Exploring Youth Mental Health Access in North Shore/Cape Ann Communities

Exploring Youth
Mental Health Access

in North Shore/
Cape Ann Communities

This digital report summarizes findings from focus groups, surveys, and in-depth research on the topic of youth mental health in the Cape Ann area of Massachusetts.

Contact

Amy Epstein, Regional Prevention Director, City of Gloucester

[email protected] | 978-325-5272

Report Authors:

Alyssa Kogan, Regional Planning Data Analyst

Elaine Zhang, Public Health Planner

Report Design: Elise Harmon, Digital Communications Specialist

Funding:

regional youth prevention network logo

Project Background

Youth Mental health in North Shore/Cape Ann Communities

Mental health, specifically youth mental health and access to behavioral health services, has become an important priority in the North Shore.

In 2019, the city of Gloucester hosted one of several statewide listening sessions held by Massachusetts Secretary of Health and Human Services Marylou Sudders in order to better understand what barriers and challenges residents face around mental and behavioral health.

Common themes and challenges identified through these listening sessions included lack of mental health providers within the North Shore/Cape Ann Area, insurance, and long wait times for counseling sessions.

The Youth Risk Behavioral Survey (YRBS), which is conducted every two years, assesses health related behavioral issues in youth that contribute to leading of death and disabilities in adults. Survey data from the most recent year (varies for each community since survey is conducted every two years), indicate there are growing mental and behavioral health needs in the region.  As seen in the first graph, high school students within the region report having felt depressed or seriously considered suicide at higher rates than Massachusetts’s average. Regarding substances, high school students within the region report lower rates of current usage for alcohol and marijuana when compared to MA but higher rates of current usage for vaping.

Data: Youth Mental Health on Cape Ann

Data: Youth Mental Health in Cape Ann

The 2019 Beth Israel Lahey Health Beverly Hospital and Addison Gilbert Hospital Community Health Needs Assessment (CHNA) identified mental health as one of the top four priorities in the community benefits service area that includes Gloucester and Cape Ann municipalities (Essex, Gloucester, Manchester-by-the-Sea, Rockport). Mental healthincluding depression, anxiety, stress, serious mental illnesses, and other conditionswas a major issue across all demographics and socioeconomic populations. In fact, mental health was the issue that people in the community struggled with the most (49%). Among the groups, youth and older adults emerged as priority populations most affected by mental health issues. According to the CHNA, youth reported feeling increased pressure to succeed in school activities, challenges with peers due to social media, and formation of positive interpersonal relationships.

The Lahey Hospital Community Health survey indicated that mental health was the issue that people in the community struggled with the most (49%).

Project Overview

The Gloucester Health Department was awarded a multi-year Tower Foundation grant to identify barriers and challenges faced by North Shore/Cape Ann residents, specifically children and youth, when attempting to access mental health services.

As part of that work, the Regional Youth Prevention Network (RYPN) conducted a series of focus groups with area parents and young people to directly hear their views on youth mental health access with the goals of better understanding additional barriers and challenges parents and youth face when trying to access mental health services. The RYPN asked the Metropolitan Area Planning Council (MAPC), Greater Boston’s Regional Planning Agency, to facilitate and develop a report detailing the findings and recommendations from the focus groups.

Types of Mental Health
Access Points

Outpatient care: Covers a wide variety of care settings that are not overnight, and can include private practice, group therapy, community mental health centers, among others

Inpatient care: Admission to a hospital for overnight care

Schools: Can include care provided by school resource officers, adjustment counselors, licensed mental health professionals, or teachers

Community-based organizations: Nonprofit groups that provide local mental health services or alternative learning models

Methods

Focus Group Guide Development:  

Click here for the
focus group questions

Development of the focus group questions was an iterative and collaborative process between MAPC, GHD, and The Regional Youth Prevention Network. MAPC developed a set of draft questions aimed at understanding barriers and identifying resources that helped connect parents and youth to the care they were looking for. These draft questions were shared with GHD, who helped prioritize a second draft of the question set. This second set of draft questions was shared with the Regional Provider Network, who were asked to prioritize questions they felt were most important. Additionally, MAPC and GHD used this network's expertise to ensure the questions were phrased in a trauma-informed manner to ensure a safe and positive experience for participants. The process resulted in a final set of 10 questions for the focus groups. Questions were adjusted slightly (e.g., changing from “you” to “your child”) for parent and youth focus group to ensure vernacular is understood between groups. See appendix for full focus group guide.

