Hartford Business Journal

www.HartfordBusiness.com • December 10, 2018 • Hartford Business Journal 21 HEALTH CARE HEROES AWARDS 2018 Category: Advancement in Healthcare — Innovation CT Children's integrates behavioral health care throughout system By John Stearns Special to the Hartford Business Journal A bout 75 percent of adults with chronic behavioral health illness first be- came ill before they were 18, according to a statis- tic cited by Dr. Glenn Focht at Con- necticut Children's Medical Center. "These are really pediatric-onset ill- nesses for most Americans who have a behavioral health diagnosis," said Focht, president of Connecticut Children's Spe- cialty 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 — hope- fully 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 coordi- nate 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 inte- grated behavioral-health clinicians in eight of its 40-plus specialty clinics. Its goal: Inte- grate behavioral- health experts throughout the entire system. "That's part of where our prior work with the primary care physicians is help- ing 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 doc- tor and behavioral- health clinician act as a team and make each other's care better and more complete, which is what Con- necticut 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 men- tal 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 behavior- al health and facilitating that referral for a parent the way a primary care physician might coordinate a cardiolo- gist visit upon discovering a child's heart murmur. "We're going to create some equity at a minimum," between mental and physi- cal health, Rogers said. Fully integrating the two system- wide would make Connecticut Chil- dren'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 iden- tified early who was going to develop dia- betes 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 manage- ment 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 inter- vention (CPI) techniques for de-escalat- ing tensions. Connecticut Children's does not have an inpatient psychiatric unit, but many families go there for behavioral-health emergencies. It collaborates with Hart- ford Hospital's Institute of Living for ED patients' inpatient psychiatric care. Connecticut Children's has inno- vated by expanding CPI training to all ED staff. A goal is to innovate further by incorporating CPI training system- wide, Focht said. When kids and families visit the ED for a mental health crisis, Con- necticut 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 seri- ously ill children, Connecticut Chil- dren'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 expe- dited, 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. "It's about trying to create a whole new ecosystem for how behavioral health care can make a difference in kids' lives." Dr. Glenn Focht , president of Connecticut Children's Specialty Group Connecticut Children's Medical Center Headquarters: Hartford Top Executive: Jim Shmerling Dr. Steven Rogers (left) is the director of emergency mental health services at Connecticut Children's. 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.

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