Children’s continuum of care (Presented at 2021 INTEGRIS Health Partners Summit)

June 29, 2021

COVID-19 has increased children’s mental health needs, making a robust and full children’s continuum of care vitally important, especially as we transition back to in-person settings. Healthy Minds shared this framework for an ideal community continuum of care for children and youth at the 2021 INTEGRIS Health Partners Summit on June 21, 2021, and we offer this here to inform discussions and community problem-solving across Oklahoma.

Prevention and Early Intervention:

  • Most behavioral healthcare can be effectively delivered in an integrated primary care setting.  
  • Standardized mental health and substance use screening is essential to prevention and early intervention.  
  • Primary care should be available at school and its clinics, utilizing telehealth when possible.  
  • Schools should work with community-based partners to provide evidence-based prevention and early intervention linking students to mental health and substance use care.

Children’s Specialty Care:

  • About 25% of psychiatric conditions need treatment by specialists in clinic and office settings.  
  • Children with higher needs can often access care if schools have connected them and their families to care.  
  • Access to consistent behavioral health specialty care helps to address higher levels of depression and anxiety.  

Rehab and Intensive Home and Community Based Services:

  • A continuum of rehabilitative care with requires both skill-building and psychiatric interventions.  
  • One in ten children with severe needs require time-limited, evidence-based intensive mental health services.  
  • Specialized interventions and functional rehabilitation geared towards individual needs include: ​ incorporating high-quality screening and assessment, formalizing collaboration with schools and treatment providers​, providing services in the home and community​ and these services are provided to youth at risk of out-of-home placement or returning from placement​. The rehabilitative continuum includes intensive evidence-based, home- and community-based practices that focus on family and caregiver services.  Modalities include Functional Family Therapy (FFT), Multisystemic Therapy (MST), and high-fidelity wraparound.  

Children’s Crisis Continuum:

  • A successful crisis system requires an array of crisis placements tailored to the needs and resources of the local system. Mobile teams are needed to respond to a range of urgent needs outside of normal care delivery. Residential treatment should be the last option, only when no other intervention can work.  
  • A crisis system is not a substitute for a robust array of outpatient and intensive community-based services. A crisis system needs a mobile crisis team that provides limited on-going in-home support, case management, and access to out-of-home crisis supports. This team also provides screening, assessment, triage, and ongoing consultation with time-limited follow-up care. These services are coordinated with emergency medical services.  
  • Crisis placements include: in-home respite options, crisis foster care, crisis respite, crisis stabilization (with 1:1 supervision), acute inpatient care and linkages to a continuum of empirically supported practices.  

Children’s Inpatient Care:

  • Pediatric inpatient settings require additional evaluation and a referral from a different care provider.
  • While children and youth are inpatient, team members create an individualize treatment plan and conduct individual, family and group therapy all while managing medication.
  • Once stabilized, team members work with the patient on discharge planning, like a safety plan and aftercare coordination.

Children’s Residential Treatment:

  • The best place for children and adolescents is at home with their family in a safe and least restrictive environment with necessary wrap-around services, however there are times needs cannot be met in a community setting.  
  • Effective programs provide comprehensive evaluation, individualized treatment plans, individual and group therapy, psychiatric care, and incorporation of family and support structures through visitation and opportunities for family therapy.

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