Acknowledgements Acknowledgements Richard Hibbert, MSW, Myla - PDF document

Engaging families and engaging Engaging families and engaging Engaging families and engaging Engaging families and engaging services services Presented by Presented by M Mary McKay, PhD M Mary McKay, PhD M K M K PhD PhD Mount Sinai School of Medicine Mount Sinai School of Medicine Acknowledgements Acknowledgements Richard Hibbert, MSW, Myla Harrison, M.D., Richard Hibbert, MSW, Myla Harrison, M.D., A th A th Anthony Salerno, Ph.D., CHAMP Anthony Salerno, Ph.D., CHAMP S l S l Ph D Ph D CHAMP CHAMP collaborators collaborators New York State Office of Mental Health & New York State Office of Mental Health & National Institute of Mental Health National Institute of Mental Health National Institute of Mental Health National Institute of Mental Health 1

Welcome and Introductions Welcome and Introductions  Identify 1 obstacle that you have Identify 1 obstacle that you have encountered as you tried to involve encountered as you tried to involve youth and their families in services. youth and their families in services. Mental Health and Children Mental Health and Children  Two thirds of children in need of mental Two thirds of children in need of mental h h health care do not receive services. health care do not receive services. lth lth d d t t i i i i  No show rates can be as high as 50%. No show rates can be as high as 50%.  Drop outs occurring after two or three Drop outs occurring after two or three sessions are common. sessions are common. 2

The Research: Barriers to Involvement in The Research: Barriers to Involvement in Child Mental Health Interventions (Urban Child Mental Health Interventions (Urban Settings) Settings)  Triple threat: poverty, single parent status Triple threat: poverty, single parent status and stress and stress d d t t  Concrete obstacles: time, transportation, Concrete obstacles: time, transportation, child care, competing priorities child care, competing priorities  Attitudes about mental health, stigma Attitudes about mental health, stigma  Previous negative experiences with mental  Previous negative experiences with mental Previous negative experiences with mental Previous negative experiences with mental health or institutions health or institutions The Research: Barriers to Involvement in The Research: Barriers to Involvement in Child Mental Health Interventions (Rural Child Mental Health Interventions (Rural Settings) Settings)  Scarce mental health resources Scarce mental health resources  Transportation Transportation  Stigma associated with mental illness and Stigma associated with mental illness and seeking care seeking care  Concerns about confidentiality Concerns about confidentiality  Isolation Isolation l l 3

Empirically supported Engagement Empirically supported Engagement Interventions Interventions  Focused telephone procedures associated Focused telephone procedures associated with increased initial show rates with increased initial show rates ith i ith i d i iti l d i iti l h h t t  Structural family therapy telephone Structural family therapy telephone engagement intervention associated with engagement intervention associated with 50% decrease in initial no show rates and 50% decrease in initial no show rates and a 24% decrease in premature terminations a 24% decrease in premature terminations a 24% decrease in premature terminations a 24% decrease in premature terminations (Szapocznik, 1988; 1997; 2004) (Szapocznik, 1988; 1997; 2004) Summary: Summary: Telephone Telephone Engagement Strategies to E Engagement Strategies to E t St t St t t i i t t Address Barriers Address Barriers “First Telephone “First Telephone p Contact” Contact” 4

Telephone Engagement Telephone Engagement Intervention Intervention  Intervention during the initial telephone Intervention during the initial telephone i t k i t k intake or appointment call intake or appointment call i t i t t t ll ll  Relies on an understanding of child, Relies on an understanding of child, family, community and system level family, community and system level barriers to mental health care barriers to mental health care  Goals:  Goals: Goals: Goals: 1) clarify the need for mental health care 1) clarify the need for mental health care 2) increase caregiver investment and 2) increase caregiver investment and efficacy efficacy Telephone Engagement Telephone Engagement Intervention (cont.) Intervention (cont.)  Goals: Goals: 3) Identify attitudes about previous 3) Identify attitudes about previous experiences with mental health care and experiences with mental health care and institutions institutions 4) PROBLEM SOLVE! PROBLEM SOLVE! 4) PROBLEM SOLVE! PROBLEM SOLVE! PROBLEM SOLVE! around concrete PROBLEM SOLVE! around concrete PROBLEM SOLVE! around concrete PROBLEM SOLVE! around concrete obstacles to care obstacles to care 5

What needs to happen on the What needs to happen on the telephone? telephone?  Referral to treatment R f Referral to treatment R f l t l t t t t t t t – Help parents invest Help parents invest initially in treatment initially in treatment for their child for their child – Help parents and child Help parents and child invest in ongoing work invest in ongoing work with provider with provider – Problem Solving! Problem Solving! Problem Solving! Problem Solving! Clarify needs of child and Clarify needs of child and family family  Perception of concern Perception of concern  Perception of services Perception of services – How Long How Long o o o g o g and helpers and helpers and “helpers” and “helpers” – Where Where – – at home at home – – at at – Relationship with Relationship with school school – – with friends with friends- - teachers teachers with other adults with other adults – Previous therapy Previous therapy experiences (either kids experiences (either kids or adults) or adults) – Previous experience with Previous experience with p helping providers helping providers 6

Needs of the child and family Needs of the child and family (cont.) (cont.)  Defining concern Defining concern  Getting help Getting help – Recent example Recent example Recent example Recent example – Can services make a – Can services make a Can services make a Can services make a difference for the difference for the – Why now Why now child child – Strengths in Strengths in – Have they sought Have they sought supporting child supporting child help before help before – Things parent has Things parent has – Was that experience Was that experience tried in the past tried in the past helpful; was the helpful; was the h l f l h l f l h h provider helpful provider helpful Getting ready for the appointment: Getting ready for the appointment: Assignments for the Caretaker & Appointment Assignments for the Caretaker & Appointment Scheduled Scheduled  Make a list of: Make a list of:  Strengths  Strengths Strengths Strengths  Goals Goals  Concerns Concerns  Discuss coming to the appointment with Discuss coming to the appointment with your child. your child. •Time •Date •Intake Worker •Address •Directions by car, bus, and subway 7

Basics of Active Problem Solving Basics of Active Problem Solving  What do you think about coming? What do you think about coming?  What could stand in the way of getting here?  What could stand in the way of getting here? What could stand in the way of getting here? What could stand in the way of getting here?  How are you going to get here? How are you going to get here?  Who are you going to bring? Who are you going to bring?  How will these people feel about coming? How will these people feel about coming? Basics of Active Problem Solving Basics of Active Problem Solving  What time is best for you? What time is best for you?  Will this interfere with anything else? Will this interfere with anything else? ll h ll h f f h h h h l l  How comfortable do you feel talking about your How comfortable do you feel talking about your child’s needs? child’s needs?  How hopeful do you feel that this will help? How hopeful do you feel that this will help? 8