Research shows that most mental and behavioral health illnesses start in childhood, with symptoms often appearing before age 14. Yet it takes an average of 10 years to receive treatment. Children’s Wisconsin created a new access center to help children get seen earlier, and results are showing promise.
Challenge
Children with mental health conditions in Wisconsin are hospitalized at four times the national rate, and 20% of children in Wisconsin are living with a mental illness. “I think that percentage is conservative,” says Julie Swiderski, executive director of mental and behavioral health at Children’s Wisconsin. “But that 20% is what we use to guide our decision-making.”
Children’s Wisconsin committed $150 million to mental health initiatives over five years. This includes a school-based program, provider training in behavioral health, primary care integration and a walk-in clinic, to name a few. Although these initiatives greatly expanded behavioral health care access, the hospital was still not able to keep up with demand. Waiting lists grew, delaying care for patients who couldn’t afford to wait. “We realized our front door was not keeping pace with all these programs we were offering for the community,” Swiderski says.
Solution
This challenge led to the development of a Mental Health Access Center, where staff conduct timely patient assessments and connect them with appropriate resources. “We really wanted to clean up how patients were presenting to us, get them through our system and provide support to them when they need it throughout their journey,” Swiderski says.
Families can call the center directly any time they have concerns about their child, or a provider can refer patients. The center’s staff guide patients to the right resource and help them navigate the behavioral health ecosystem.
Access navigators
Access navigators preferably have a master’s degree with mental and behavioral health experience.
This team of eight serves as the front line of the access center, ensuring patients are placed with the correct clinician or directed to the appropriate resources. When a family calls with a crisis, they are transferred to the access navigator who asks a series of questions to determine next steps. At the end of every call, they either schedule an appointment with a clinician or put the patient on the waiting list.
Before this team was established, patients would sometimes get referred to the wrong clinician, such as a therapist when they needed a psychiatrist. “We worked with our clinicians to develop decision trees for this team,” Swiderski says. “That has helped us place them into the right level of care at the beginning with a higher rate of success.”
Care navigators
Care navigators preferably have a bachelor’s in social work, public health, psychology or human service.
This team of 11 guides patients to resources to address social determinants of health, such as transportation, housing and food. “Whatever barrier we can remove that helps them stay within their treatment plan is a win,” Swiderski says. “Their child gets through the system quicker and gets healthier, and they aren’t wondering if they’ve been lost in the system.”
When a Children’s Wisconsin provider determines their patient needs assistance, they simply put the request in EPIC, and the care navigators find the appropriate solution. “There's really nothing they won't try to do to help a family, and the families are really grateful,” Swiderski says.
Virtual schedulers
Virtual schedulers preferably have front-desk expertise.
This team of four ensures patients leave a virtual appointment with their next appointment scheduled or understand their next steps. When virtual appointments increased at Children’s Wisconsin after the pandemic, the team realized a flaw in their process. “The session would end without the family knowing what to do next,” Swiderski says. Because it was virtual, they didn't know which clinic it was or who to contact to schedule another appointment.
Now, when a virtual appointment is about to end, the provider notifies the scheduler who joins the call before the family logs off. “It has done a lot to keep people engaged,” says Swiderski. Even though telehealth visits have declined since the pandemic, they continue to make up 40% of visits, and the virtual schedulers also assist the front desk.
Results
Children’s Wisconsin provided about 130,000 outpatient visits across their mental health services last year. The new access center handled about 70,000 phone calls. “Its scale is huge,” Swiderski says. “The reach is significant and it's growing. Those are 2022 statistics, and I anticipate that in 2023, we’ll exceed those.”
The access center has also cleared time for clinicians who previously had spent time helping families navigate resources. Now, they can see more patients and reduce the waiting list. Families have more continuity because of the virtual scheduler, ensuring they continue to receive appropriate care at the right time.
While the access center has been a success, there’s room for improvement, Swiderski says. Children’s Wisconsin is piloting a new model with billable appointments (phone intakes are not currently billable), less redundancy of intake questions, and more accurate placements.
Swiderski’s presentation was part of the power session, “An All-Hands-on-Deck Approach to Supporting the Behavioral Health Needs of Children,” at Children's Hospital Association’s 2023 Annual Leadership Conference.
