More than 60% of children with major depression in the U.S. do not receive any treatment. In spring 2021, emergency department visits for suspected suicide attempts were nearly 51% higher for adolescent girls compared with the same time period in 2019.
At the same time, there is a critical shortage of behavioral health specialists. By 2024, analysts expect the United States to be at a deficit of as many as 31,000 psychiatrists. 570 counties in the U.S. right now have no mental healthcare providers at all.
In 2019, the Texas Child Mental Health Care Consortium (TCMHCC) received funding for five different statewide behavioral health programs. They include a primary care access program that facilitates consults for primary care physicians; a school-based telehealth access program for direct intervention for students; and more.
"Government agencies are trying to solve the mental health crisis by expanding access to behavioral health services," said Dr. Laurel L. Williams, professor of child and adolescent psychiatry at Baylor College of Medicine, and medical director, Council on School Health (COSH) for the TCMHCC. "The most-organized efforts now are the primary care access programs and collaborative care models.
"Aimed at treating more patients within the primary care setting, they create a formal process through which primary care physicians can reach out to psychiatrists and therapists for mental health assistance with their patients," she continued.
This alignment happened due to Texas legislation that required providers and agencies throughout the state to work together. Thus, Texas avoided the fragmented approach that many other states have experienced, she added.
"The two programs I work closely with connect primary care physicians, school counselors and school nurses to behavioral health services: the Child Psychiatry Access Network (CPAN) offers peer-to-peer consultation to primary care providers during their work day, and the Texas Child Health Access Through Telemedicine (TCHATT) serves at-risk children and adolescents with in-school behavioral telehealth care after consent from a legal guardian," Williams explained.
"To successfully implement these statewide access programs, we needed a HIPAA-compliant, secure platform to achieve our state-mandated goals and connect with primary care providers, school personnel and parents all within one system that could then provide access to that data for performance review, outcomes and development of future programming and education," she said.
Because TCMHCC is state-funded, it had an open procurement process that included a request for proposals from any vendor. Trayt was selected given its ability to customize the build and its experience in working directly with youth and families to engage, assess and synthesize behavioral, medical, life stressors and resiliency factors to help clinicians strive toward a whole-person perspective, Williams said.
"Texas is a big state, and the consortium is state-funded and works with 12 health-related institutions of higher education for CPAN and TCHATT," she explained. "Rather than 24 different solutions for these 24 teams, we needed one platform we could customize per our specifications."
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MEETING THE CHALLENGE
Trayt’s platform met the technology challenges TCMHCC faced to build a statewide behavioral health program, Williams said. It’s designed specifically for a behavioral health workflow, not adopted from another specialty.
"By design, this solution also focused on expanding the quality of our program to include patient health outcomes, instead of metrics that focused only on the number of engagements, referrals and consultations," she explained.
"The company’s measurement-based care model combines the validated and evidence-based measures with symptom-level data from other observers and patients’ real-life experiences that patients track in between visits," she continued. "The platform provides the much-needed and valuable data clinicians need in addition to their observation data at the time of visit."
The platform is intelligent enough to collect and analyze more than 750 health and environmental factors to help clinicians make better-informed diagnosis and treatment decisions, she added. It provides a 360-degree view of the patient, she said.
"With this platform, we can track the patient across the system of care to connect the school counselor and the primary care physicians to the psychiatrist," Williams noted. "This patient-centered component truly brings our vision to reality."
Early results from Texas are demonstrating statistically significant improvement in patient outcomes:
"By August 2023, we are hoping to reach the greater than 2,000 school districts serving around 5 million students in Texas," Williams noted. "As of March 2023, we serve 528 school districts on 4,410 school campuses with more than 2.5 million students.
"We know 12,000 students, with their parents’ permission, have downloaded the app and used it to check in with their clinical team," she continued. "We have more than 7,000 school counselors who are part of this care continuum."
ADVICE FOR OTHERS
Williams has two recommendations for provider organizations using similar technology: Know your needs and require flexibility in the technology platform.
"With a statewide access program for behavioral health services, it’s important to know the needs of the program, your staff and all users of the technology," she advised. "I also recommend looking at how and what you use technology for now and and the vision your team has for the program.
"Include the stakeholders in the process to ensure the solution is multifaceted," she continued. "As a physician, measurement-based care is important in my collaboration with patients and their families. I want secure and easy access to patient data and for the patient to have access as well to ensure the most effective use of our shared time together."
And, flexibility with a technology platform means the program is easy to change in development of the software and later, once implemented, she continued.
"We needed to connect stakeholders across the state and design workflows for their unique and individual care protocols," she concluded. "We knew an off-the-shelf solution would not meet the challenges we faced in implementing these connections and workflows across the state."
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