Recruitment:  

Flyer for
recruitment

The target focus group participants were youth and parents who had attempted to access youth mental health services within the last year. GHD worked with their network of stakeholders to recruit the target population for the focus group. MAPC developed a flyer for GHD to distribute to potential participants that provided more details about the focus groups. See appendix for a focus group flyer.  

Focus Group Participation
Qualitative Analysis
COVID-19 Limitations
Data Limitations

Top Five Themes

MAPC identified five primary themes based on a final coding and analysis of the focus group data. Focus group participants mentioned a variety of factors that either prevented them for accessing services or enabled them to do so.  Even as different participants may have described preventive or enabling factors differently, MAPC staff was able to group similar issues into these five major themes described below. For example, barriers to using certain types of insurance or difficulties maintaining continuity of care were often mentioned as barriers to accessing mental health services but can both be linked to an underlying root cause faced by parents and youth, I.e., the challenges of navigating the mental health and health care system.

Lack of Providers

The limited number of youth mental health service providers on Cape Ann is a primary contributing factor to many of the other challenges that focus group participants enumerated, such as long wait times, having to travel far distances to reach a provider or access specialized care. Almost all focus group subsets mentioned insufficient provider availability. The broad extent of this theme suggests that it is a root cause of other barriers to mental health access. School officials noted that when they refer students, unless they have personal connections already established with providers in the area, their students endure long wait times to get to a provider. Many parents noted a shortage of clinicians that specialize in adolescent care (specifically child prescribers), and once they can find a therapist and establish a connection, the clinician often leaves, highlighting an issue with clinician turnover. This also begs the question: What is contributing to such a large clinician turnover in the area; is it low pay, insufficient support, lack of benefits, or something else? This could be an area of future research to discuss directly with providers.

Navigating the System

Navigating the mental health care system was an underlying issue when focus group participants spoke about attempting to access care, particularly in terms of insurance coverage, identifying a clinician that fits the unique needs of families and youth, and continuity of care. One parent focus group participant who works in the field of mental health care said, “If you don’t know how to navigate these systems, and even if you do, you’re still kind of screwed. You know, it’s a lot of work.”

Insurance coverage was the number one barrier parents identified when trying to navigate the mental health system. Parents often spoke about how time consuming it is to find a clinician or provider that meets their needs and accepts their insurance. As a result, some parents mentioned paying out-of-pocket for their child to see a clinician to avoid long wait times. Moreover, parents told of gaps in coverage due to dual insurances. One parent shared that her disabled son is covered by her employer’s insurance as well as MassHealth. Generally, when individuals have dual insurance, the primary insurance is billed first and then MassHealth is billed secondarily if the primary insurance doesn’t cover a specific service. This parent reflected on a recent experience where they attempted to access mental health services and were denied coverage by both their primary insurance and MassHealth.

Continuity of mental health care, or the quality of care over time, was another barrier parents identified when trying to navigate the health care and mental health care system. Parents noted the lack of wraparound services after being discharged from inpatient treatment. Another example of where continuity of care has posed serious barriers for parents and youth is when students transition back to school after being absent for an extended period. Due to siloed communication among sectors, such as health care and schools, schools are often unaware of sensitive situations the student may be experiencing, making it harder for students to assimilate back into the school environment.

Interactions with Coordinators and Clinicians

The manner in which youth and adults felt they were treated by those they sought assistance from in accessing services and those who provided them clinical care emerged as a significant theme.

