Over the past 150 years, The Children’s Home of Cincinnati has successfully transformed the lives of thousands of children at risk. As their challenges, diagnoses and treatment protocols have evolved, The Children’s Home has continually responded and expanded to meet children’s needs. One of the largest undertakings in the organization’s service history is the foray into the world of integrated care, with the notion that treating the ‘whole child’ is both beneficial and impactful.
To ensure a strong future, The Children’s Home convened a Health Advisory Council last fall. It is a group of 18 community stake-holders who are charged with providing feedback on the strategic direction of healthcare initiatives, overseeing partnership engagement and promoting continuous improvement in service delivery.
Recently, Barbara Terry, vice president of health and systems integration at The Children’s Home, sat down with three of the Advisory Council members to talk about the work, the challenges and the opportunities for continued success.
The Pursuit of Excellence
Although healthcare financing, policy and delivery systems have historically separated primary healthcare from mental health and substance abuse services, The Children’s Home recognized that bringing these clinical services together increases access, quality, health outcomes and cost effectiveness of care.
Dr. William de Buys, chair of the Health Advisory Council and a member of The Children’s Home Board of Trustees, framed the issue perfectly.
“As a pediatrician, I have spent my entire career making sure that children have every opportunity to grow into healthy adults. We know that mental health is a children’s health issue – and I think we have an obligation to ensure that the children we serve have healthy bodies and healthy minds.
“Integrated care is the standard of care that defines excellence.”
At the Intersection
The pathways leading to the co-occurrence of mental and physical disorders are both complex and bidirectional, and integrated care lies at the intersection. Physical disorders may lead to mental disorders, mental conditions may place a person at risk for physical disorders, and mental and physical disorders may share common risk factors.
Karen Bankston, Ph.D., is associate dean at the University of Cincinnati College of Nursing. In her role, Bankston is responsible for clinical practice, partnership and community engagement. She talked about the health challenges that children face and used Attention Deficit Hyperactivity Disorder (ADHD) as an example.
“Last year, the Centers for Disease Control and Prevention released a report on children’s mental health. The CDC found that as many as one in five American children under the age of 17 have a diagnosable mental disorder and the most common diagnosis for children age 3 through 17 is ADHD. If that isn’t challenging enough, we also know that individuals with ADHD have an increased prevalence of asthma, we know that ADHD and asthma are both associated with a higher prevalence of obesity and we know that obesity is a risk factor for the development of asthma. It is definitely complex and a great example of why all of our systems need to work together.”
Research has shown that the key to disrupting this phenomenon is the development of preventive and early identification strategies, including integrating care systems for children that address the primary care, behavioral health, specialty and social support needs in a manner that is continuous and family-centered.
Building Systems of Tomorrow
Despite the inherent challenges, The Children’s Home of Cincinnati has enhanced services both on campus and in the community over the last 18 months. There are nearly 300 students attending the campus-based therapeutic education and treatment programs on a daily basis. All of these children have learning and behavioral challenges, many have unmet health needs and most live in abject poverty.
Stephanie Byrd is the executive director of Success By 6. Byrd’s passion for children complements her role on the Advisory Council and was clearly evident when she said, “As a society, we have no higher obligation than keeping our children safe and protecting their health. That is our most fundamental task – but we are falling short when we work in our clinical silos.”
“Recently I have been thinking more about how our medical/healthcare system is outsourcing the various systems of our anatomy to the respective specialists,” Byrd continued. “They rarely communicate with each other about the intersections, let alone the patient (or client). The integrated approach that The Children’s Home is pursuing is a great step in coordinating systems of care.”
To help address the physical health needs of students, The Children’s Home has created a campus-based wellness program. In addition to a health clinic staffed with a nurse, flu vaccines and oral health care are now part of the model; nutrition services are embedded in the curriculum; and a specialized fitness course promotes exercise and healthy lifestyles.
Community-based services have focused on influencing systems and creating partnerships. It’s about bringing behavioral health and physical health together.
But, as Bankston said, “Supporting integrated services does not mean that everything has to be integrated into one package. The aim is to provide services that are not disjointed and that the user can easily navigate.”
The Children’s Home provides therapeutic services in more than 75 schools throughout Greater Cincinnati. As part of the work, therapists engage with school nurses and nurse practitioners to ensure that services are delivered to students in a complementary, coordinated fashion. Co-location has become a stronger component with The Children’s Home therapists also providing services at the Crossroad Health Center sites and in Cincinnati Health Department sites. In addition, education and training has been promoted so that discussions and new learnings are being shared with colleagues throughout the region.
“I cannot wait for the day when all children receive the right care, at the right place, at the right time,” said Byrd. “We need all parts of the equation to be successful. No part of the equation can stand alone, and we will not succeed if one element of the equation is missing.”
The Children's Home of Cincinnati is located at 5050 Madison Road, Cincinnati, OH 45227. you can reach the organization at 513.272.2800 or visit www.thechildrenshomecinti.org.