To provide the best mental health care, start by looking at the barriers to that care.
According to the American Academy of Child and Adolescent Psychiatry, about one in five children have significant mental health challenges. And half of teenagers who are living with mental illness that is severe enough to cause significant impairment in their day-to-day lives are not receiving treatment.
What role can children's hospitals and health systems play in bridging the gap between how the emotional and mental side of health care is treated? "The earlier we can design treatment and intervention, there is a payoff not just to the kids and families but to society as well," says Jena Hausmann, CEO of Children's Hospital Colorado. "We must look at what role children's hospitals can have with schools and other community organizations."
At the 2017 Annual Leadership Conference, Hausmann outlined how Children's Colorado is adopting a population health model for treating mental health. But, she says, the work is not without its challenges. Here are seven things Hausmann says children's hospitals should consider as they implement or increase mental health services:
Knowledge gaps. While there is knowledge out there about the best pediatric mental health practices, some of it is outdated. How do you make sure your organization has the best science in the field and can quickly disseminate it to teams?
Stigma. The stigma around mental health can cause people to not seek treatment. Providers and staff members should talk about mental health openly and encourage equality between mental and physical wellness. How do you talk about mental health with children, teens and their friends?
Access to care. Hausmann says this is an extreme challenge across the U.S. Those facilities providing mental health services at any level don't have enough capacity are not significant enough in capacity to take care of demand.
Workforce shortages. Hausmann says 42 states have a severe shortage of child psychiatrists—there are just not enough providers for the demand.
Quality of care and variation in practice. Most providers and clinicians were trained decades ago in different models. How do you get a team to follow best practice and close knowledge gaps?
Fiscal performance. Many organizations will need to have the "mission/margin discussion"—how do you best optimize payment reform? Children's Colorado has spent years advocating at state and federal levels.
Payment landscape. Colorado Medicaid pays fee-for-service for medical treatments but pays in a managed-care model for mental health services. Hausmann says this creates a lack of clear legal and fiscal responsibility, and is an example of where thinking about the integration of mental health into physical health must change at a philosophical level. While there are significant challenges, Hausmann says don't give up. "This is an opportunity for all children's hospitals to work together and share knowledge and best practices to take steps to address these issues."
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