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CHDI: A Model for Advancing A State’s

Children’s Mental Health System

New Hampshire Workforce Collaborative

April 4, 2014

Judith C. Meyers, Ph.D.

President & CEO

meyers@uchc.edu

CHDI Key Features

• Independent not for profit

• Subsidiary of the Children’s Fund of

Connecticut

• Established as partnership with leading

academic institutions

• Relationship with CT Children’s Medical

Center

• Over 15 years grown from staff of 1 to 25

• Sources of funding – Children’s Fund,

Grants

All children

Health & Mental Health Care Systems

Effective

Comprehensive

Community Based

CHDI VISION

4

MISSION

Advance and inform sustainable

improvements through:

•Programs

•Practice

•Policy

Strategy

Long term systemic change

Sustainable innovations and improvements

Partnerships

– Providers

– Policymakers,

– Academic institutions

– State agencies

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KEY AREAS

Pediatric

Primary

Care

Early

Childhood

Mental

Health

Treatment

STRATEGIC GOALS

• Comprehensive, quality health care services for

children through the pediatric medical home

model

• Comprehensive, community-based, quality

mental health care for all children and families

• Full integration of health/mental health systems

in a comprehensive approach to children 0-8 in

CT

Strategy: To develop and advance

programs, practices and policies that will

result in sustainable improvements in

primary and preventive health and mental

health care in Connecticut

Role and Functions

• Identify best practices

• Systems Design

• Test and evaluate models/demonstrations

• Research/evaluation

• Education and Training

• Securing funding - Grant writing/grants management

• Technical Assistance

• Consultation

• Quality Assurance – data collection/monitoring/

• Policy/Advocacy

• Financing

• Resource to state and communities

• Facilitation/convening

Child Health Services Framework

Medical Home

Part C (B-to-3)

Title V (CYSHCN)

Links to Preschool

Special Ed and

Special Ed (LEA)

Developmental/Behavioral Surveillance & Screening

Family Education/Parent & Child Counseling/Anticipatory Guidance

Literacy Promotion

Health Supervision Services

Oral Health/Dental Home

Nutritional Services

Medical / Surgical Subspecialty Services

Early Childhood Consultation Services

Developmental / Behavioral Health Services

(Mid-level, Comprehensive Assessments)

Home –based Services

Help Me Grow

Practice

Improvement

System Changes

Child Health Services Building Blocks

Family Support

Services

Medical Home [Accessible, Continuous,

Comprehensive, Coordinated,

Family-Centered, Compassionate,

Culturally Effective]

Child

Health

Services

Developmental Services

Medical Services

Home –Based Services

Prt C (B-to-3)

Title V

Desired Outcomes for School Readiness Family Capacity and

Function Emotional / Social /

Cognitive Development Physical Health &

Development

.

Early Care and

Education

Programs

.

Link with other child-serving systems

Child Healthcare System

Link with other child-serving systems Integration

• Intensive Clinical Intervention

• Mid-level Assessment

• Integrated Care Plans with Subspecialty Care

• Promoting healthy development (nutrition, oral health, literacy promotion) • Providing universal screening and referral

• Providing nurturing/responsive relationships and supportive environments • Health supervision/anticipatory guidance

• Intensive Clinical Intervention

• Mid-level Assessment • Early Identification/ Intervention

• Promoting healthy socio-emotional development

• Providing universal s-e screening and referral

• Providing nurturing/responsive relationships and supportive environments

• Education & training • Care coordination • Capacity building in practice settings • Public policy • Community investments

Child Health Child Mental Health

CHDI Workforce Development Initiatives

• Pre-service

– Current trends Course

• In-service

– EPIC

– Learning Collaborative Model (TF-CBT; Child FIRST)

– Training and TA – Wraparound; Care Coordination

– MATCH – ADTC;

– EMPS Quality Improvement

• Developing and embedding models in other systems

– Infant MH Endorsement in CT

– CONCEPT

– School Based Diversion Initiative

• Fellowships – graduate/post graduate

Adult Learning Principles

Educating Practices in the Community

(EPIC)

• Brings timely information and training to child health

professionals to change their practices

• Practice-based for entire office team

• Emphasis on practice change using clinical information,

tools, resources

• Topics for which there are resources to address

• Modules:

– Universal BH screening – tools and strategies for primary care

– Brief BH counseling in primary care for less complex concerns

– Connecting children to local behavioral health services

– Developmental Screening

– Autism Screening

– Maternal Depression

• Maintenance of Certification

Learning Collaborative Overview

• Learning collaborative approach is an implementation

and quality improvement model

• Based on the Breakthrough Series Collaborative

developed by the Institute for Healthcare Improvement

(IHI)

• Diverse implementation teams from each agency

• Intensive training / consultation process (9 – 12 months)

• Use of data and implementation science

Current Trends in Family Intervention:

Graduate Course

• Developed by Wheeler Clinic

• Funded by MH T-SIG Grant

• 14-weeks

• 3 credits

• Curriculum

• Instructor’s Toolkit

• Training fellowships for Instructors

• 17 faculty/11 institutions trained as of 2012

• Required or regularly scheduled elective

• Provides exposure

• Exposure/experience/expertise

Top Ten Learnings: 1-5

1. The field has changed dramatically but professional

training has not kept up. Embed new models into

graduate training.

2. Shortage of qualified professionals – Expand

definition of workforce

3. Skill building is not sufficient if systems and culture

don’t change in tandem

4. To advance practice change, need to work at policy

and systems level

5. High turnover – work is never done – build in

models of sustainability

Top Ten Learnings: 6 - 10

6. Need advocacy to support sustainability

7. Support an outcomes approach and

disseminate information about results (RBA

effective tool in CT)

8. Partner with philanthropy – source for

infrastructure, training, convening, planning,

organizational support, scholarships

9. Incorporate families at every level

10.Usefulness of an intermediary (backbone)

organization

Issues for Consideration

• Home

• Partnerships

• Governance

• Focus

• Functions

• Staffing

• Target Audience/Stakeholders

• Funding Sources

“We have learned to create the small exceptions

that can change the lives of hundreds. But we

have not learned how to make the exceptions the

rule to change the lives of millions.”

Lee Schorr