Care Coordination

An Innovation Journey

By: Allison Matthews-Wilson, LCSW

Here at Connecticut Children’s Office for Community Child Health, and at Connecticut Children’s at large, there’s a lot of talk about innovation. Where to find it, how to foster it, and how to fund it. I’m proud to say, in the space I work, we not only talk about innovation, we live it every day. The work coming out of Connecticut Children’s Center for Care Coordination is rich with innovation, from how we challenged ourselves to define an enhanced care coordination model, to how we engage and support the families we serve, to how we disseminate our information and services to create value-add for Connecticut Children’s “One Team” approach. It is through that lens of action that I have come to believe that innovation is more than just brainstorming and creative “what ifs”. It is a reality that, with hard work, one idea, one person, and one team can make a difference.

“If you think you are too small to make a difference, try sleeping with a mosquito.”  – Dalai Lama

My work and my passion is improving children’s behavioral health. Before coming to Connecticut Children’s more than 10 years ago, I worked as an in-home clinician for at-risk youth, as a group home clinician for teenagers in the custody of the Connecticut Department of Children and Families (DCF), and as a consultant to DCF throughout New England. The work was gritty and the results were often hard to see. I came to realize that my temperament was better suited for systems work. This is “big picture” work, the ability to see how the pieces of a child’s clinical care, like puzzle pieces, fit into and benefit the family, the community, and the system of care. In social work we call it an EcoMap that features concentric circles that move from the micro (the client) out toward the macro (the welfare and child systems we function in). The intention of my work has been to support families by increasing and improving those outer circles of service available to many, while strengthening the links between micro and macro.

And so, armed with my experience and passion, three years ago at Connecticut Children’s Center for Care Coordination, I watched as my first innovation in systems change came to life. After I worked on a particularly challenging behavioral health case, I recognized that if we had an opportunity to reach that family earlier in their journey, we might have made a bigger impact in supporting them through the disconnected and often confusing behavioral health system. After that case, I partnered with other colleagues to develop and launch the Enhanced Care Coordination Emergency Department Pilot Project. With innovation seed money from Connecticut Children’s Office for Community Child Health and funding from DCF, we started a project that is now a nationally recognized and published best practice that allows all children leaving the Emergency Department (ED) here at Connecticut Children’s to have access to a clinical care coordinator who helps them navigate discharge plans and connect with appropriate clinical and support services. Perhaps because of the success of this innovation, this idea that took form one night and with relative haste moved into integrated practice for our institution, I never doubted the ability to make change.

“Necessity is the mother of invention.” – Plato

Fast forward to late November 2018 when most thoughts were drifting toward holiday to-do lists. Dr. Glenn Focht, president of Connecticut Children’s Specialty Group, made an audacious suggestion during a Behavioral Health Oversight Committee meeting, that we should actually DO something to effect the backlog of children in our ED with behavioral health issues. His passion was palpable. His timeline was daring. Create something, BIG, in approximately 10 weeks. I was on board. Why wouldn’t we try? How could we fail?

The goal was to create an outpatient clinic, called the Transitions Clinic, which would service children assessed in our ED who are determined to be at moderate risk. Such clients are those who do not meet the criteria for an inpatient level of care, but are also unable to return home. Unfortunately, such children can often stay in the ED for days and in some cases weeks as overtaxed social work, psychiatry, and nursing staff seek out community supports so these at-risk children can safely return home. Extensive wait lists, a lack of state resources, and funding challenges all exacerbate the problem. For these children, the clinic would serve as an immediate resource offering an innovative triad of clinical support in the way of psychiatry, clinical social work and care coordination. Intake appointments would offer a full assessment of individual and family needs and offer the unique ability to start medication management immediately, which is an essential service that is often lacking for children who are just starting their behavioral health treatment journey. The clinic would serve as a bridge to community-based clinical services that often have extensive wait-lists.

Bringing an innovation of that size to fruition is challenging, to say the least. Building an outpatient clinic in 10 weeks was a feat that took an extensive team (35 people to be exact) from departments across the hospital, including Building Management, Information Services, Finance and Legal. There were daily meetings, often multiple meetings each day, a total of 98 by the end of the project. That did not include all of the phone calls, emails and “offline” discussions that we were steeped in. We even took an out-of-state “field trip” to observe another institution’s model. There were decisions to be made about referrals, staffing, billing and sustainability. The fact that the 2018 holiday season fell in the middle of our planning only added to the controlled chaos. I won’t lie, there were grumbles of doubt and a fear of failure. Throughout, there was encouragement from hospital executives. They reminded us that our efforts served as an opportunity for innovation, made strides toward becoming a leader in integrated behavioral health, and bolstered our institutional goal of promoting optimal child health and wellness for our most vulnerable children.

The clinic’s launch was purposefully chosen to coincide with Martin Luther King Jr. Day on January 21. Dr. Focht saw that goal as an opportunity to pay homage to a man and dream that are synonymous with bold ideas and compassion for all. This clinic in its most ideal form would be both. Opening day has since come and gone. It arrived with little fanfare, a simple write up by Dr. Focht in our hospital’s weekly internal newsletter. His message reiterated the stark statistics which show mental health diagnoses collectively are the single largest cause of death in the U.S. for individuals ages 15-24, and reminded us of the challenging landscape of Connecticut’s oft-shrinking behavioral health safety net.

With the successful launch of the Transitions Clinic, we learned lessons, formed relationships, and became more hopeful that we can do better for the children we serve. I feel confident that we have added another circle to the EcoMap of a family’s care, and in turn strengthened the community of behavioral health. It, therefore, came as no surprise to me when Dr. Focht noted in our most recent Behavioral Health Oversight Committee meeting that it was time to identify our next rapid improvement project. Innovation never sleeps! The man we honored with our clinic opening, Dr. Martin Luther King Jr., once said, “Faith is taking the first step, even when you don’t see the staircase.” This is what innovation in practice is. It’s pushing through, it’s fighting the shouldn’ts, the can’ts, and the status-quo and believing in something bigger than you. I can’t wait to see what we do next.

Allison Matthews-Wilson, LCSW, is a clinical program specialist and Strengthening Families Protective Factors Trainer with Connecticut Children’s Center for Care Coordination.

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