When “Breakthrough” Really Means Change

By Alice Forrester, PhD, Executive Director, Clifford Beers Clinic

As a seven year old, Josie was told she needed to repeat kindergarten. Again. Her severe asthma had caused too many absences, but it was her anxiety that caused Josie’s pediatrician to refer her to Clifford Beers Clinic (CBC). CBC is a mental health agency treating the cases of 2,000 children and families in Greater New Haven each year.

When Josie and her mom came to us (after two cancellations), anxiety was by no means the family’s biggest problem. Josie’s father was incarcerated for domestic violence. Josie’s mother had a pain-pill addiction following a severe back injury. Josie’s older siblings had mental health issues and were avoiding school. Maybe worst of all, the family was on the brink of eviction.

The level of trauma exposure, the lack of basic needs like food and safe housing and the family’s overall physical and mental health were stifling. Within CBC’s traditional outpatient framework—one patient for one hour with a focus on symptom reduction—we were unprepared to adequately help this family. They left CBC after two sessions because it was just too hard for them to get to the Clinic, and our care wasn’t going to be good enough. We referred them for in-home help, but there was a six-week wait. Later, we heard the kids were placed in foster care.

This treatment failure drove us to realize we had to rethink care and make it accessible and useful to families with complex health and mental health needs.

With seed funding from the Connecticut Health Foundation, we hired a consultant who led us to the Institute of Healthcare Breakthrough Improvement Model of Change Management. That series took us through the process of designing an integrated wraparound model for chronically stressed families. We held conversations with parents, staff and national leaders whose ideas informed the model. Soon thereafter, our board of directors adopted a new strategic plan stressing the need to work with the whole family from an integrated strength-based perspective in order to reduce the potential lifelong exposure to chronic stress.

Since 2013, all new initiatives launched at CBC have been centered on the core values of this strategic plan, and this led to CBC receiving a substantial grant from the Center for Medicaid and Medicare Services in 2014 (one of only 39 Healthcare Innovations Grants in the country).

It is because of the work done via the Breakthrough Series that we could design a trauma-informed wraparound model of care that uses multidisciplinary teams of care coordinators, pediatricians, social workers and psychiatrists who can offer in-home support for children living with chronic health/mental health conditions. Our partners—Yale New Haven Hospital, Fair Haven Community Health Center, Department of Children and Families, Connecticut Department of Social Services, and the City of New Haven—are helping us enroll families who need help. Families like Josie’s.

Alice Forrester, PhD, is the executive director of Clifford Beers Clinic, a CT Health Foundation grantee.

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