Grant to fund integrated care delivery system in Vermont

By Pamela Berard
November 1st, 2017

The Vermont Department of Mental Health was recently awarded a five-year, $9.9 million federal grant from the Substance Abuse and Mental Health Services Administration to establish the Vermont Family Centered Healthcare Home Project (VFCHP).

VFCHP is an integrated care delivery system – including mental, emotional and physical health – for children who have been diagnosed with, or are at risk of, severe emotional disturbance.

It also is designed for youth and young adults receiving mental health services who are transitioning to adult services and their families.

In its grant application, organizers noted that Vermont is the second most rural state in the nation and public transportation is largely non-existent. Nearly 30 percent of Vermont children and youth live below the federal poverty level and 12.4 out of every 100 children have two or more chronic health conditions.

More children in Vermont experience adverse family experiences than the national average, and the Vermont DMH estimates that there are 12,000 children who have, or are at risk of, severe emotional disturbance, yet the percentage of Vermonters accessing behavioral health treatment is low, according to the application.

“One of the issues that we’ve heard is that while the designated agencies provide important core services for children, there are a lot of children who end up for various reasons getting care outside of the designated agencies – in some cases, through their pediatric practices,” which aren’t always fully equipped to deal with mental health issues, said Nick Nichols, MSW, mental health policy director for the Vermont DMH.

Additionally, there is a shortage of child psychiatry in the state, Nichols said. “Families are struggling to find providers who have the specialization and the expertise to provide treatment and support and in some cases, providing coordinated care for children with complex mental health needs and health issues, development disabilities or autism,” Nichols said.

“You need to be able to provide integrated coordinated care across multiple providers for children and their families and in some cases that can be hard to achieve.”

VFCHP will provide integrated pediatric and mental health services that invite and engage the family into the process, with care coordination that incorporates evidence-based mental health services and will support coordination and service delivery improvements between Vermont’s Community Mental Health Centers and the Federally Qualified Health Center in two regions of the state.

To begin, the grant funding will be used to implement the project for children and families in Windham and Windsor Counties at Health Care and Rehabilitative Services and Springfield Medical Care Systems, and in Franklin and Grand Isle Counties at Northwest Counseling and Support Services and Northern Tier Center for Health. The Department expects to later expand activities to other regions.

The grant will help facilitate training and assistance for mental health sites, and Nichols also said new financial and payment structures for children’s mental health are being modeled, with the goals of better supporting integrated care and sustaining the project.

“There’s no question that there’s an identified need in our state, so we are really committed to finding ways that the enhanced capacity and practices being implemented are sustained after the five years,” Nichols said.

Nichols said a full-time person will be hired to coordinate the project and a state implementation team comprised of providers and stakeholders is being formed to help manage and coordinate the project, which should begin by January.

VFCHP has a focus on supporting the entire family, including helping them make their own decisions about care and treatment.

“Our department and mental health system as a whole has for a long time been really focused on making sure care is really family-centered and that families are at the core,” Nichols said. “We know from research and personal experience that when you place families at the center of care and allow them to be fully involved and provide direction on what the needs are for their children and for their family as a whole, that you end up getting better outcomes.”

“Part of the activities of the grant will be providing coaching and mentoring and support for the families, so that when they are not in the doctor’s office, they know what they can do at home to better support each other and their children,” he said.

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