CT Children's integrates behavioral health care throughout system

Photos | Contributed Behavioral health doctors and staff at Connecticut Children's Medical Center are being integrated into regular patient care to try to solve mental health issues at an early age.

Dr. Steven Rogers (left) is the director of emergency mental health services at Connecticut Children’s.

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By John Stearns

Category: Advancement in Healthcare — Innovation

Connecticut Children's Medical Center

Headquarters: Hartford

Top Executive: Jim Shmerling

About 75 percent of adults with chronic behavioral health illness first became ill before they were 18, according to a statistic cited by Dr. Glenn Focht at Connecticut Children's Medical Center.

“These are really pediatric-onset illnesses for most Americans who have a behavioral health diagnosis,” said Focht, president of Connecticut Children's Specialty Group and the senior executive supporting behavioral-health initiatives.

That underscores the importance of Connecticut Children's focus on primary care physicians screening for and addressing pediatric behavioral health issues as they emerge — hopefully to stave off bigger problems later that can trigger trips to an already busy emergency department (ED), like attempts at self-harm and mental health problems as adults.

About 18 months ago, Connecticut Children's integrated a behavioral-health specialist in its two primary care practices. Physical and mental-health providers coordinate among each other and families to ensure children get appropriate help.

“It's about trying to create a whole new ecosystem for how behavioral-health care can make a difference in kids' lives,” Focht said, noting children can be screened at least once a year during well visits.

Connecticut Children's also has integrated behavioral-health clinicians in eight of its 40-plus specialty clinics.

Its goal: Integrate behavioral-health experts throughout the entire system.

“That's part of where our prior work with the primary care physicians is helping us because we're starting to pivot use of some of those tools and involve our specialists in that same work: How do we identify these kids who need help, how do we get them plugged in to services?” he said, noting children with complex, chronic medical conditions also are more likely to have behavioral-health needs.

Behavioral-health specialists' integration into medical settings is key, Focht said, not mere colocation. The medical doctor and behavioral-health clinician act as a team and make each other's care better and more complete, which is what Connecticut Children's seeks throughout its operations, which includes a 187-bed hospital, clinics statewide and 2,800-plus staff.

Being healthy in mind is more likely to result in a healthy body and vice versa, said Dr. Steven Rogers, director of emergency mental health services at Connecticut Children's.

By improving communications between the two systems, pediatricians can more easily refer a child to a mental healthcare provider, but also receive feedback and hopefully integrate what they're doing medically with what the mental healthcare provider is doing, Rogers said.

It's trying to create parity between physical and mental health, he said of conveying the importance of behavioral health and facilitating that referral for a parent the way a primary care physician might coordinate a cardiologist visit upon discovering a child's heart murmur.

“We're going to create some equity at a minimum,” between mental and physical health, Rogers said.

Fully integrating the two systemwide would make Connecticut Children's a forerunner, Rogers and Focht acknowledged.

Another national statistic Focht cited: It can take almost eight years, on average, between the time a child starts presenting signs of behavioral-health issues outside normal development and receiving appropriate treatment.

Rogers said if every child could be identified early who was going to develop diabetes sometime in their life, their lifestyle and diet could be tailored to minimize impact, “so that's how we have to look at mental health … as a whole — we have ways to identify that” through screening.

Early behavioral-health management also can reduce ED loads.

Behavioral-health emergencies will occur, though. Connecticut Children's has trained frontline ED personnel, such as security, in crisis prevention intervention (CPI) techniques for de-escalating tensions.

Connecticut Children's does not have an inpatient psychiatric unit, but many families go there for behavioral-health emergencies. It collaborates with Hartford Hospital's Institute of Living for ED patients' inpatient psychiatric care.

Connecticut Children's has innovated by expanding CPI training to all ED staff. A goal is to innovate further by incorporating CPI training systemwide, Focht said.

When kids and families visit the ED for a mental health crisis, Connecticut Children's helps coordinate behavioral-health help through a care-coordination plan linking them to behavioral-health resources, hopefully preventing future ER visits.

By mid-January, for the most seriously ill children, Connecticut Children's plans to coordinate a meeting with a psychiatrist within 24 to 48 hours of an ED visit, Focht said.

“For some kids, if that's not expedited, that could be a several-month wait,” he said. “Those are all the things now that we're working on, sort of this next generation of interventions” to create healthier lives.

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