On Wednesday, we joined the Fordham University Graduate School of Social Service to welcome more than 200 leaders and stakeholders at our first ever Policy and Practice Forum, funded with support from the NY Community Trust. Together we began to unpack the complex changes and evolving priorities of the health care system that are having a deep impact on the lives of the vulnerable children and families we serve.
Our Collaborative – and the forum – emerged in response to a system that has fallen short. The data is clear, showing that children and families in greatest need of comprehensive care are not receiving the support they need, when they need it, in order to be healthy and successful in the long term. Instead, chronic illness persists and emergency room visits are frequent.
Yet the prevailing sentiment at Wednesday’s forum was one of hope and a sense of confidence in our ability to change systems and outcomes for families by working together. Take a look at some of the top takeaways from a day of knowledge-sharing, dialogue, and progress.
One-size-fits-all health care is not working. Panelists told us that they had seen the most success when caregivers acknowledged the specific trauma, needs, and experiences of each individual. They were effective when they worked with children and families as equals or as fellow humans, not as anonymous patients exhibiting a list of symptoms.
“If the opposite of poverty is justice, then the opposite of trauma is presence,” said Jacob Ham, PhD, Director of the Center for Child Trauma and Resilience at the Icahn School of Medicine at Mount Sinai. “Being witness to their suffering and their experiences, knowing that you could have been in their shoes, that’s the basis of technical practice. It has to start from the heart.”
Euphemia Adams, Executive Director at Families on the Move, emphasized the importance of peer-to-peer support. Who better to provide person-centered care than a peer who can personally relate?
Social Determinants of Health
The definition of health is changing, and it’s a good thing. It is broadening to include mental, social, behavioral, economic, family, and community health. Until symptoms are addressed in each of these areas, children and families cannot achieve sustained, total well-being.
As Rahil D. Briggs, PsyD put it, “There is no health care without mental health care. And there is no child mental health without parent mental health.”
As Director of Pediatric Behavioral Health Services at Montefiore, she has seen first-hand how collocating behavioral health and pediatric services for high-risk moms and their young children can significantly improve health outcomes for both.
“We need to start asking, ‘What happened to you?’ not, ‘What’s wrong with you?’” added Jane Golden, SVP and Chief Program Officer at Sheltering Arms, introducing the idea that trauma is the root cause of diseases which will persist, despite medical treatment, until trauma is addressed.
Kerron Norman, Vice President and Chief Program Officer at ANDRUS, qualified that idea. “Some of the symptoms we see are in fact related to food insecurity or housing insecurity. That instability would make anyone anxious,” she said. The typical formula for treating anxiety won’t work for the family Kerron describes. Until the family receives social supports and access to stable food or housing, the mental health symptoms will persist. The solution lies in a holistic view of health and treatment.
Gary Belkin, MD, MPH, PhD, Executive Deputy Commissioner, NYC Department of Health and Mental Hygiene, also sees the solution in linking community and mental health services. “Investing in economic development, education, and public health, those are mental health policies,” he said.
Healthy Workers, Healthy Families
Caring for those who have been traumatized or who feel “Underserved and undervalued by providers,” as Kerron Norman puts it, is stressful for caregivers.
“Staff have to feel safe, welcomed, and known,” said Virginia Strand, DSW, Professor and Co-Director of the National Center for Social Work Trauma Education & Workforce Development.
When her staff were getting “harmed on the job” and experiencing trauma themselves, Lina Pasquale, Division Director at Good Shepherd Services, turned to “The four Rs of trauma: rules, roles/responsibility, respectful communication, and relationships.”
Virginia Strand also encouraged organizations to consider staff support and retention now, even if HR is in the early stages of building a staff of care managers. “Ask yourselves what kinds of career ladders you’re going to build for these people. How will you diversify your workforce? How will you support them?”
Shared Benefits, Shared Responsibility
The benefits of working together to better serve the same families are clear. We can avoid duplicating services, provide more accurate diagnosis, pool resources, and prevent crisis which put a strain on both families and the staff and systems which support them. How we will work together is less clear. Our panelists and speakers helped us imagine how integrated care will look and how it has worked in existing collocated or managed care programs.
For Khalid Khan, MD, Director of Mental Health Services at New Alternatives for Children, collocation has eliminated the need for many outside referrals to labs and other services, which are so often the source of misdiagnosis, or the point at which families disengage.
Nevertheless, audience members pointed out that collocating all programs and services is not realistic for many agencies and providers. Fortunately, that’s where the Health Home’s Care Managers will come in, said Alan Mucatel, Chair for the Collaborative for Children & Families.
“Referring to another provider across the hall is not real integration,” echoed Monica Cierrici, Project Management Director of Bronx Partners for Healthy Communities at St. Barnabas Hospital. “Collocation is a precursor to collaborative care. It’s a continuum.”
Janna Heyman, PhD, Professor and Chair of the Henry C. Ravazzin Center, Fordham University Graduate School of Social Services, introduced the importance of breaking down silos between disciplines and departments.
“In the interest of breaking down silos, we have to stop building them in the first place,” added Sergio Matos, Executive Director at the Community Health Worker Network.
On a practical level, Monica Cierrici, suggested “Making IT part of everyone’s job so workflows support data-sharing,” as well as good communication.
Similarly, Lana Earle, Deputy Director at the Office of Health Insurance Programs for the NYS DOH, pointed to the shared value that will come with billing for services together, but also the shared risk and responsibility.
In his closing remarks, Mucatel also acknowledged that integrating care will require some sacrifices, but the forum gave us myriad reasons to be confident in the success of our children’s health home, the Collaborative, and the entire movement to give children and families a real chance at complete, sustained wellbeing.