Health care providers and educators aren’t typically trained on how the other system works.
A pediatrician recommends a child be evaluated for special education services. The family brings the recommendation to school, expecting a clear next step. But the school has its own legally required process to assess and support the student.
A teacher recommends a student be seen by their pediatrician for challenges they feel are consistent with attention deficit disorder. The family expects a one-time office visit and treatment. But the primary care provider needs to perform a thorough assessment that includes the child, family, and school team.
Both systems are trying to help. Yet the family is left to navigate conflicting guidance.
Leaders at University of Rochester Medicine Golisano Children’s created Connecting for Kids (C4K) to bridge the divide between schools, primary care providers, and behavioral health professionals. The structured, efficient model gives teams a way to understand the other’s systems, build trust, and agree on next steps.
The C4K model was developed by an emergency workgroup of education, pediatrics, behavioral health, and community partners during the COVID-19 pandemic.
Recognizing that siloed systems were not working well for children and families, individuals representing all Rochester area health systems and independent practices, multiple school districts, and community-based organizations worked closely to enhance kids’ access to mental and physical health services that had been disrupted.
The program has grown substantially since then, engaging more than 550 professionals across seven counties in western New York and the Finger Lakes region.
When good intentions create barriers
Schools, health care systems, and behavioral health professionals all serve the same children, but they operate under different regulations, processes, and communication structures. The differences can create misunderstandings that impact care.
“Everyone cares about kids and wants their well-being to be elevated, but they unintentionally engage in actions that work inefficiently across our system,” said Allison Stiles, PhD, child and adolescent psychologist and lead developer of C4K. “Sometimes that means kids fall through the cracks or families receive conflicting messages from providers.”
Pediatric providers aren’t usually trained in how school systems make decisions about services and support. Similarly, educators often have limited insight into clinical processes. Those gaps can lead professionals to make recommendations that do not align with how another system operates.
“There aren’t a lot of accessible, effective models for how to build trust, diffuse the turf issues that exist across our different systems, and really build system-level changes in how we communicate and collaborate,” Stiles said.
Designed for busy professionals
Program developers focused on creating a practical process that busy professionals could use. Sessions often bring pediatric clinicians and behavioral health professionals together with school-based nurses, mental health providers, and administrators who serve the same children and families.
The format is intentionally simple. Facilitators guide participants in a conversation focused on cross-sector collaboration, using specific discussion points to identify changes that could improve coordination across systems.
In the beginning, these conversations lasted up to two hours, but program leaders refined the model based on participant feedback and now typically conduct sessions in one hour.
That’s part of the appeal.
“It’s doable and effective even for systems and individuals that are time constrained, because everybody is,” said Laura Jean Shipley, MD, the hospital’s vice chair for regional pediatrics and population health.
Each conversation follows four steps:
- Identify the shared goal. Participants discuss common goals each sector has for supporting students’ physical and behavioral health and academic well-being.
- Reflect on current efforts. Teams discuss what is working, what gets in the way of collaborating and what resources may be needed to improve partnership.
- Set the stage for action. The group identifies what needs to change, how communication could be streamlined, and who can help coordinate next steps.
- Decide actionable next steps. The facilitator reviews common themes, and partners identify one or two strategies to engage and who will be responsible.
The magic moment
According to program leaders, nearly every dialogue follows a similar pattern.
Participants often join ready to talk about what is not working. School teams may be frustrated because they can’t contact providers. Clinicians might talk about difficulties reaching educators.
And then the tone shifts.
“It happens every single time when all of a sudden people realize they are allies,” Shipley said. “That’s when the magic moment is. It goes from these are ‘my’ kids to these are ‘our’ kids.”
Participants often start sharing their cell phone numbers and identifying ways to reach one another more efficiently.
Making a workflow change
Across multiple dialogues, the same challenges surfaced: Professionals couldn’t identify the right contact and struggled with communication issues and misunderstandings across systems.
An interdisciplinary group of educators, pediatric providers, and behavioral health professionals worked together to create a solution.
They developed a request-to-collaborate letter template that includes key contact information and the details each system needs to support children. The letter invites each partner to share their perspective and information so they can lean on each other’s professional knowledge to make an informed decision.
“We know that even when services are co-located or integrated, it doesn’t mean that they are communicating,” Stiles said. “We use the C4K model and related tools to ensure teams are building relationships, creating systems for communication, and fostering shared understanding.”
The letter also helps break down the barrier of mismatched schedules among busy professionals by including the best time and method to contact everyone. If professionals can’t connect directly, the letter template still guides professionals to collaboratively exchange key information asynchronously.
The tool has been incorporated into school processes and multiple electronic medical record systems used by primary care teams across the region.
A model built to scale
Although C4K was originally designed to be a one-time intervention, many communities continue meeting long after the initial dialogue. In some areas, C4K participants have formed ongoing regional communities of practice focused on common challenges such as chronic absenteeism and school avoidance. Others have adapted the model to address regional alignment of primary care, behavioral health, and to engage in effective listening sessions with parents, caregivers, and youth.
The team also developed a train-the-trainer model to help other communities adopt the approach.
Program evaluations have found increases in participants’ attitudes, knowledge, and confidence with cross-sector collaboration, improved communication between systems, and stronger understanding of how partner organizations work. Participants also felt more connected and had a greater recognition of shared goals.
Program leaders emphasized that meaningful change starts with intentional relationship building.
“What I love about this model is it strengthens what’s best about health care so we’re really collaborating well with our other colleagues, caring for the whole child, and making system-level change,” Shipley said.
The challenges that prompted C4K are not unique to western New York. Schools, health care providers, and behavioral health professionals across the country face many of the same barriers.
Melissa Heatly, PhD, child and adolescent psychologist and codeveloper of C4K, hopes the model offers a practical way to build stronger support systems for kids.
“Children and families right now need us to come to the table together with community partners and colleagues,” Heatly said. “Team-based care is what health care should be, and it should always be about the whole child.”