Focus group participants shared positive experiences if they felt that their needs were understood by those helping them find clinical support or if they developed a personal connection with their provider. Conversely, participants that described feeling a sense of disrespect, condescension, or lack of compassion from such parties reported negative experiences. These negative experiences were widespread among focus group participants. Many shared stories about such interactions across the spectrum of mental health care – within the schools, in outpatient and inpatient settings, and in engaging care coordinators. Some youth specifically lamented a lack of privacy and confidentiality with their outpatient provider. Other words used to describe unfortunate interactions ranged from "dismissive" to "unresponsive" to "rude."

Although it’s not possible to objectively determine a lack of compassion, there was clearly a perception among youth and their parents that providers did not always treat them in a respectful and compassionate manner, a factor that exacerbated the sense that the system was not accessible to those in need of youth mental health services.  

What We Heard

“I think more teaching around empathy is important…Then you have to go to a school or to whomever to ask for help... their response to you can either be really off-putting or can make you feel really safe. You know, sometimes therapists are so busy, billable by whatever increments, and you got to have their billable rate, you know, at time. Sometimes it’s like a factory. So I think making it almost like a more humanizing experience again. Like, that they want to be there and connect.”

— Parent Focus Group Participant (March 2020)

What We Heard

“It’s kind of like -- so I’ve actually had an experience with that before where this one place that my brother and I got therapy at -- he’s about eight years younger than me and him and I both had issues with each other. The two people that we saw, the two therapists, would constantly say back and forth information about him to mine and mine to his, tons of HIPAA violations and everything. It’s just like that’s not how you run a therapy place. That’s going to get both the therapy place shut down and the people not getting therapists.”

Youth Focus Group Participant (February 2020)

What We Heard

Female Student: "And it’s also like you’re trying to keep this information confidential and then they go and break that barrier. How are you going to get any help at that rate?"

Male Student: "Yeah and it’s not even things that they have to report, too."

Youth Focus Group Participants (February 2020)

Role of Schools as an Access Point

The role schools play in responding to mental health issues was a prominent theme mentioned in all focus groups. Perspectives on the role of schools varied based on the respondent (parent, youth, school stakeholder) and school district they came from. Identified school-based barriers included insufficient resources (e.g., not enough staff to handle the volume of students that need mental health support), mental health issues handled in a disciplinary manner, and “cookie-cutter” education curriculums. Youth and parents also shared they often felt there was a lack of compassion and trust from teachers in the public school system when they would report on what they were going through. Schools were also identified as an important facilitator in aiding parents and youth in accessing needed care. Specifically, parents noted schools at times played a key role when there were staff willing to champion and advocate for their child’s specific needs, which in turn helped students meet their interim mental health needs or receive a referral to see an outpatient clinician.

Stigma and Perception of Mental Health

Stigma and the negative perception of mental health illnesses was often a concern of parents and youth when trying to access care. A frequently mentioned source of stigma occurred when youth needed to leave school for an extended amount of time for treatment related to mental health challenges. Parents and youth often mentioned how difficult the transition back into school was, and how they felt they were viewed negatively or treated differently. Parents and youth often reported feeling disrespected by schools when dealing with mental health challenges. One parent said that “the school professionals were really kind of condescending and really made me feel like maybe there’s something I’m not doing right.”

Youth also reported feeling a lack of support from their parents when requesting mental health care. A number of youths shared that their parents refused to believe that their children needed care and expressed fear that their reputation within the community (i.e., workplace, neighborhoods) might be jeopardized. Additionally, participants perceive North Shore communities to be smaller in population and more insular with little privacy “because everyone knows everyone so if you’re in therapy then everyone’s going to know.”

What We Heard

“It’s hard. Because try to be in that kid’s place of trying to go back when, like, everyone knows everything about you. And you are walking down the hall, and yes, they are looking at you. And you are trying to function in a normal place, and you’re a teenager, and that means so much to you. So it’s hard. I think -- I don’t know how many of them successfully come back into school and feel good about it.”

