Carolina Serna’s job as a care coordinator for the Clifford Beers, a behavioral health care provider based in New Haven, puts her in the middle of today’s mental health crisis for kids, teenagers and their families. When Clifford Beers gets referrals for cases, Serna and other care coordinators become the face of the organization, helping children and families get the clinical care they need. But Serna and her colleagues do much more than that. In a sense, they’re the bridge between troubled families and the rest of society.
Take one of the many tough situations Serna handled during the COVID-19 crisis: A young Hispanic mother in New Haven had just lost her job. Her husband left. She was pregnant. Her son faced behavioral health and disability issues. And she was being evicted from her apartment. The first thing Serna did was get the mom a lawyer. Then she reached out to the school and social service agencies for help. “The mom didn’t know how to connect, so I connected the family to the help they needed,” says Serna, who is bilingual.
The story has a happy ending—at least so far. During the six months that Serna worked with the family, the eviction was stopped, the mom enrolled in a program for people reentering the workforce, and the son was placed in a school for kids with special needs and received the necessary counseling.
Across the nation, the number of adolescents reporting poor mental health is increasing. A U.S. Centers for Disease Control and Prevention 2021 survey released in March showed that 37% of high school students experienced poor mental health during the pandemic and 44% said they persistently felt sad or hopeless during the previous year.
Separation from school and friends, the threat of becoming seriously ill, and family stresses—including lost jobs and income—sent kids to hospital emergency departments in record numbers. Other social stresses fuel crises, including domestic violence, gun violence and racism. The pain is most acute in disadvantaged communities.
“Many of my patients were at home doing virtual school, but they were also tasked with taking care of the younger kids because their parents are essential workers. The kids were overwhelmed.”
— Dr. Deepa Camenga, associate professor of emergency medicine at Yale School of Medicine.
The nation’s patchwork health care system isn’t built to handle this kind of crisis. There aren’t nearly enough behavior health caregivers and facilities to address demands for service, especially for poor people, says Dr. Andrew Ulrich, who is in charge of the EDs at Yale New Haven Health’s hospitals in New Haven. In addition, says Alice M. Forrester, CEO at Clifford Beers, Medicaid reimbursement levels don’t even cover the basic costs of the care organizations like hers provide, forcing them to depend on philanthropy to make ends meet.
The Connecticut General Assembly made a down payment on addressing some of these issues this session when it passed bills, which the governor signed into law recently, that expanded mobile crisis programs throughout the state and created grant programs to hire more school-based counselors.
Despite the depth of the crisis and dearth of funding, there is a glimmer of hope. In communities across the state, groups are collaborating and experimenting with innovative approaches to improving health and well-being. One example is how Serna of Clifford Beers helped the New Haven woman and her children. The idea is that when the social determinants of health are considered and community resources are coordinated, the well-being of individuals and entire communities can improve. The approach also involves families and neighborhood organizations in decisions affecting them.
Ultimately, these experiments could change how our society thinks about and delivers health care. Following this model, health care and social service organizations aren’t competing with one another or operating in isolation but are working together to achieve common aims. “We’re shifting from short-term self-interest to long-term shared interest,” says Rick Brush, the CEO of Wellville, a national nonprofit health advisory group that assists local collaboratives in five U.S. communities, including north Hartford neighborhoods.
The community-health-collaboration idea is taking hold in Connecticut. Just before the pandemic, Connecticut’s Office of Health Strategy (OHS) launched its Health Enhancement Community (HEC) initiative. So far, nine HECs have been established across the state. All are focused on community-led collaborations aimed at addressing social, economic, and physical conditions to improve general well-being. OHS is also encouraging the HECs to change the incentives in the health care system—from pay-for-service to paying for better health outcomes. “Our strategy is around driving community-directed and community-led initiatives to address specific needs in each community, reducing disparities and ensuring communities are engaged for the long game,” says Victoria Veltri, OHS executive director.
Rick Brush, the CEO of Wellville, supports the work being done in north Hartford neighborhoods to bring together residents and community organizations to improve their quality of life.
