SAN FRANCISCO-A horrifying incident in Richmond, Calif., last month underscores the urgency of a pilot program to integrate children with mental health needs into the managed-care system, local healthcare experts say.
A 6-year-old boy has been charged with attempted murder and burglary in the severe beating of a 4-week-old baby. The 6-year-old, along with twin 8-year-old boys, allegedly entered the apartment of the infant to steal a tricycle. At deadline, the infant was hospitalized at Oakland Children's Hospital in critical condition.
The vicious incident in the blue-collar neighborhood near San Francisco shocked officials and community leaders and points to underlying social and psychological problems that demand multidimensional solutions.
One such solution will be outlined in a four-year managed-care demonstration pilot, funded through a $600,000 grant from HHS' Maternal and Child Health Program.
The pilot program-a consumer-provider partnership-is being undertaken by Parents Helping Parents Family Resource Center in San Jose and Kaiser Permanente facilities in the South Bay area of San Francisco.
PHP is one of the oldest and largest children's charities and advocacy groups in the country. The group provides information and support to families of children with special emotional and physical needs.
The purpose of the pilot is to create a model program for national implementation.
"It is estimated that more than two-thirds of the nation's 7.5 million youth requiring mental health services are not getting the care they need, making them vulnerable to serious behavioral problems leading to abuse, violence and crime," said Florene Stewart Poyadue, PHP national projects director.
Poyadue is creator and director of the pilot project.
The groups-made up of parent volunteers and also staffed by parents-help children and families receive the individualized help they need. The aim is to keep those children at home with their families and out of institutions.
The cost of institutionalization can be steep. For example, it costs $72,000 a year to house a child with autism in a state facility, Poyadue said.
San Jose, Calif.-based PHP has helped establish groups in more than 39 states, she said.
The model that will be demonstrated in the pilot project is known as a "Wrap-Around." In that process, "we engage parents as full, active partners in the design, implementation and evaluation of highly individualized services that keep children in their homes and help build strong families," said F. Jerome Doyle, president and chief executive officer of Eastfield Ming Quong, a not-for-profit mental health agency based in Campbell, Calif.
Eastfield Ming Quong recently hosted the fourth national WrapAround Children's Mental Health Conference in San Jose.
Advocates say WrapAround-also called family-centered care -treats an entire family for about the same cost as treating an individual and with more successful outcomes. Advocates hope that as a result of the pilot, HMOs will see the technique's value and will put it in place.
Research has shown that family-centered care is cost-effective, said Debbie Jackson, the pilot program's coordinator at the Kaiser facilities.
"One of the most important things we do that helps to maximize cost-effectiveness is we try to match parents with other parents who are experienced with the specific disability," she said. Those experienced parents "are experts in what resources are available in the community and how to work the system," she said.
When less experienced parents can contact their support parents, "they are less likely to panic" in stressful situations. "When you know that someone who is not a health professional has successfully done a catheterization, it gives you the courage to try," Jackson said.
In its grant application, PHP described the pilot project's goals as follows: "How will family-centered care be introduced into the managed-care system of healthcare with its emphasis on `critical pathways' (time lines for care and cost containment)? The general public and health officials lack knowledge about and lack a connecting link to managed-care plans. Our major goal is to create a model for the nation for introducing family-centered, culturally competent care into managed-care health plans. Humanity in healthcare."
Jackson also is a "parent liaison," which is a new hospital position created by the pilot. One of the liaison's functions is to keep communication flowing between physicians and families.
In the project, "families and professionals are going to mainly be trained in communication skills. The problem is each has not been listening very well to the other. Our project is teaching each to listen to the other because both have a piece of the answer-the family because they live and work with the person. And so we're asking the families to bring that experiential expertise, while the professionals bring theirs," Poyadue said.
Part of physician training involves "better ways of breaking diagnostic news," Jackson said. And both physicians and nurses will be trained in "understanding what it feels like to have a special child."