Parent Focus Group Participant (March 2020)

Findings

Focus group participants described various points by which they connected with youth mental health care. Below were the four most common access points identified by parents and youth: each highlighting respective barriers and benefits. 

Existing Community Based Organizations

Parents and youth shared examples of how existing community-based organizations or alternative learning models have been able to provide the services that met their needs or connected them to external providers for additional help. Some youth shared that they decided to choose an alternative education pathway when the traditional public-school curriculum did not align with their mental health care needs. Parents who utilized the community-based organizations often noted that they were connected to these organizations through word of mouth or through the recommendation of schools. Parents and youth tended to speak positively about their experiences at existing community-based organization once they were seen.  

Barriers

Benefits

What We Heard

“I had a really good therapist at [provider name redacted]. I just can’t go anymore because of our insurance.”

Youth focus group participant (February 2020)

“As far as [provider name redacted] goes, my son’s been on a wait list there since September. And I’ve had him on a wait list for a month another place in Beverly since the beginning of October.”

Parent Focus Group Participant (March 2020)

“I didn’t want to go to [provider name redacted] because at the agencies like that you see the turnover rate so fast, so they do just decide to leave. And, you know, these kids—that’s what happened. He had a really great therapist, but she went private and kind of had turned away from taking kids."

Parent Focus Group Participant (March 2020)

Outpatient Care

The most common setting for youth to receive mental health care is in an outpatient setting. Many care touchpoints eventually lead to therapy, whether through direct connections or referrals from school officials, community-based organizations, or inpatient care.

Barriers

Benefits

What We Heard

“And I think there’s a real dearth of available counselors and prescribers and programs in this area. We also did like a three-months DBT workshop, again, in Salem. That’s not something that was offered anywhere locally, so people that have those needs here might be completely unable to access—even if you find something that could help you—completely unable to access that. So I think that’s, in general, a barrier for a lot of people.”

Parent Focus Group Participant (June 2020)

“Yeah, I mean, I feel pretty lucky in that I have pretty decent insurance. That said, nutrition counseling, for example, is maxed out at 12 sessions. Well, someone with an eating disorder can’t stop nutrition counseling after 12 weeks. You know? And the first three months, they need to be seeing that nutritionist every week. So in three months you’re out of your nutrition, so now you’re paying cash at $200 for nutrition counseling. And what do you do here, right? This is your child’s health, so you’re going to try to prioritize that over anything else. Now, what if you—to me, $200 is significant but it’s not the end of the world. To some people, $200 is two weeks of groceries. What do you do now? Or that’s a week’s rent or what have you, and how can they prioritize that over access to... So they’re not going to go to the nutritionist, right? So I can see that overall we’ve managed, but I can see that you don’t have to step down too far for that to be unmanageable.”

Parent Focus Group Participant (June 2020)

“They might send a kid to a program for three days, but that doesn’t address their problems. And then they end up just sending them back into the same program, you know, the same setting that kind of triggered what happened before, and they’re not getting any better. So I guess transition services, so if you do need the help you kind of need someone with you there through the process and not just kind of being, you know, okay, you’re done. You’re cleared now, go home, and then things act up again. That's a problem.”

— Parent Focus Group Participant (June 2020)

"You see a lot of great progress and support when there are other agencies for [youth] to connect with. And so during these transition periods from middle school to high school to college to a working career, these are still young adults; there’s not enough support, as well as, I think, not enough for kids who might not be doing too bad but still have the potential to really backslide and not reach their potential without some outside assistance.”

— Parent Focus Group Participant (June 2020)

“I reached out to her pediatrician, and he gave me three recommendations, and no one could see her off that list, however, I did get one clinician on the phone who was able to tell me about another agency. And they didn’t have one, but they were able to get me the in-home therapist to do, like, family therapy. And then it got better from there.”

