HealthVine Behavioral Health
Our Focused, Integrated Approach to Behavioral Healthcare
There is a national crisis in children's mental health. At its root, we find that too many children are never screened or treated for conditions like depression and anxiety that affect their ability to learn and thrive, and there is little preventive care for children's mental health. This drives further strain on a system that already faces scarcity of resources such as licensed trained professionals, inpatient beds, and outpatient programs. HealthVine’s Behavioral Health Team addresses the systemic gaps in behavioral healthcare today with a host of initiatives, including:
- Integrating pediatric medical and behavioral healthcare practices and developing partnerships with the potential to become national models.
- Training providers in evidence-based treatment and providing them with educational opportunities to improve services for children and youth.
- Promoting information sharing and technical connections among medical and behavioral health providers to produce better outcomes for children
What We Do
The Behavioral Health Team works across health systems and nonprofit and government agencies to meet the needs of the children covered by CareSource and, by extension, families, and children within southwest Ohio.
With the support of the Community Engagement Team, we help to promote education and training opportunities to primary care providers to help improve child mental health care. We also use feedback from those who care for children to help make them more effective in developing and delivering programs—from staffing and training to solving the vexing problems of member attribution and time-critical follow-up care.
By enlisting experts in mental health at Cincinnati Children’s, community behavioral health providers, agencies that are charged with the health and welfare of youth, and colleagues across the multitude of HealthVine programs, HealthVine’s Behavioral Health leaders are forging innovative approaches to the child mental health crisis.
How We Do It
HealthVine addresses the factors that contribute to the deficit in children’s mental health care from many angles—from providing direct resources to improving member attribution and provider training to increase the connections among the many agencies and practitioners with a stake in children’s mental health.
Primary Care Partnerships Increase Access
HealthVine works with pediatricians to expand primary care activities to include mental health screenings and interventions. It supports pediatric practices in Greater Cincinnati by providing:
- Guidance in hiring, training, and integrating a behavioral health provider, such as a licensed clinical social worker or clinical counselor, into practices.
- Financial support, when needed, for pediatric practices to acquire and incorporate the services of a behavioral health specialist.
As a result of their partnership with HealthVine, pediatric practices also receive expert help with developing screening and crisis management protocols, identifying appropriate and available referral options, and connecting families to community resources and supports.
Member Attribution and Data-Harnessing Tools Help Close Gaps
Enabling all providers and entities involved in a member’s care to view histories, medicines, and other pertinent information puts them a step ahead in treatment. HealthVine has spearheaded projects that support robust collaboration among physical and behavioral health organizations to provide holistic care to members.
Innovation in member attribution: HealthVine partnered with the Health Collaborative, a regional data collection entity, and the Cincinnati Children’s Information Services Department to tackle the challenge of behavioral health attribution. “Attribution” refers to the process of identifying where a member is receiving services and providers accountable for their care.
This has been historically difficult in behavioral health space due to the diversity of behavioral health-related services, supports and provider types. Cincinnati Children’s Epic electronic medical records (EMR) system now incorporates information from behavioral health agencies regarding who their clients are and what level of behavioral health treatment they are engaged in. This information is available via the Epic Link application to approved external care systems and practitioners, as well as Cincinnati Children’s providers.
As a result, medical providers can see if their patients are receiving care from behavioral health organizations and so form an integrated patient care team. It also helps identify opportunities to address care needs, physical or behavioral, and any duplication of services that could drive up cost without providing value.
Healthy Planet dashboards extended to behavioral health organizations: Historically, behavioral health organizations had limited access to Epic-based tools such as Healthy Planet dashboards. The HealthVine team developed this dashboard tool in partnership with the Cincinnati Children’s Information Systems Department to enable primary care providers at HealthVine partner organizations to see valuable information about their patient populations, including emergency department and urgent care admissions and patients engaged with the HealthVine Care Management team.
It has piloted the development of Healthy Planet dashboards specifically for behavioral health organizations. These tools enable care teams across physical and mental health to better monitor their client populations.
Strides in member attribution and access to tools such as dashboards help to create greater transparency between physical and mental healthcare providers, which enables the more holistic care of members.
When a primary care provider, for example, refers a child to an agency for mental health services, that provider can follow up if the dashboard reveals the child has not visited. And behavioral health providers can, by seeing a child’s physical health record, help close gaps in age-appropriate care such as exams and immunizations.
Project ECHO Advances Training and Education
Behavioral health training and experience can vary widely among providers and clinicians. Social workers, for example, are trained differently than psychologists. Whatever their professional credentials, many are eager to get the intensive, case-based education that is a hallmark of rigorous training, such as medical residency programs.
To meet that need, HealthVine promotes a peer-to-peer education and training model supported by Cincinnati Children’s known as Project ECHO. Founded at the University of New Mexico in 2003, Project ECHO has spread across the country. Its mantra is “All teach, all learn.”
