NYC Health + Hospitals announced three new or expanded prevention, diagnostic, treatment, and training programs to reflect its commitment to providing enhanced access to behavioral health services for children and adolescents. The programs include one to address early childhood development in children who may have experienced toxic stress, another to better train pediatric and adolescent providers on identifying and treating behavioral health conditions in primary care settings, and another to provide enhanced support in schools for students who have emotional, behavioral, or substance-use challenges.
“While more and more people are recognizing the value of seamlessly integrating behavioral health into primary care, less attention is paid to the importance of such integration in the care of children and adolescents,” said Stanley Brezenoff, interim president and chief executive officer of NYC Health + Hospitals. “Our youngest patients may be the most meaningful for this work because the long-term benefits can be greatest.”
The projects address the recognized need to better integrate behavioral health into primary care or to provide more service in the community. All the projects involve partnering with other organizations to support health outcomes, one of the goals of “One New York,” the report issued in April 2016 outlining New York City’s plan to transform NYC Health + Hospitals.
“These innovative programs reflect our City’s commitment to addressing the mental health needs of our children and adolescents early and in a holistic fashion,” said First Lady Chirlane McCray, who leads ThriveNYC – the most comprehensive mental health plan of any city or state in the nation. “Expanding support for our youth and investing in our workforce helps further a goal of ThriveNYC, to meet more young people where they are – whether that is in their pediatrician’s office or in school.”
NYC Health + Hospitals/Gotham Health, Gouverneur and NYC Health + Hospitals/Coney Island have both launched Healthy Steps, an innovative national program focused on early childhood behavioral health. Created by Zero to Three—a nonprofit organization working to ensure that all babies and toddlers have a strong start in life—the program helps identify children at risk during early childhood development and introduces steps to prevent behavioral health issues.
Healthy Steps integrates a specially trained child development professional, called a “Healthy Steps Specialist,” within the primary care team. This specialist partners with families during well-child visits, coordinates screening efforts, and problem-solves with parents for common and complex child-rearing and other challenges. Trained to provide tailored guidance and referrals, on-demand support between visits, and care coordination and home visits when needed, the specialist takes the steps needed to give children the best start to life.
The Healthy Steps Specialist looks for symptoms of stress, anxiety, or lack of connectedness in young children. These symptoms occur in children from all social classes, but may be especially common among children impacted by poverty. Poverty may expose children to under-nutrition, early loss of caretakers, homelessness, or neighborhood violence. Unmitigated stresses like these can produce toxic stress, which negatively affects brain development in young children. “Toxic stress” refers to a child’s exposure to strong, frequent, and/or prolonged adversity without adequate support.
“The Healthy Steps Specialist knows how to support families to tap into their strengths,” says Dr. Mary McCord, director of pediatrics at NYC Health + Hospitals/Gotham Health, Gouverneur. “This support has been shown to reduce the chances of the child’s early stresses developing over time into a behavioral health issue.”
The two NYC Health + Hospitals facilities each received a $369,000 grant from the New York State Office of Mental Health to institute Healthy Steps. NYC Health + Hospitals/ Gotham Health, Gouverneur was the first to institute the Healthy Steps program in Manhattan. Both programs will serve speakers of English and Spanish, and NYC Health + Hospitals/Gotham Health, Gouverneur will also serve speakers of Chinese—one of only a few programs in the country to do so.
“We are excited to receive funding for this innovative program,” said Dr. Morris Gagliardi, Chief Medical Officer of NYC Health + Hospitals/Gotham Health, Gouverneur. “This will provide the community much needed support for families and children. Addressing toxic stress to mitigate potential behavioral health issues in young children is critical.”
“Feedback from our community has let us know that greater access to behavioral health services is needed, which is why we have made this program a priority,” said Anthony Rajkumar, chief executive officer of NYC Health + Hospitals/Coney Island.
Forty pediatricians from throughout NYC Health + Hospitals participated in a specialized Project TEACH program in February, focused on the integration of behavioral health and primary care. The providers—specialists in both pediatrics and adolescent medicine—learned practical and effective ways to better screen their young patients and facilitate further evaluation for children and teens who screen positive.
“In the past, infectious diseases were at the core of pediatric practice. Today, behavioral health issues are the new morbidity,” said Warren Seigel, MD, co-chair of the Pediatric Council and a provider at NYC Health + Hospitals/Coney Island. “Project TEACH offers a whole different way to screen and treat for the conditions we most frequently encounter in a medical home setting: depression, anxiety, and behavioral health issues.”
The program offers practical suggestions about things providers can do. For example, while parents or guardians are in the waiting room, they can fill out a simple screening questionnaire, the answers to which might trigger more focused questioning during the appointment. When a behavioral health concern is flagged, the primary care physician often has the tools to treat the patient, frequently without medication or referral to a psychiatrist. When a child actually needs medication, the primary care provider can start that treatment, track the initial patient response, and determine whether a referral is in fact needed.
As part of the program, there is also ongoing support via phone available to primary care providers on weekdays.
Topics covered in the training program included the importance of universal social emotional screening, the use of assessment tools, diagnosis and treatment of the most common childhood mental health disorders, effective use of psychopharmacology, and ways to incorporate consultation. Each participant brought back the knowledge from the training to share with colleagues throughout the system.
Project TEACH is a collaboration of the New York State Office of Mental Health, New York State Department of Health, Conference of Local Mental Hygiene Directors, American Academy of Pediatrics, and New York State Academy of Family Physicians. Its mission is to strengthen and support the ability of primary care providers to provide mental health services to youth in the providers’ practices.
100 Schools Project
OneCity Health, a subsidiary of NYC Health + Hospitals, and three other New York City-based Performing Provider Systems—Community Care of Brooklyn, Bronx Health Access, and Bronx Partners for Healthy Communities—launched the 100 Schools Project with a pilot last September. The program is now active in 40 schools, and this fall, 58 more schools will be engaged in the work. Through the 100 Schools Project, schools are learning how to connect students who have emotional, behavioral, or substance-use challenges with top-tier local mental health providers while enabling the students to remain in school.
The four Performing Provider Systems are funding and overseeing the project, while a community partner—the Jewish Board of Family and Children’s Services—is coordinating the initiative.
At each school, local mental health and substance abuse providers from the four Performing Provider System networks who have been trained by experts from the Jewish Board of Family and Children’s Services are teaching educators, administrators, and guidance counselors how to recognize signs of distress, how to approach students and, where appropriate, their families, how to access local behavioral and mental health providers, and how to handle behavioral crises.
“To engage adolescent New Yorkers and improve their mental health, it’s sometimes more important to go where they are than to wait for them to come to you,” says Dr. Ross Wilson, Interim Chief Executive Officer of OneCity Health Services. “Our partnership with a venerable community-based organization alongside other leading New York City health care providers allows us to keep kids in school and may better address their particular needs.”
The original five pilot schools were in the Bronx, while the schools added in 2017 extended the project’s reach to Brooklyn, Queens, and Manhattan.
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