— Parent Focus Group Participant (June 2020)

"You have to have some sort of background knowledge here. If you don’t have any kind of perspective on this problem at all as a parent, you’re really, really underwater. You would have no idea how to go about this. If you don’t know yourself or have friends who know how to navigate things like asking, advocating for the things you need, or know what to advocate for, then I don’t know how you would ever get really what you needed. It would just be dumb luck, really. That’s sort of my sense.”

— Parent Focus Group Participant (June 2020)

“As a parent, just being that annoying person, unfortunately, which puts you in an awkward position, but seems sometimes the parents for the individual is the strongest advocate and support.”

— Parent Focus Group Participant (March 2020)

“The [therapist] that we have now was a complete word of mouth, because I just tell everybody, does anybody know anybody? Does anybody know anybody? And they’re like, 'Nobody’s taking anybody'.

Nobody’s taking patients, and then somebody gave me the name of somebody who is actually an elderly neighbor’s of mine. And their granddaughter was seeing somebody, and they said, 'Oh, she sees so and so.' And so I called and left a message, and I did say 'I heard about you from so and so.' And she actually called me back and said 'do you want to come in tomorrow?'

And she was completely overbooked, but she said, 'Because you mentioned that you knew somebody, and I really respect that family.' And so now we’re seeing somebody regularly, but it was not with any help from [a behavioral health organization]. It was not with any help from school. It was just my own desperation of not giving up. And it just feels like there’s nothing to help us.”

— Parent Focus Group Participant (March 2020)

“I would say one of the more positive aspects was once we had someone to work with, then referrals from that clinician were better as we sought to get a more focused or a better connection or once something wasn’t working. But we sort of already had to be in some sort of a system before we could access that knowledge.”

— Parent Focus Group Participant (June 2020)

Schools

The public school system’s role and responsibility in handling youth mental health issues was a prevalent theme across the youth and parent focus groups. From the perspectives of parents and youth, participants felt that the school systems were not accommodating of their mental health needs which resulted, at times, in the disruption of learning. Youth often voiced their frustration around how restrictive traditional public school curriculums are and how the curriculum did not allow enough flexibility for creative learning methods. In response to the prevalence of schools in focus group conversations, MAPC also conducted key informant interviews with school representatives to ensure there was a more nuanced understanding of the barriers.

Focus Group Participants: Barriers

Focus Group Participants: Benefits

What We Heard

“So the counselor at the school was like, 'Does she have a therapist?' And I said, 'No. I don’t even know where to go. Do you have any recommendations?' And she said she was going to get back to me. I think it was almost three weeks, almost an entire month, I kept asking her, and she never got back to me. So in the meantime things kept escalating, and I was having to leave work every day. And I was on the verge of losing my job.”

Parent Focus Group Participant (June 2020)

“Everybody’s so different and they have their own ways that they need to go but they’ll still punish you if you can’t fit into that way that they want you to fit in. And it does not make sense. And then when you get punished nothing gets fixed, you just get punished and then put back in the environment and set up to fail again. And when you’re expected to fail you’re more likely to fail because they’re expecting it from you.”

Youth Focus Group Participant (February 2020)

“Some teachers are really awesome, like [name redacted] is a really awesome teacher. She made my freshman year so much better because I don’t think I would’ve survived freshman year. I was failing a few classes and...one of the awesome things that she did was she asked what she should know as a teacher about the student and about our lives. And she gave me more leeway, which I really did need because I was really struggling at that point."

Youth Focus Group Participant (February 2020)

School Officials: Barriers

Inpatient

Youth can receive inpatient care (i.e., admission to a hospital for overnight care), when they experience a mental health crisis. Pathways leading to inpatient care can involve parents, schools, or even the youth themselves.

Barriers

What We Heard

"I have a very similar situation right now with my son, spending almost an entire week in the ER with him after calling 911 for help, and an EMT telling me that he couldn’t help the situation, he couldn’t help that my son and I had a poor relationship and that he didn’t feel that it was an emergency, which was a horrible feeling, for somebody to tell you that when you’re in the middle of a crisis.”

