Hillary Clinton famously said, “It takes a village.”
For behavioral health providers, that concept – played out in communities all across Tennessee – has proven to be true. By taking an integrated, collaborative approach between mental health clinicians, primary care physicians, and an array of social service providers, some of the most vulnerable Tennesseans are finding not only their voice but their sea legs, as well.
Leading the charge on a statewide level is the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) and the Tennessee Association of Mental Health Organizations (TAMHO), but community-based mental health providers from Johnson City to Jackson are on the healthcare delivery front lines.
One of the nation’s largest not-for-profit providers of community-based behavioral health is Centerstone. Offering a range of mental health services, substance abuse treatment and intellectual and developmental disability services in Tennessee, Illinois, Indiana and Kentucky, Centerstone cared for nearly 84,000 individuals and families last year. Ben Middleton, COO for Centerstone Tennessee, said he remembers the not-too-distant past when care was delivered in a much different manner in this state. Middleton noted that into the late 1980s and early 1990s, there was a heavy reliance on institutionalization in state hospitals and private residential facilities.
One example of how that is changing is a specialized program and training for foster parents. Centerstone handles foster parent training across the state. In addition, the organization’s integrated therapeutic foster care program serves youth in more than 50 counties. “With the Foster Care Parenting Program, we have children who come to us through a DCS contract,” Middleton explained, adding the youth … mostly teens … typically have needs that require a coordinated effort between community mental health providers, social services, DCS and the foster parents.
“The intent is to provide a homelike environment,” Middleton said. “They don’t need to be in a facility where they are locked in.”
Yet, that’s what used to happen. “We used to be one of the top five states for hospitalization rates. Our hospital rates for children have gone down significantly,” Middleton said. “Historically for the state of Tennessee, if this kind of service wasn’t in place, there’s no doubt in my mind that we’d be going back in time.”
Instead, Tennessee has flipped the script when it comes to reaching those in need of mental health services. “Prior to these community-based services, you had to go to the provider. It was always tied to you having to come to a facility, be assessed and go from there,” Middleton explained. Now, he continued, ‘community-based’ means providers come to those who need help in their own communities. “It is seeing people where they live, and it has opened the eyes of our clinicians to see that all the things we’re asking people to do may not be possible until we change their living environment.”
Middleton described it as a more holistic, integrated approach where the client receives services – therapy, of course, but also the other social services necessary for success from food to clothing to transportation.
Tom Doub, PhD, CEO of Centerstone Research Institute (CRI) said his affiliated organization works hand-in-hand with Middleton. “Ben is responsible for programming. CRI writes grants,” Doub said of the funding mechanism to be able to put boots on the ground. In the last half of 2014, CRI secured $19.8 million in grants and contracts from state and federal organizations to launch and expand community-based behavioral health programs throughout Tennessee.
Two grants Doub is particularly excited about focus on suicide prevention as a partnership between TDMHSAS, the Tennessee Suicide Prevention Network and Centerstone. “On a statewide basis, we’re educating a whole range of people who work with at-risk children,” Doub said. “People don’t know how to have conversations about suicide, but those conversations are incredibly important,” he said.
The grant allows Centerstone to help police, teachers, healthcare providers, foster parents, those working in the juvenile justice system and others working closely with Tennessee youth know how to respond when comments about suicidal thoughts or depression arise. “It equips them to have conversations with kids to understand what the risks really are and when to intervene,” Doub noted.
And, he added, the need is critical. Tennessee suicide rate is higher than the national average and now approaches the number of accidental deaths by motor vehicle each year.
Another grant specifically targets veterans. “In Tennessee – the Volunteer State – we have a large veteran population,” Doub said. Middleton added Supportive Services for Veterans and Their Families (SSVF) is a three-year grant from Veteran’s Affairs to target vets who are homeless or at risk of being homeless.
Middleton noted that again, the focus is on integrated community-based services whether that means hiring an attorney to help with legal needs or providing addiction therapy services. “The grant allows us to make sure they have access to the basic things of life – a place to live, food to eat, and transportation. It makes sure they have all their behavioral, physical and social needs met,” he explained.
Technology, Doub added, plays a critical role in meeting needs and curbing expenses. He said typically a small number of people have the most expensive healthcare issues. “Probably about two-thirds of that population with high healthcare costs also have a mental health or substance abuse problem.”
Doub continued, “One of the things we’ve been working on is a new strategy on healthcare delivery – coactionHealth.”
The new initiative integrates mobile technology and data analytics as CRI, Ginger.io and Verizon have partnered to solve the ‘super-utilizer challenge.’ Doub said the program, which is being piloted in both Tennessee and Indiana, looks at “how we can begin to use mobile technology in smart ways so you can access your healthcare provider as easily as you can FaceTime your mother in California.”
He added that for someone having a panic attack on Friday night, getting in touch with a provider over the weekend has been problematic. On the other hand, he pointed out, “9-1-1 is a very easy way to access care. The question is how can we become, as this community-based system, more convenient than 911? How do we become more accessible than pressing three digits?” he asked. Doub noted the early data from the project has been very promising. “It appears we’re going to cut hospitalizations and emergency room visits by approximately 50 percent.”
Centerstone is also looking at a number of other innovative ways to incorporate technology into behavioral healthcare. Doub said perhaps it’s alerts from a smartphone when the user significantly deviates from their normal pattern of activity, such as remaining in bed for days … or maybe it’s a game that incorporates positive psychology. “By the time a child graduates from high school or at 18, they will spend over 10,000 hours on a screen or mobile device. That is a tremendous risk and opportunity,” Doub said.
Although Centerstone isn’t going into the game development business, the organization is helping to host some national gaming competitions to encourage developers to build games for good. Doub said the response has been really positive from the game development community.
“We’ve been very involved in this intersection of technology and healthcare,” Doub said. Middleton added, “We’re able to interface without being face-to-face. The rest of the world is ahead of us outside healthcare in terms of technology because that’s how you do business.”
Having the additional funding provided by grants, Middleton continued, helps close that gap between healthcare and other service industries by allowing Centerstone to launch innovative initiatives that wouldn’t otherwise be possible.
WEB:
