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DURHAM — A broad coalition of local agencies led by Duke Medicine is working to provide improved mental health care to Durham Public Schools students.
The Integrated Pediatric Mental Health Care Collaboration “gets key stakeholders together at the table,” said Helen Egger, the chief of the Division of Children and Family Mental Health at Duke, who is leading the initiative.
Often those working on children’s mental health issues “don’t know what others who are involved are doing,” Egger said. “We’ve all been in individual silos and it’s not been a very efficient way to approach problems, leverage the different investments we have and make sure we are producing lasting outcomes.”
The new collaboration, she said, “brings different expertise and resources together. We know that individually we don’t have all the solutions, but together, as a community, we can help find the answers.”
With a four-year, $1.6 million grant from the Duke Endowment, the collaboration will work to improve mental health care for children in Durham through three linked initiatives:
-- Assessing and evaluating current pediatric mental health care and identifying gaps in care and collaboration.
-- Enhancing knowledge about pediatric mental health through professional development of emergency department providers and staff and training teachers and school staff with a targeted curriculum.
-- Developing, implementing and evaluating the impact of innovative school-based models of mental health care to improve the transition of care between systems.
“We clearly know that student academic achievement is linked to a student’s mental and physical health,” said Deborah Pitman, the DPS assistant superintendent for student services. “By bringing the community together in this initiative, we can address the whole child and improve achievements like graduation rates.”
Students’ mental health is a significant issue. According to recent figures, one in 10 children suffers from an emotional or behavioral disorder. But less than a quarter of these children receive any mental health services.
Many times, Pitman said, “teachers will see that something is wrong, but may not be able to pinpoint exactly what the problem is or how to address it. [This collaboration] will expand their tool box. It will help them identify issues and get the appropriate treatment for their students.”
Egger pointed out that there are already numerous treatment options and agencies involved. But “they exist across different systems, in different departments, in different places. There is a lack of cohesion and integration across these programs”
Rather than trying to deal with a child who has mental health issues in the emergency department, the idea, Egger added, “is to provide support in the school and elsewhere earlier on, so the child won’t wind up in the ED.”
One part of the effort will be tracking all Durham children, around 200 a year, who are seen at Duke’s psychiatric emergency department.
“We’ll follow them and find out what is happening to them, what services they are receiving in school and what’s happening to them outside of school, with child welfare agencies and juvenile justice, and what’s happening with their healthcare in general,” Egger said.
Working with a state educational database, Egger and her colleagues will then merge what mental health services the children are receiving to their educational performances and outcomes.
Mental health providers and school personnel also will be trained to identify mental health issues. “Every person who works in such a setting has an impact on the child,” said Egger. “We need to educate teachers, principals, school counselors, all those interacting with children, to be able to recognize what psychiatric disorders look like.
“And there’s a surprising gap in the training for physicians and staff, even in a place like the emergency department,” Egger said. “There is still a stigma about mental illness.”
In the schools, the training will “present a wonderful opportunity for our educators to increase their knowledge and understanding of the mental health of a child in deeper and richer ways,” Pitman said. .
The collaboration includes, among others, the Durham Center, Northern Piedmont Community Care, Duke’s Sanford School of Public Policy and several different divisions of Duke Medicine, including the department of pediatrics, the school of Nursing and the Department of Community and Family Medicine.
But even with all the agencies involved, “this is a very practical approach to find solutions that won’t have inefficiencies,” Egger said. “There will be a single point of access for children and their families. Just one number to call.
Ken Dodge, the director of the Duke Center for Child and Family Policy, said the collaboration reflects a growing understanding of the benefits of a holistic approach to children’s health and development.
In the past, he said, the community has focused too much on test scores. “That is too narrow a focus if we are looking at ways to help children graduate and be life- and career-ready,” Dodge said.
“If we want them to become adults, parents, workers, it’s more than reading and math. We need to help our children learn how to have self-control, come every day to work or school, to be mentally healthy. I think we’ll see that the gains [of this collaboration] will improve attendance, lower the number of dropouts and help improve the lives of our children.”
