Brief Summary:
The Safety-Net project was intended to disrupt disparities in mental health treatment access for
children at risk for childhood trauma, also known as ACEs, and/or serious emotional disturbance
(SED). “Safety Net” used mobile clinical and family support teams to improve mental health
outcomes. This clinical innovation was nested in an integrated system-of-care and was piloted
for children ages 3–18 with SED who received primary care through Cambridge Health Alliance.
Detailed Description:
“Safety Net” used mobile clinical and family support teams to improve mental health outcomes.
This clinical innovation, nested in an integrated system-of-care, was piloted for children ages
3–18 with SED who received primary care through Cambridge Health Alliance. Massachusetts
had the highest rate of child abuse and neglect in the U.S. during 2016 (DHHS, 2017).
Approximately 25% of these children lived below the federal poverty level (American
Community Survey, 2011–2013). The “gateway” cities targeted in Metro-Boston, Malden and
Everett, had 2–3 times the rate of foreign-born residents compared to the rest of Massachusetts
(43% vs. 15%) and twice the statewide rate of children whose parental language was not English
(54% vs. 22.3%). Together, SED and ACEs placed children at much higher risk for adverse
health and mental health outcomes in childhood and beyond.
CHA’s Children’s Health Initiative (CHI) leadership combined evidence-based interventions
from its earlier MHSPY program, including family support, care management, and shared goals,
with new strategies such as interdisciplinary child mental health evaluation teams, all within
primary care. Clinical expertise was combined with peer-to-peer parent/guardian support for
trauma-informed care delivery to both parent and child. All aspects of the care continuum were
provided in a culturally and linguistically competent manner, with child- and family-driven care
planning.
Overall, the program was sited in two cities and was supported by a larger, specialized system of
care involving state and local child-serving agencies, schools, and community resources. The
study team served 171 children and families in total, at approximately 70 children per year.
The goals of the program included:
- Promoting earlier recognition of child mental health needs;
- Using a family-driven assessment approach to offset disparities in treatment engagement
and outcomes; and - Facilitating state, local, and care-planning team coordination and collaboration using
system-of-care principles.
The objectives included:
- Assessing the presence of SED through standardized measures of clinical functioning,
including CGAS and CAFAS; - Screening for adverse childhood experiences (ACEs) using a modified ACE-Q tool;
- Increasing access to child mental health evaluation and treatment using pre-post measures
of patterns of service use for study participants and assessment of patterns of care for a
propensity-score weighted comparison group; - Improving family care experience, as measured by baseline and follow-up Family
Professional Partnership Scale assessments; and - Improving clinical functioning, as measured by baseline and follow-up CGAS and
CAFAS assessments.
Safety-Net’s goals aligned with CHA’s goals within its Accountable Care Organization contract
with MassHealth, thus offering a chance to measure and evaluate outcomes for a customized
system-of-care for some of the state’s most vulnerable populations.