In Hartford, for instance, a HEC was organized under the auspices of the North Hartford Triple Aim Collaborative, whose goal is to improve individual and community health while lowering health care costs. The group includes representatives from the city of Hartford, the United Way, Trinity Health, Connecticut Children’s, and Hartford Hospital, but it also invites community organizations and individuals to the table.
In addition, Connecticut Children’s has partnered with the City of Hartford, Hartford Public Schools, and other organizations to develop a signature new project, the North Hartford Ascend Pipeline. They landed a $30 million federal grant to be matched by local contributions that will fund an array of interlocking services to improve the well-being of young people from prenatal into young adulthood. “The key is getting to children and supporting families early,” says Dr. Paul H. Dworkin, director of Connecticut Children’s Office for Community Child Health. “That way, we can achieve much better outcomes for these children as they grow to be adolescents and adults.”
Community health innovators in Connecticut aren’t shy about adopting and adapting approaches that have been piloted elsewhere. For instance, the community outreach program at Clifford Beers is based on the Wrap-Around Milwaukee model for coordinating social and health care services.
Clifford Beers plans to take its community engagement to another level with a resilience center it hopes to locate in New Haven’s Newhallville neighborhood, offering early childhood services, mental health programs, after-school programs, and community health and disease prevention activities.
Health experts say the closer these coordinated service programs get to neighborhoods and families —really listening to what people want rather than dictating to them— the more likely they will have positive effects.
When Cynthia Cruz, a bilingual coordinator serving the communities of northwest Connecticut for Wellmore Behavioral Health, gets assigned to a new youth behavioral health case, the first thing she does is visit the family in their home.
They discuss what’s going on and what they would like changed. Her program only lasts six months, so she also reaches out to others in the community to see if they can help on a longer-term basis, including pastors, sports coaches, and extended family members. Wellmore refers to these human networks as “natural resources.”
Cruz recalls one situation involving a boy and his family in the far northwest corner of the state. Earlier in the COVID crisis, the boy had retreated to his room and spent much of his time playing video games. He withdrew from his family, barely talking to his mother. During sit-downs with the family, Cruz learned that the boy loved to watch football on TV, but he didn’t play the game. So, in addition to finding a counselor for him, she recruited his uncle to toss a football around with him once a week. That broke the ice. She got the family a membership at the local YMCA. The boy began socializing with other people. He and his mom reconciled. “You know what they say,” says Cruz. “It takes a village to raise a child.”
A program launched by a team at Yale’s Child Study Center, Supportive Parenting for Anxious Childhood Emotions (SPACE), puts parents at the center of their offspring’s care. Clinicians train parents to deal directly with children who have anxiety disorders, rather than depending on professional therapy sessions.
“There are young people who can’t or won’t engage with cognitive therapy, so we were driven to find another tool,” says Eli R. Lebowitz, an associate professor at the Child Study Center whose team developed the technique. Their approach has been adopted by therapists worldwide and really took off after Lebowitz published a best-selling book in 2021 about it, “Breaking Free of Child Anxiety and OCD.”
In one of Lebowitz’s cases, a 12-year-old Milford girl had developed such severe anxiety that she would not speak to anyone outside her home. Lebowitz helped the parents understand they were hampering her recovery by speaking for her in such situations. They changed their behavior, which gradually led to their daughter regaining confidence and speaking for herself once again.
COVID triggered the youth behavioral health crisis, but it has also encouraged innovative approaches that could help address the problems young people face going forward.
“It has been a deep, deep couple of years, and, for the clinic, it has been in some ways revolutionary,” says Forrester of Clifford Beers. “We have emphasized the outreach work in the communities. Now we’re seeing the aftereffects, and we know what needs to be done.”
To connect with the Anxiety and Mood Disorders Program at the Yale Child Study Center, where free care is available in certain circumstances, call (203) 737-4644.
Information on Wellmore is available here.
You can reach Clifford Beers, which is changing its name to Clifford Beers Community Care Center on July 1, here.
This story was originally published June 6, 2022, by the Connecticut Health Investigative Team.