Starting on the local level to help answer a national need, the Hillsborough County Board of County Commissioners intends to support a youth mental health initiative with funding from Hillsborough County Health Care Plan. The potential initiative is led by USF Health faculty members Dr. Adam Lewin (lead investigator), Dr. Alison Salloum and Dr. Eric Storch and results from recommendations of a Mental Health Task Force created by the commission under the leadership of County Commissioner Sandra Murman and Dr. John Curran, associate vice president at USF Health. The Task Force included USF Health Faculty Dr. John Petrila, Chair of Health Policy and Management and Dr. Steve Freedman from the College of Public Health and Drs. Jamie Fernandez (Psychiatry and Behavioral Neuroscience) and David Orban (Emergency Medicine) from the USF Morsani College of Medicine.

The Commission voted on Aug. 1 to invest $2 million in the Hillsborough County Health Care Plan specifically for the creation of a pilot program to better address mental health needs of adults and children. The increase represents the first major investment by the HCHCP integrating mental health and direct medical services provided by the Hillsborough County Health Care Plan, and is designed to functionally integrate physical and behavioral health care by providing care in up to four county community health centers to adults with need for enhance mental health services and to add children at risk for mental illness.

County commissioners created the Hillsborough County Health Care Plan in 1991 to ensure access to health care for low-income, uninsured residents. The fund provides care to approximately 30,000 residents a year who do not qualify for other coverage. However, the plan historically did not cover mental health services except for medication monitoring with a limited number of visits per year. Last fall, the commission created a Mental Health Task Force to consider whether and how the fund should cover behavioral health services. The task force represented an ongoing partnership between the community, USF Health, and the county, and one of the recommendations is the pilot project.

As many as 20 percent of children ages 7-15 years have mental illness causing significant impairment across multiple domains and significant concerns and risks to the educational system of our community.  Without assessment of risk and access to adequate treatment, these problems persist into adulthood, increasing the risk for further mental health problems including suicide, violence, substance abuse or other antisocial behavior.

Nationally, despite the development and testing of numerous evidence-based psychotherapeutic practices (EBP) to treat these youth, the vast majority of children are not receiving effective care. Despite a strong network of local community resources, there are a number of barriers limiting the large-scale implementation of EBP into routine practice.

Consequently, the purpose of the pilot project is to successfully implement EBP within four Hillsborough County community health centers to address youth exhibiting significant anxiety, depression, post-traumatic stress reactions or conduct problems. The program will include measurable outcomes of patient improvement/satisfaction, as well as of therapist performance, in order to deliver the highest quality evidence-based mental health treatment to the youth of Hillsborough County.

The target result for children and families is readily accessible, evidence-based treatment that is efficient and cost-effective. For providers, the goal is the provision of expert training in EBP implementation and related decision-making procedures in order to successfully implement high-quality behavioral health into the identified community health centers. To that end, one goal of Project Reach is to begin a sustainable infrastructure for clinician education/training, expert consultation and improvement in service delivery for Hillsborough County youth.

The Affordable Care Act emphasizes the integration of mental health and physical health services. This pilot represents an excellent and on-going public-academic partnership in the service of better care for at-risk children and adolescents and their families. The success of the project can provide further evidence that integrated behavioral and physical health services not only can work but can work better than the often fragmented service systems that have sometimes impeded care in the past.

Following models with proven state-wide success (Hawaii) and district-wide success (Los Angeles), it is anticipated that dissemination and implementation of EBP achieved through the program will form the platform for a consistent partnership that will maximize child behavioral health outcomes while reducing cost, recidivism and long-term negative behavioral health outcomes, and further, we believe it may serve as a statewide model of excellence in integrative behavioral health for youth.

Story by Dr. John Petrila, USF College of Public Health.