HealthVine member practices and organizations receive priority in enrollment in Project ECHO courses, with 41 HealthVine partner-affiliated providers participating in a recent Therapy ECHO course. Mental health courses are popular and help practitioners become better at identifying children with conditions like anxiety and depression, understanding their options for evidence-based treatments, and selecting the intervention most appropriate for each patient. Project ECHO participants indicate a statistically significant increase in knowledge gained through participation in the various course offerings, indicating that the courses are filling a gap in provider education.
Pre-Post Self-Efficacy Scores of Fiscal Year 2021 Project ECHO Cohorts
Project ECHO participants take a pre and post course survey. "Self Efficacy" is rated on a 5-point scale; a score of 5 indicates the respondent is "Extremely Confident" e.g. "I feel confident to perform this action and advise colleagues"
The scores to the right are from cohort participants who were enrolled in Project ECHO courses from July 2021-July 2022. The average Self Efficacy score post-course increased across all cohort participants.
Commitment to Continuous Improvement
There are some problems in behavioral healthcare that seem difficult to change, yet they deeply affect the lives of children and their futures. HealthVine’s Behavioral Health program works with its colleagues in HealthVine’s Quality Improvement and Data Analytics department to test and model ways to break through barriers to care.
In a 2021 pilot, HealthVine supported the Mental Health Crisis Care Collaborative (MHC3), a collaborative of community-based mental health organizations, to shore up resources so patients discharged from Cincinnati Children’s inpatient psychiatric hospital at College Hill could get prompt follow-up care in the community.
In another project, HealthVine addressed the unique needs of hospitalized patients in the custody of one or more child protective agencies in Hamilton County having their discharges delayed because of:
- A lack of available foster care families, group homes, and residential treatment facilities that would be appropriate for their next level of care, or
- Challenges in coordinating among the various social and child welfare agencies, the juvenile justice system, and mental health organizations that can be involved supporting a single youth’s care.
Working with Ohio Families and Children First, HealthVine invited stakeholder agencies and psychiatric experts at Cincinnati Children’s to join a quality improvement project to raise the issue's visibility and find ways to align better by holding weekly meetings to review cases of identified youth, brainstorming ways to accommodate their needs upon discharge and breaking down bureaucratic barriers.
Our Impact
In fewer than two years, HealthVine’s Behavioral Health Team has demonstrated that an integrated, focused approach advancing the adoption of evidence-based practices and increasing access to mental health services addresses care of the “whole child.”
To date, the HealthVine Behavioral Health program has led programs and collaborated with other critical stakeholders to achieve the following:
- Supported integrating behavioral health providers (in addition to those affiliated with Cincinnati Children’s) in three practices serving 2,655 CareSource members and consulted with pediatric providers about integrated behavioral health in another four practices.
- Expanded Healthy Planet dashboard access to three behavioral health organizations, scaling the initial innovative pilot.
- Successfully supported the recruitment and enrollment of community providers in Project ECHO courses – courses that have measurably improved the knowledge of primary care practitioners in behavioral health topics and their confidence in their ability to screen for and address issues such as depression and anxiety.
Pre-Post Knowledge Scores of Fiscal Year 2021 Project ECHO Cohorts
In the Project ECHO pre and post course survey, a "Knowledge" score is based on a series of questions related to the Project ECHO course education. A score of 100% indicates the participant has answered all questions correctly.
The scores to the left are from cohort participants who were enrolled in Project ECHO courses from July 2021-July 2022. The average Knowledge score post-course increased across all cohort participants.
Where We are Going
Activities now underway are aimed at continuing to produce better outcomes and prospects for children who need behavioral healthcare. Those include:
- Expanded training and quality improvement opportunities for providers through Project ECHO and a new regional learning network
- Adding a psychologist to the team increases the Behavioral Health team’s capacity for consultation, support, quality improvement, research, and program management.
- Addressing the needs for training and resources for school-based providers, teachers, and staff, who often identify children with potential behavioral health needs.
- Mining data amassed through Epic and Healthy Planet dashboards to identify new opportunities to improve care quality and reduce healthcare costs.
Success Story: Integrated Behavioral Health
At a well-child medical visit, a 16-year-old showed symptoms of mild depression, including poor sleep. Fortunately, their primary care provider was at a clinic with an integrated behavioral health (IBH) clinician.
During the same visit, the IBH clinician met with the patient and discussed ways to address their sleep issues and related mood change.
The patient’s two subsequent visits to the clinic included follow-up with medical and behavioral health providers—in a familiar setting and with providers they knew and trusted. Their symptoms of depression and sleep have improved significantly. The patient’s integrated team continues to monitor their progress and is ready to provide ongoing care if needed.
“Integrating medical and behavioral healthcare practices within the ‘walls’ of a health system has been going on for some time. What’s rare—and what we are demonstrating—is that it’s possible to forge partnerships among providers wherever they practice and share critical data that can help us get the right care at the right time to a child in need.”
Jessica McClure, PsyD, medical director, HealthVine Behavioral Health