Getting our youth the help they need

Our youth in crisis

 

Youth in the United States are suffering at unprecedented levels. In 2020, 1 in 6 teens experienced a major depressive episode; 3 million had serious thoughts of suicide; and mental health-related emergency department (ED) visits increased by 31%.¹

The numbers are starker among high-risk youth. Twenty-one percent of youth ages 6 to 17 from low-income families have mental health disorders, along with 57% of youth in the child welfare system. Kids with autism spectrum disorders are more likely than their nondisordered peers to experience depression and anxiety. Thirty-one percent of white youth receive mental health services compared to 13% of children of color.²

Furthermore, high-risk youth with untreated behavioral health concerns are likely to continue to experience increasingly negative outcomes: 70% of youth in the juvenile justice system have a diagnosable mental health condition.³

Lastly, in April through October 2020, the number of children's mental health-related ED visits rose 24% among ages 5 to 11 and surged 31% among ages 12 to 17, compared to the same period in 2019.4 Since COVID, EDs have increasingly served as youth mental health crisis units, with a 60% increase in average length of stay. This is commonly referred to as “emergency room boarding.”⁵

While these numbers show our at-risk youth are at a crisis point, there is hope. According to the Department of Behavioral Health for Washington, D.C., when children receive early intervention and treatment for their emotional and behavioral needs, they can live happier, healthier, and more fulfilling lives.⁶

Youth benefit from quality behavioral healthcare and whole-health services. At-risk children and their families can also benefit from liaisons in the community that guide them through the healthcare navigation process, identify resources that address the youth’s issues, and coordinate these resources as a cohesive whole. 

 

Youth Behavioral Health Navigator

 

The Youth Behavioral Health Navigator program , a partnership between Carelon Behavioral Health and Washington State Health Care Authority, acts as a liaison for children and families through Kids’ Mental Health Southwest Washington. The program connects high-risk youth and their families with the care and resources they need. This helps reduce time spent in the emergency room (ER).

 

History

 

The program launched on March 1, 2023, in Southwest Washington (Clark, Skamania, and Klickitat counties). The Youth Behavioral Health Navigator is modeled on a similar program in Pierce County, Washington as part of a statewide initiative. The program will eventually extend to all 10 regions in the state. 

 

Purpose

 

The Youth Behavioral Health Navigator program facilitates specialized care coordination services for complex and high-risk youth. It aims to connect youth and their families with the resources they need to reduce repeat visits, also known as recidivism. The program specifically targets the number of kids sitting in ERs or involved with law enforcement and works to prevent these incidents from happening in the first place. 

 

Who it serves

 

Although the program covers all children regardless of insurance status, it focuses on youth who have had challenges getting counseling as well as their families. “We serve the most high-risk, school-aged youth. These might be kids who have been languishing in ERs or foster kids who have lost their placements,” says Leah Becknell, Account Director at Carelon Behavioral Health. “While anyone can go online and fill out a referral form, we focus on serving the highest of high-risk children and youth.”

 

How the program works

 

When a youth enters the program, a multidisciplinary team (MDT) rapidly convenes to put together a support plan and identify resources. Looking to engage a wide range of partners, the program invites managed care organizations (MCOs), the child’s school, and anyone else who can offer support on behalf of the child to the meetings. “It’s ultimately up to the child and family as to who is part of the team,” emphasizes Brook Vejo, Program Manager at Carelon Behavioral Health.

“We take a trauma-based approach, involving the youth in the process as much as possible. The team prefers that the youth be involved, though the youth doesn’t have to be, if they’re not comfortable,” explains Inna Liu, Director at Carelon Behavioral Health.

 

How the MDT helps

 

The MDT opens the door to a broad spectrum of care for at-risk youth and their families. Up to 25 participants may become part of the MDT, including school administrators, counselors, and representatives from various organizations that offer resources. 

A meeting usually starts with the family discussing the youth’s situation. The team learns about the challenges the youth faces, behavioral issues, self-harm incidents, and how the situation escalated to the point where additional support and resources are needed. 