— Parent Focus Group Participant (March 2020)

“And so then they took [my daughter] from [the crisis center] to the ER, and we spent four days in the ER. And it was awful. You know, locked in a room, because you’re in lockdown and being the victim she felt like she was being locked up. It was like she was the criminal. And then finally from there we took an ambulance ride to [another ER] and they had a bed for her. But we got there, it was 6:30 at night, and a nurse came down and met us and then locked us in this little tiny room and we filled out paperwork. They took her and went to this room, a small room also, strip searched her, and then had us locked in that room for two and a half hours with nothing. They said, 'The doctor’s going to be by.' We finally went up and said, 'What is going on? You know, we’ve been doing this forever'...We went on a Friday night. There was nothing all weekend. So come Monday she was done.”

— Parent Focus Group Participant (March 2020)

Recommendations

The focus groups and stakeholder interviews highlighted numerous barriers that parents, youth, and educators face in obtaining access to mental health services, but participants also suggested several potential solutions that build on what is currently working well across the region.

Below are examples, identified from participants, that provide a pathway to drive more systemic changes. The examples also highlight that the region is already making progress which is important to ensure that momentum is sustained. The following recommendations seek to encourage and reproduce the numerous enablers for youth mental health services cited by parents, youth, and school-based staff.

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Training

Model: Psychological First Aid/Teen Mental Health First Aid/Crisis Intervention Training

At a regional level, school districts and local law enforcement have undergone Mental Health First Aid and Crisis Intervention trainings. In order to ensure that mental and behavioral health issues are handled in a consistent and trauma informed manner, training should continue to be provided for school personnel, law enforcement, and expanded to include first responders.

Initial Action Steps:

  • Schedule two school personnel trainings in 2021
  • Conduct evaluation to assess mental health literacy among school personnel

Recommendation #1: Improve how mental health issues are addressed within public schools

Train all staff and educators on trauma-informed mental health literacy, including understanding warning signs for mental health issues

Action Steps:

  1. Provide regular and refresher trainings for all school personnel that interact with students on a regular basis. Trainings such as Mental Health First Aid and Youth Mental Health First Aid should be provided to all new staff. Refresher courses should be offered for staff every 2 years following their initial training.
  2. Provide targeted trainings for educators and other school officials around mental health issues that are more prevalent and unique to each high school (i.e., suicide, substance use, anxiety, etc.).
  3. Provide training on trauma-informed care interventions geared specifically towards educators.
  4. Conduct biennial evaluation to assess mental health literacy among school staff and educators.

Why?

Parents and school officials often mentioned the need for increased mental health literacy among staff and teachers that interact with students on a daily basis. With increased mental health literacy among staff and educators, the hope is that responses to mental health issues happen in a timely, effective, and compassionate manner.

 

Create multiple systems of supports for youth and expand current support systems
Secure funding to provide multiple levels of support
Establish and enhance meaningful and trusting relationships with existing community-based organizations and new potential partners
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Support Systems

Model: Gloucester Youth Leadership Council (GYLC)

In wading through the mental health system and navigating the challenges of either experiencing a mental health condition or having a family member with a mental health condition, focus group participants, particularly parents, expressed a desire to connect with other parents both as a source of support and empowerment.

The Youth Leadership Council, convened by the Gloucester Health Department, is a group of teens that works to make positive impacts in the community around issues that impact teen health, also creating a space for teens to connect, share experiences, and have an impact.

Initial Action Steps:  

  • Invite participation from Cape Ann youth for the next four council meetings
  • Test model for incentivizing participation
navigation

Navigation

ModelThe Navigator Role

Focus group participants mentioned how difficult it is for them to navigate the mental health care system. Issues related to navigation include insurance, finding the right provider they connect with, and long wait times. Focus group participants often voiced their desire for a “one stop shop” that would help them navigate all these barriers. Currently, there is a pilot Navigator Role that is aimed at helping families navigate barriers when trying to access mental health care. Although it is a pilot position, the Navigator Role presents several opportunities for expansion and improvement.

