-serving agencies, such as child welfare (DCF), and mental health (DMH), as well as with Cambridge and Somerville Police, and specialty substance abuse (IHR)

The E-SOC child integrated care teams relied on the three defining activities of the Collaborative Practice Model: co-location, coordination and collaboration. However, recognizing that each hub will have its own culture, we worked closely with clinic leadership and provider teams to identify which characteristics of our Windsor St. pilot approach were readily transportable, what needed adapting, and any new elements that were likely to increase effectiveness and further improve outcomes.

Throughout the E-SOC implementation process and evaluation, we maintained our focus on the overarching hypothesis, which is that earlier, and more comprehensive, integration of care for children will improve health care quality and expense outcomes throughout the lifespan.