- Hope Children's Hospital/Hope Clinic, Oak Lawn, IL
Please note that all data below was derived from the collaboration's nomination for the Collaboration Prize. None of the submitted data were independently verified for accuracy.
The collaboration was between the Childhood Trauma Treatment Program (CTTP), a program within Advocate Family Care Network and Advocate Hope Children’s Hospital, a children’s hospital serving five counties within the Chicago metropolitan area. CTTP was established in 1979 as a program to provide direct therapy to children who were sexually abused, to support their families in recovering from trauma, and to educate future therapists as well as to provide in-service to professionals throughout the area. Although both CTTP/Advocate Family Care Network and Advocate Hope Children’s Hospital are divisions of the same parent organization, namely the Advocate Health and Hospitals Corporation of Advocate Health Care, they individually operate totally separately with separate budgets and separate governances.
This collaboration started in 2006 from an identified and documented need in the community for increased behavioral health services for children, adolescents, and their families who are covered under Medicaid. In the Chicago Metropolitan area there are few Medicaid providers, and almost all of these providers have long wait lists for new patients.
The hospital staff at Advocate Hope Children’s hospital, specifically the Hope Clinic, expressed concern and frustrations that while their medical outpatient clinic had grown in size and in the number of patients serviced, their patients were unable to receive essential behavioral health assessments and counseling and psychotherapy services. Alice Stratigos, MD, Medical Director, approached the Clinical Director, Gene Carroccia, Psy.D., to request Childhood Trauma Treatment Program (CTTP) assist Advocate Hope Children’s Hospital in developing essential behavioral health services for their patients. Despite not being a Medicaid provider, CTTP agreed to provide assessments and brief counseling/therapy services for the child and adolescent patients, and their families, who had no health insurance or Medicaid. In these collaborative efforts, CTTP clinicians fax the initial intake summary and the closing summary to the referring physicians and the staff at Advocate Hope Children’s Hospital to inform referring professionals about the progress of referred patients. The staff may then follow up with the clinicians about any additional questions that they may have about the patients.
Additionally in 2006, the same Hope Hospital staff requested that CTTP also assist in their Multidisciplinary Weight Management Program (called “Hope for Fitness”). This program assesses and treats obese children and adolescents (ages 11-17) to manage their weight issues and make healthier lifestyle choices. One parent is required to participate in the program with the child. This program involves a pediatrician, registered dietician, social worker, and youth fitness leader. The goals of the program are to increase the physical activity for the child and their family, improve the nutritional education for the family for healthier eating, and to help the family develop strategies to change eating behavior in a positive way. The program lasts for eight weeks, and includes follow-up sessions after the eight weeks has ended. The CTTP clinicians provide several group therapy sessions for each eight week program to address various behavioral health aspects of child and adolescent obesity and weight loss and to reinforce the new learning with the child.
Dr. Carroccia, Psy.D., Clinical Director, supervises and manages the outpatient assessment and brief therapy referrals received from Advocate Hope Children’s Hospital, as well as overseeing the clinical staff’s involvement in the “Hope for Fitness” program. Dr. Carroccia works with Maureen Breenan, Medical Social Worker, at Hope Hospital to coordinate referrals from Hope Hospital and the “Hope for Fitness” program. Additionally, Dr. Carroccia works closely with and supervises CTTP clinical staff to provide behavioral health services to any identified referred Hope Hospital patient requiring services. John F. Smith, Ph.D., Vice President of Ambulatory Behavioral Health Services manages CTTP and Jennifer L. Gibson, Psy.D., a senior psychologist, also supervises the CTTP clinical staff. Dr. Smith, Dr. Carroccia, and several other CTTP staff members meet monthly to review the operations of all programs, including the services to the Hope Clinic and “Hope for Fitness”. As part of this review, the progress and stability of the program are examined with improvements implemented as needed. The review is based on a continuous quality improvement model.
Challenges that we have encountered are dealt with through various modes of communication including meetings, phone calls, and emails between the lead social worker and medical director at Advocate Hope Children’s Hospital and the Clinical Director, as well as between clinical staff members and the referring staff members and physicians at Advocate Hope Children’s Hospital.
This collaboration has led to the assessment and treatment of over 100 children who are at the highest risk in the State of Illinois. In the “Hope for Fitness” program, several clinical pre-test and post-treatment psychological instruments and measures are given to child and adolescent patients and their parents. These include two self-report measures - the Revised Body Esteem Scale for Children and the Behavior Assessment System for Children – Second Edition (BASC-2). Participants who successfully completed the “Hope for Fitness” program would ideally have higher scores on these scales. However, for the past two years the Advocate Hope Children’s Hospital staff has been administrating these pre and post measures to patients without our assistance since we have taught them how to administer them.
For the Hope Clinic, we have measured the impact of services by tracking the change in the Hope Clinic patient’s individual GAF score after they have completed services with us. The Global Assessment of Functioning (GAF) score is a numerical rating of the overall level of functioning a patient has including their symptoms and difficulties in all areas of their lives. A score of 100 indicates a person is a perfectly functioning individual, a score of 50 indicates they have serious symptoms and impairments, and a score of 10 indicates they are in persistent danger of severely hurting themselves or others or are unable to function in almost in any capacity. This GAF score is assessed and documented at the first and last session. The expectation is that the patients who have completed the services at CTTP will have a GAF score that will increase by at least 5 points.
