Rebekah Fatzinger, LMSW, Coordinator Van Buren Community Mental Health Authority

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Jack Waters
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Consultant Michigan Dept of Health and Human Services Rebekah

1 Taggert Doll, MS, CAHC Program Coordinator Michigan Dept of Health and Human Services Lauren Kazee, LMSW, Mental Health Consultant Michigan Dept of Health and Human Services Rebekah Fatzinger, LMSW, Coordinator Van Buren Community Mental Health Authority

2 1. Describe and discuss the Child and Adolescent Health Center (CAHC) program. 2. Describe integrated behavioral and medical care currently happening at the CAHCs. 3. Identify methods to integrate behavioral and medical care in a clinic setting.

4 Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.

5 Emotional, behavioral and social difficulties diminish the capacity of children to learn and benefit from the educational process (Rones & Hoagwood, 2000)

6 MASLOW-Hierarchy of Needs Motivated and Learning Sense of Positive Self-Esteem Sense of Belonging and Importance Sense of Being Loved and Appreciated Free of Fear and In A Safe place Physical Health

7 Healthy children make better learners! Bringing health care to schools for student success.

8 Provide quality primary health care services on, or near, school property, including mental health services. They are organized through school, community, and health provider relationships. They are staffed by quality health care professionals. They reduce barriers to learning and help students succeed in school. They are not the same as a school nurse.

They are organized through school, community, and health provider relationships.

Goals and Core Values Program Goal: To help support student success by achieving the best possible physical, intellectual and emotional status of children and adolescents by providing services

9 Goals and Core Values Program Goal: To help support student success by achieving the best possible physical, intellectual and emotional status of children and adolescents by providing services that are high quality, accessible and acceptable. Core Values: Broad-based community support. Need-driven services! Parents and youth engaged as key partners. Quality services that are youth-centered.

are high quality, accessible and acceptable. Core Values: Broad-based community support.

10 Funding located within the K-12 Budget (31a) at MDE and the MDHHS budget draw down federal Medicaid Match dollars. All centers and programs must provide a 30% match Many communities provide more than 30% and effectively leverage state dollars Clinical centers must bill 3 rd party payers

All centers and programs must provide a 30% match Many communities

11 100 centers & programs Located in urban, rural, and suburban communities across the state Serving nearly 200,000 students

12 Models of Care School-Based/Linked Health Centers Alternative School Based Health Centers School Wellness Programs Network Sites

13 Centers must provide a range of services based on a needs assessment of the community/target populations and approved by the advisory committee. Minimum Services: Preventive Services Health history Physical Exams, including EPSDT/well-child exams. Primary care for common and acute illnesses Chronic disease management Immunizations Medicaid outreach & enrollment Health education Mental health services Referral for specialty care

Minimum Services: Preventive Services Health history Physical Exams, including EPSDT/well-child exams.

16 Services provided by percentage:

17 CAHC reports indicate that mental health needs of students are surpassing their physical health needs. The most frequent mental health problem diagnoses across the 60 CAHCs that provided mental health services were adjustment disorders followed by depressive disorders. (FY 14) 35%-Adjustment Disorders (21 out of 60 centers) 18%-Depressive Disorders (11 out of 60 centers) 79% were screened for Depression

services were adjustment disorders followed by depressive disorders.

18 Health Partnerships CAHCs are about schools and communities working together for student success. CAHCs provide access to health/mental health care and support services that schools need.

19 Staffing: Family Nurse Practitioner Health Center Coordinator Licensed Master Social Worker Certified Medical Assistant Biller/clerical support Oversight by physician 19

Integrated approach: primary care and behavioral health Supervising physician: pediatrician/psychiatrist Increased early identification of problems through

20 Integrated approach: primary care and behavioral health Supervising physician: pediatrician/psychiatrist Increased early identification of problems through screening and assessment: RAAPS (Rapid Adolescent Assessment for Preventive Services), Bright Futures, Youth Screen Focus on whole child not just presenting problem 20

screening and assessment: RAAPS (Rapid Adolescent Assessment for Preventive

21 Goal: serve approximately 500 unduplicated patients per year Typical year: Approximately 1,200 medical services Anticipatory guidance: Healthy eating/exercise BMI Tobacco usage Risk assessment well child exams immunizations 21

22 Approximately mental health clients per year mental health services per year Assessment and treatment plans Pre / post screenings: depression, anxiety, CAFAS Risk Assessment (RAAPS) results: 28% report having difficulty or getting into trouble when anger 25% report feeling sad or depressed for more than 2 weeks in prior year Referrals to/from Van Buren CMH

23 Type 4 Close collaboration in partly integrated system: share same systems; committed team approach; frequent face-to-face communication between providers; shared work space Type 5 Close collaboration approaching a fully integrated system: integrated/single treatment plan; unified behavioral and physical health services Type 6 Care provided through team based approach involving joint assessment and treatment plans, with shared responsibilities for outcomes; patients view system as cohesive and holistic 23

Child and Adolescent Health Centers www.michigan.

26 Child and Adolescent Health Centers School Mental Health

27 Contact Information Taggert Doll, MS CAHC Program Coordinator Michigan Dept of Health and Human Services

28 Lauren Kazee, LMSW Mental Health Consultant Michigan Department of Education/ Michigan Dept of Health and Human Services

29 Contact Information Becky Fatzinger, MA, LMSW Health Center Coordinator Community Wellness Supervisor Van Buren Community Mental Health Authority

MINIMUM PROGRAM REQUIREMENTS FOR CHILD AND ADOLESCENT HEALTH CENTERS ADOLESCENT SITES

MINIMUM PROGRAM REQUIREMENTS FOR CHILD AND ADOLESCENT HEALTH CENTERS ADOLESCENT SITES ELEMENT DEFINITION: Services designed specifically for persons 10 through 21 years of age aimed at achieving the best