IC3 Integrated Comprehensive Care for Children
Principal Investigator: Karen Hacker, MD MPH
Award: On July 1, 2004, The Institute for Community Health (ICH) and
the Medical Care Foundation were awarded a grant from the Maternal and Child
Health Bureau of Health Resources and Services Administration to work with
the communities of Cambridge and Somerville on designing a model of care
that integrates mental health and substance abuse services, with physical
health care for children, adolescents and their families.
Background: For the communities of Cambridge and Somerville,
current services for child and adolescent health are disconnected from
behavioral health. Families must visit multiple venues, negotiate
categorically funded programs, and essentially "manage their own care."
Over the last 3 years, community groups have mobilized to address
behavioral health, conducted needs assessments, and engaged political
allies and stakeholders to commit to a collaborative planning process to
design an integrated model of care for children, adolescents and
families.
Results from these activities and recent reports confirm the need to
integrate these services. In 2001, 50% of youth in Somerville and 38% in
Cambridge have had sexual intercourse and 25% in Cambridge and 46% in
Somerville did not use a condom at last intercourse. In Cambridge, suicide
attempts among high school students have remained between 6% to 8% for the
last six years as compared to the state rate of 6% and the national rate
of 2.6 %. Somerville experienced 4 adolescent suicides and several young
adult drug overdoses in the last few years. Both Cambridge and Somerville
have struggled with adolescent substance abuse issues. In 2001, 2, 231
patients at CHA with substance abuse disorders were under 18 years. In
January of 2004 there were 14 overdoses, including those from Oxycontin, 4
suicide attempts and one completed suicide in Somerville.
Goals: The ICH will provide facilitative leadership to this
collaborative planning process. Representatives from Somerville and
Cambridge community based agencies, mental health substance abuse and
physical health providers, community coalitions, parents and youth will
work together to design a final model which will then be submitted for
an implementation grant. This collaborative project has several goals 1)
engage a broad spectrum of stakeholders, including providers, parents,
public and private sector managers, schools, youth, ethnic advocacy
agencies and community-based organizations in a participatory strategic
planning and design process 2) understand the needs of the community in
order to design a model of Integrated Care 3) determine an appropriate
model applicable to Cambridge and Somerville 4) design a culturally and
developmentally appropriate, fiscally sustainable integrated, patient
and family centered service system model 5) design and conduct process
and outcome evaluations for planning and implementation 6) complete a
proposal for Integrated Behavioral and Physical Health Care for
Children, Adolescents, and their families.
Evaluation: Evaluation will be conducted by the Institute for
Community Health along with Dr. Michael Murphy of Massachusetts General
Hospital and Harvard Medical School, and Dr. Katherine Grimes of Harvard
Medical School. Guiding questions include: 1) Are health outcomes in
both the physical and behavioral health arena improved compared with
usual care? 2) Are clients experiencing fewer problems negotiating the
system? 3) Are clients more satisfied? 4) Does satisfaction vary by
race/ethnicity, language, age and gender? 5) Is the new system
cost-efficient compared with usual care?