This model has been extremely effective and useful since it has helped underserved children and adolescents receive essential mental health services. This collaboration between a large hospital facility and a community outpatient mental health center has enabled children, adolescents, and their families to receive the essential care they needed in an efficient, cost-effective, and timely manner.
Twenty-one percent of children and adolescents ages nine to 17 receive mental health services in a year (U.S. Department of Health and Human Services, 1999). The social good that inspired this collaboration was to intervene as early as possible with children and adolescents (age three to 17 years) who are among the highest risk for long-term mental health problems. Much to our satisfaction, over one hundred (100) children and adolescents have received assessment, triage, and treatment over a four (4) year period (2006-2010). This accomplishment was achieved through a strong collaborative partnership between Hope Children’s Hospital and Advocate Family Care Network/Childhood Trauma Treatment Program.
When mental illness goes untreated, it is more likely to result in a psychiatric hospitalization. In addition to increasing program delivery by providing service to one hundred (100) young patients, the collaboration saved nearly an estimated quarter-million ($250,000) dollars by preventing the cost of psychiatric hospitalization for ten (10) patients, a conservative estimate of the number of patients at risk for a psychiatric hospitalization. Child and adolescent patients are typically admitted for a twelve (12) day average stay at an average total cost of twenty-four thousand ($24,000) dollars each stay (Saba et al., 2008).
The far-reaching effects of mental illness on society are both direct and indirect and come with great cost. The indirect costs of mental illness imposed a nearly seventy-nine billion ($79,000,000,000) dollar loss in the U.S. Economy in 1990 (Moscarelli et al., 1996). Most of that amount ($63 billion) reflects morbidity costs, the loss of productivity in usual activities because of illness, i.e. at school, work, or home. Indirect costs also include almost twelve billion ($12,000,000,000) dollars in mortality costs, lost productivity due to premature death, and almost four billion ($4,000,000,000) dollars in productivity losses for incarcerated individuals and the time of individuals providing family care. These indirect cost estimates were described as conservative because they do not capture some measure of pain, suffering, disruption, and, reduced productivity that are not reflected in earnings.
In terms of direct costs, insurance coverage of mental health services is typically less generous than that for general health, and government plays a larger role in financing mental health services compared to overall health care. In 2006, government payers were billed for more than sixty (60%) percent of all mental health discharges (Saba et al., 2008). The collaboration specifically and methodically identifies, assesses, and treats children and adolescents who would otherwise not receive necessary mental health treatment due to lack of funding and/or who eventually cost society billions of dollars should early intervention not be available.
Moscarelli, M., Rupp, A., and Sartorious, N. (Eds.) (1996). Handbook of mental health economics and health policy. New York: John Wiley and Sons.
Saba, D. K., Levit, K. R., and Elixhauser, A. (2008). Hospital stays related to mental health, 2006. HCUP Statistical Brief #62, October 2008. Agency for Healthcare Research and Quality, Rockville, MD, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb62.pdf.
U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general-executive summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Hope Children’s Hospital was established in 2000 in Oak Lawn, Illinois on the campus of Advocate Christ Medical Center. Advocate Family Care Network/Childhood Trauma Treatment Program was established in 1979. In 2006, an informal working relationship between these two parties was established in writing. Since 2006, the relationship has grown and expanded.
One major challenge (“Bump in the Road”) was the loss of funding in 2007 from Hope Children’s Hospital for the services provided by Advocate Family Care Network/Childhood Trauma Treatment Program. This challenge was met by seeking additional funding through fundraising efforts.
The success of the collaboration has been measured by (1) the increase in number of children served, (2) the increase in patient Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) diagnoses, (3) the increase in patient Global Assessment of Functioning (GAF) scores, and (4) the increase in patient stability, i.e. a decrease in the intensity and frequency of acting out incidents at school and home. From 2008 to 2010, eighty-six (86%) percent of DSM-IV-TR patient diagnoses stabilized or improved while eighty-seven (87%) percent of patient GAF scores stabilized or improved with an average 5-point increase.
This collaboration should be awarded the “Collaboration Prize” because it demonstrates how a medically based children’s hospital can effectively collaborate with a free standing child mental health center to deliver services in a timely, cost effective, and competent way to children and adolescents who are at the highest risk. The collaboration team is an interdisciplinary team made up of a social worker, a pediatrician and other medical staff, two clinical psychologists, and two clinical psychology interns in training. The U.S. mental health service system is complex and connects many sectors (public-private, specialty-general health, health-social welfare, housing, criminal justice, and education). As a result, mental health care can become organizationally fragmented, creating barriers to access. Unfortunately for those individuals with the most complex needs, and who often have the fewest financial resources, the system is fragmented and difficult to use to meet those needs effectively. The mental health service system is also financed from many funding systems, adding to the complexity. As a result, it is not as typical for a hospital to utilize a free-standing outpatient mental health clinic for patient services or for patients’ multi-faceted needs to be met so efficiently.
This collaboration of multi-disciplinary health care professionals has reduced overall medical costs by bridging the gap between services and decreasing the number of psychiatric hospitalizations, and reduced stigma associated with psychiatric care. This collaboration has resulted in patients having greater access to services they need, fewer direct mental health care costs, and fewer indirect mental health care costs to the greater community due to early intervention of these patients’ mental health needs that would otherwise cost the community billions of dollars if left untreated.