Initial Action Steps:

  • Convene the Regional Youth Prevention Network and develop an updated and comprehensive job description of The Navigator to ensure this position is fulfilled by a highly skilled candidate.
  • Establish standardized data collection methods to facilitate data-informed decisions in the future.

Recommendation #2: Create supports for parents and youth to navigate the mental health care system

Provide support for parents navigating the mental health care system

Action Steps:

  1. Expand the current navigator role to include additional positions that are responsible for the following tasks:
      • Comprehensive case management (including next steps, follow-up, check-ins etc.)
      • Intake and triage
      • Ensuring warm hand offs
  2. Convene all navigators or people in similar roles within the region to create a Learning Community
  3. The Regional Youth Prevention Network should convene all appropriate stakeholders to develop an updated and comprehensive job description to ensure this position is fulfilled by a highly skilled candidate.
  4. The navigator should have access to updated information about provider availability and insurance information, community-based programs, specialty programs, alternative schooling programs, inpatient programs, etc.
  5. Establish a standardized way for the Navigator to collect demographic data from parents and youth (e.g., insurance provider, type of services they are looking for, age, municipality, etc.), provider information (e.g., referral processes, insurance information) to facilitate data-informed decisions in the future.
      • Utilize data to conduct continuous quality improvement efforts such as improving process in how Navigator handles referrals from start to finish, identifying which providers that might need to be removed from list, etc.
      • See Navigator survey results for more information
  6. Work with the Regional Youth Prevention Network and school districts to continue to promote the Navigator position as a resource for families.
  7. Put this information on a website where parents and youth can see waitlist time updated in real time.

Why?

A prominent theme from the focus groups was the difficulty parents faced in trying to obtain care for their child.

Facilitate a space for parents and youth to connect and organize around their challenges and experiences
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System Coordination

Model: The Regional Youth Prevention Network

Continuity of care was a key component that focus group participants cited was lacking from their mental health care experiences. They often mentioned that the health care system felt disjointed, with minimal support for patients in ensuring sustainable and comprehensive care.

The Regional Providers Network convenes providers, lending itself to coordination and communication amongst providers in the area. This Network can be bolstered to enhance their authority and tap into their knowledge and potential.

Initial Action Steps:  

  • Develop 5-year Goal for Network
  • Schedule bi-monthly meetings for the Network

For more action steps, click here for Recommendation 3.

Recommendation #3: Formalize comprehensive collaboration and communication within the mental health care space

Continue to expand and improve on the Regional Youth Prevention Network

Action Steps:

  1. Regular convenings for the Network to provide formal and informal opportunities for people to connect and learn
  2. Establish a collaborative workplan/agenda that the Provider Network would like to achieve on a yearly basis
  3. Regular assessment to determine if the appropriate partners are at the table
Create a system to unite disjointed settings and providers
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Provider Network

Model: Children’s Friend and Family

High turnover of clinicians and providers and long wait times were often the root of frustration for parents, youth, and key informants. Parents and youth shared how frustrating it is to form a trusting relationship with a provider or clinician only for them to leave. Key informants also noted that due to high turnover, it creates gaps in continuity of care and a repetitive cycle of staff needing to build trust with cohorts of students.

According to key informant interviews, some community based organizations, such as Children's Friend and Family, have remained consistently successful in retaining providers and clinicians. This presents opportunities for learning and regional collaboration on how to increase and retain the number of providers in all settings.

Initial Action Steps: 

  • Conduct research with outpatient clinicians (both in private and community-based settings) to determine what could help with retention, reduce turnover, and onboard new clinicians.
  • Backed by findings and research, develop a local policy agenda to advocate for change at state level

For more action steps, click here for Recommendation 4.