The participants in the meeting — who are from the area and part of the community — create a comfortable, safe space for open communication. The participants ask questions to understand the family culture and norms. They seek the family’s feedback on tactics that have worked in the past for the youth, and those that have not. 

Representatives from area organizations take turns introducing themselves, provide details on their programs, and suggest ideas. Resources are wide-ranging, including support groups, grief counseling, after-school programs, summer camps, peer-to-peer counseling, sports programs, crisis stabilization, occupational therapy, and supports for the family. Many programs are free, are low cost with scholarship options, or operate on a sliding scale.

Participants talk at length with the family about finding a therapist and work with the youth’s school on scheduling options. They talk with the youth about their interests and offer tips, methods, and resources to help with life crises. 

In an MDT meeting, the family’s only role is to engage. The team takes care of the rest. A designated team member takes notes, so the family does not have to. After the meeting, the notes are compiled into a full, confidential report for the family. The team helps with all support arrangements and helps the family make calls, facilitate applications, and navigate the care process. Team members help the family execute the action plan until they feel they no longer need it.

 

Youth outreach care specialists

 

Outreach care specialists, experienced in diverse areas of youth services, work to fill any gaps for the family. “We act as a middleperson and recommend resources,” says Charity Joy, Youth Outreach Care Specialist Lead at Carelon Behavioral Health. “We are a hope bridge.”

“We handle communication barriers by bringing all people to the table to talk to each other. We are liaisons: the glue that helps things stick together,” adds Taylor Peterson, Youth Outreach Care Specialist Lead at Carelon Behavioral Health.

The facilitators’ background in the community is a considerable advantage in helping them do their jobs. “We are all part of the community with local contacts and relationships,” says Joy. “Being networked and connected helps us do our job, as we know the culture of the community and are part of it. It also helps get the word out about the program.” 

Peterson agrees. “We all have different backgrounds, experiences, and resources that we bring together.”

 

How youth and families discover the program

 

While referrals can come from anyone, including youth and families, they typically come from juvenile court; the Washington State Department of Children, Youth, and Families (DCYF); crisis teams; and schools. The intake form is conveniently located on the program’s website.

The team reviews referrals within the next business day and determines if an immediate MDT is required to address the needs of the youth and family. Outreach care specialists gather additional information and prepare for the MDT.

 

Community outreach and word of mouth

 

The Youth Behavioral Health Navigator team currently engages with schools and community meetings to build awareness. As the program expands over time, the team plans to connect with more youth and families. “We’re being very intentional as to how we reach out so we can deliver a positive experience with this new program and not exceed capacity,” says Becknell.

“We want to have the resources to meet community demand, so we are being very deliberate about how we market the program initially. Word of mouth will be meaningful,” adds Liu.

 

What success looks like

 

Success will be measured over both the short and long term.

Immediate feedback is solicited from the family through a simple mobile survey, sent out via email or text. The assigned outreach care specialist then follows up with the family at the 90-day mark to solicit detailed feedback.

The Youth Behavioral Health Navigator team is currently exploring pathways to appropriately check in with a family at the 6- to 12-month mark to track outcomes and program success.

 

Reducing recidivism

 

A goal of the program is to track and prevent repeat visits. “We want to prevent kids from ending up in ERs or becoming involved with law enforcement by working with their families to get ahead of behavioral health concerns,” explains Becknell.

 

Incremental change

 

“When you serve the most high-risk youth, success is different. Change comes slowly. Years of trauma and chaos need to be worked through in baby steps. Simply improving a family’s plan of action is a step in the right direction. For example, if a youth lands back in the ER, but the family has a plan and the resources available to help them out of that situation quicker than the previous time, that’s success,” explains Vejo.

 

Replicating the program

 

With adequate funding and the right expertise, a tiered approach can work in terms of building out the program in other regions. “Whoever does this work should have some kind of clinical background and experience to know how to manage it,” observes Vejo.

Additionally, it is important to recognize that the program is a navigation tool. Liu explains, “This program drives a facilitation process. It provides support as an intensive case management program.”

“We are excited for this pilot program to address the youth behavioral health crisis and to make an impact,” concludes Liu.