Month: December 2012

Reducing Risk: Our Response to the CT Tragedy

After the Connecticut shooting, President Obama in his address to the nation stated we need to “take meaningful action to prevent more tragedies like this.” Discussion is on gun control and although stronger gun policies may help, this not a solution to the problem – we need to identify at risk youth in their middle and high school years and provide appropriate counseling and referral services to prevent them from future acts of violence.  In the US there are many recommendations for risk screening in teens. The Centers for Disease Control and Prevention recommend screening teens in six categories of risk that are known to contribute most to morbidity and mortality, including unintentional injury and violence. The American Medical Association created recommendations that include annual risk behavior screening. The American Academy of Pediatrics Task Force on Mental Health recommends routine, periodic screening using validated instruments to identify adolescents with mental health symptoms. Despite these recommendations, provision of adolescent screening for risk behaviors remains far below recommended levels and failure to screen has led to serious sequelae. It has been noted that 80% of children do not receive much needed mental health services. The Institute of Medicine states that mental health screening offers the potential to intervene early and prevent fully developed disorders. Studies have shown that identification of mental health symptoms, improved access to services, and provision of interventions before the onset of fully developed disorders offers the greatest cost effective approach.

Sweeping change needs to be instituted that calls for adolescent screening in primary care offices, middle and high schools, and universities with mandates for appropriate reimbursement. We are ignoring teens in our country because of lack of understanding of the impact of risky behaviors; limited risk identification at a time when interventions would be most effective; and lack of incentives, training, and resources for professionals working with teens. Time efficient, validated surveys exist for professional use. Preliminary data from a study of teens in Michigan shows significant decreases in risky behaviors following identification, risk reduction counseling, and appropriate referrals. In order to prevent reoccurrences of Connecticut, Columbine, and Virginia Tech requirements for risk identification and intervention need to be instituted.

Putting RAAPS into Practice: MI Department of Community Health

The Michigan Department of Community Health oversees the Child and Adolescent Health Center (CAHC) program which provides funding and administrative oversight to 70 school-based and school-linked health centers across the state. Michigan has the fourth largest school-based health center program in the country, with centers located in medically underserved areas in order to care for the state’s most vulnerable children and teens.

Carrie Tarry is the Manager of the Adolescent and School Health Unit for the Michigan Department of Community Health. In this role, Carrie oversees many programs including teen pregnancy prevention, health education, coordinated school health, school nursing and the CAHCs.

These school-based and school-linked health centers (CAHCs) are primary care settings, located either within or close to a school. In addition to managing physical health, the centers offer a wide continuum of health-related screenings and services such as: mental health care, dietary guidance, health education and risk reduction, oral healthcare, and insurance enrollment assistance. Carrie likes to say “Anything you can get in a pediatrician’s office you are able to get at a school based health center, plus more.”

In Michigan, State-funded CAHCs are required to administer a risk assessment on all patients by the third visit that the teen makes to that center. This is a state-based rule for the CAHCs and it is also a best practice recommendation and guideline nationally.

Access to the data was especially important to the state of Michigan – particularly the ability to review data across multiple CAHCs. Carrie says “We ran the school-based health center program for 15 years and never had risk data about the teens accessing care. We could not report on their overall risks or the progress that we were making in changing behaviors. We could not compare our CAHCs or help them match their programs to the needs of their teen patients.”

Carrie further explains “We had 60+ centers identifying risk behaviors and no way to collect, consolidate, and report the data on those adolescent populations. We didn’t have any population data because it was all sitting in patient charts. We wanted to paint a clear picture for ourselves and the CAHCs about what the needs of the teens accessing these centers. We wanted to be able to look at data for differences between rural and urban centers, for regional – like between the Upper Peninsula and Detroit, for race/ethnicity differences, and income disparity differences. We immediately saw the value of the data.”

And the state is using this newly gathered data, on the “real issues” teens are struggling with, to tailor program offerings. Carrie explains “We wanted to make sure that centers direct their programs towards the needs of the patients coming into the center. If most teens are saying that they have depression or that they need sexual health information – we wanted to ask the centers ‘Do you have programs around those areas?’” Carrie states that the number of centers who actually use RAAPS is a testament to the support of the product.

Finally Carrie hopes that RAAPS is used even more on a national basis, saying: “It would be huge for school-based health centers across the country to have aggregate data on the teen populations we serve and to be able to show the differences we are making in changing their risky behaviors over time. Getting more comparative data on a national level would be icing on the cake.”

Read more about the Michigan Department of Community Health and how they put RAAPS into practice by viewing their case study.

Contact us today with questions about how to effectively integrate RAAPS into your practice!

Putting RAAPS into Practice: Henry Ford Health System in Detroit, MI

More than 15,000 services are delivered annually to metro-Detroit students and community members through the Henry Ford School-Based and Community Health Program.  In 1991, its first school based health center opened in Detroit’s Hutchins Middle School. It has grown to include 9 school and community settings across metro Detroit.

Mary Serowoky, a nurse practitioner, is clinic coordinator for the state-funded school based health center at Southwestern High School in Detroit.  This center serves adolescents between the ages of 10 and 21.

All adolescents seen in Southwestern’s center complete a risk assessment annually.  Serowoky, who’s worked in school-based health for a decade, has used risk assessment tools her entire career.  She knew the paper-based, lengthy forms were tedious and difficult for teens to complete — and for medical providers to review.

Implementation “was super-easy,” Serowoky said.  Training took 10 minutes.  Then, it was a matter of determining where youth would complete the assessment and how providers would access and use it.  A medical assistant, care manager, and clinical therapist all use RAAPS data to support the teen patients.

Serowoky says the RAAPS’ electronic features make it a “must have.”  Teens complete RAAPS faster, more thoroughly and more honestly than they did the former, longer, paper assessment.  Health providers supporting a given teen can access that teen’s results, review results more efficiently, and there’s consistent information across the entire patient population.  What’s more, RAAPS’ multilingual capabilities are invaluable to students who, in Southwestern’s case, need Spanish or French versions.

RAAPS produces comprehensive reports that Serowoky uses to evaluate top risk areas.  She catalogs behaviors by race and gender to advance the team’s understanding of patients, and she will compare the population to a national peer group using RAAPS data.  “We love that this is electronic since we can pull all the reports and we have a database of all the kids.  This is really good for us,” Serowoky said.

Read more about Henry Ford Health System and how they put RAAPS into practice by viewing their case study.

Contact us today with questions about how to effectively integrate RAAPS into your practice!