Recommendation #4: Increase the number of providers in all settings

Increase the number of providers in all mental health care settings because one of the most prevalent barriers to mental health care was long wait times

Action Steps:

  1. Incentivize outpatient clinicians to work in the North Shore (e.g., subsidy for student loans to attract more people into the field)
      • Actively recruit bilingual and multicultural clinicians
  2. Conduct research with outpatient clinicians (both in private and community-based settings) to determine what could help with retention, reduce turnover, and onboard new clinicians.
      • Backed by findings and research, develop a local policy agenda to advocate for change at state level
  3. Implement more sustainable funding mechanisms and billing
      • Establish reimbursement rates that ensure mental health and substance use providers to ensure participation with health plans
  4. Engage in conversations with local pediatric doctor’s office to explore implementing team-based care, including community-based supports.
  5. Promote effective use of technology to increase accessibility of the current available providers.
  6. Develop career ladders and opportunities for new clinicians and providers, peer mentorship programs, specifically for individuals already in communities
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Literacy

Model: North Suffolk Public Health Behavioral Health Working group

Promoting mental health literacy to the general population emerged as a key recommendation in order to reduce the frequently mentioned themes of stigma and negative perceptions of mental health. While a local model did not emerge in the research, there are many agencies and organizations within the region that have the influence and authority to promote and normalize a more modern and less antiquated view of mental health issues. For example, the Behavioral Health Working Group from the North Suffolk Public Health Collaborative, recruited and trained youth to deploy a social media campaign aimed at reducing stigma around mental health within the community. This model can be applied to the North Shore/Cape Ann Communities since the foundation is already in place (I.E. The Youth Leadership Council).

Initial Action Steps:  

  • Mobilize the youth leadership council to create social media campaigns to promote a normalized and holistic concept of what mental health constitutes, including culturally appropriate media and outreach campaigns targeted at immigrant families.
  • Conduct regular outreach campaigns within schools to promote and encourage that all the services provided by a school-based clinician, adjustment counselor, school resource officer, etc. are available to students, irrespective of severity of mental health issues.

(Also see Recommendation #1, above)

Recommendation #5: Promote mental health literacy to the general population to reduce stigma and improve perceptions of mental health

Promote and normalize a more modern and less antiquated view of mental health issues

Action Steps:

  1. Mobilize the youth leadership council to create social media campaigns to promote a normalized and holistic concept of what mental health constitutes.
      • Develop culturally appropriate media and outreach campaigns targeted at immigrant families
  2. Conduct regular outreach campaigns within schools to promote and encourage that all the services provided by a school-based clinician, adjustment counselor, school resource officer, etc. are available to students, irrespective of severity of mental health issues.
  3. Promote and advertise more holistic examples of self-care
Combat cultural fear and stigma

Appendix

Navigator Survey Results  

GHD is currently piloting a Mental Health Navigator position with support from an existing community-based organization. The Mental Health Navigator assists parents and youth by connecting them with a mental health provider that accepts their insurance coverage. Additionally, the navigator works to ensure that the mental health provider is a good match for the parent or youth’s unique needs, and that the wait time is manageable. 

Since the start of this pilot position, the navigator has received a total of 52 referral requests. Referral requests the navigator received were often from parents calling on behalf of their child or parents calling after being referred from an existing provider. The navigator has been able to refer everyone to at least one mental health provider fitting their needs; in some cases, they have been able to provide more than one option. Currently, the navigator works from a list of 53 mental health providers that are located throughout Cape Ann and North Shore communities, primarily Beverly, Danvers, Gloucester, Ipswich, Manchester by the Sea, Peabody, Salem, and South Hamilton.  

Based on data collected by the navigator, of the 53 mental health providers that the navigator utilizes, 63% of providers accept some form of public insurance or private insurance and 47% of providers accept both public and private insurance. Tufts Public Health Plan (MassHealth) is the most accepted public insurance option, and Blue Cross Blue Shield is the most accepted private insurance option.  

Post-Focus Group Survey Results  
Key Informant Interviews with School Officials

1 E. McCance-Katz & C. Lynch. Guidance to States and School Systems on Addressing Mental Health and Substance Use Issues in Schools. SAMHAS. July 1 2019.