Funded Projects

Problem:

In the remote, primarily rural counties of eastern Washington State, the numbers of children and adolescents showing up in primary care and at community hospitals with suicidal ideation and psychological distress is alarmingly high. In a region where it is not uncommon to travel up to several hours to the nearest urban center (Spokane) to seek treatment, behavioral health providers are scarce, and the need is great. Geographic, racial, ethnic, and language barriers are common throughout the ten mostly rural, underserved counties in which we will be addressing our efforts, and the prevalence of serious behavioral health issues - including suicide - among youth is significantly higher than in the state as a whole.

Goals and Objectives:

This proposed project - SAFES - Supporting Adolescents and Families Experiencing Suicidality - will be led by the Title V Maternal and Child Health Services Block Grant program of the Washington Department of Health's (DOH) Thriving Children and Youth Section. SAFES is designed to address the behavioral health patient surge (higher in our target area) due to the COVID pandemic, assist children in crisis and their families, develop enhanced access to telehealth behavioral services, provide access for primary care providers (PCPs) to psychiatric consultation for children and adolescents, increase capacity of community therapists to safely care for suicidal youth in outpatient settings, decrease the need for mental health emergency department (ED) utilization, and address disparities in behavioral health care in rural eastern Washington communities.

We will strive toward the following short-term outcomes:

• Increased awareness, value, and utilization of Washington's child psychiatry access program by pediatricians and PCPs in two mostly rural Accountable Communities of Health comprising ten counties in eastern Washington.
• Improved 1) support provided to primary care providers, 2) access to services for primary care providers, and 3) ability of community therapists to manage youth in crisis.
• Improved access for youth in Health Provider Shortage Areas and/or who speak English as second language.

In addition, we will work toward these long-term outcomes for the youth and families in our targeted region:

• Access to care and behavioral health outcomes improve for youth in the target area.
• Behavioral health disparities for target-area youth decline.

Methodology:

This project will support primary care providers in our high-need target area with Seattle Children's Hospital's (SCH) existing Partnership Access Line (PAL), a successful statewide child psychiatry access program that has offered care coordination, care management, consultation, and support services to pediatric primary care providers since 2008. The project scope also includes enhancing PAL by adding an eastern-Washington-based crisis care service based on a successful model developed in Seattle. DOH and SCH will partner with Spokane-based Frontier Behavioral Health (FBH). SCH will work with FBH to implement new crisis support services embedded in our target area, hiring care managers and therapists trained by PAL to deliver its crisis services for youth both through in-person and through televideo connections, operating as a contiguous system with PAL's primary care support network.

Coordination:

In addition to HRSA and primary partners SCH and FBH, Washington's Title V program will work with a number of DOH divisions, including DOH's COVID Behavioral Health Group (BHG); two Accountable Communities of Health; Health Care Authority's Family Youth System Partner Roundtable (FYSPRT), from which we anticipate composing the project advisory council; providers in the target area; and many other statewide and regional organizations.

Evaluation:

The SAFES evaluation will be led by DOH and will include DOH'S existing public health monitoring measures and service data provided by the PAL team, Seattle Children's, and Frontier Behavioral Health. Qualitative and quantitative information will provide understanding of system delivery, resources, successes, challenges, and recommendations for refinement. All evaluation measures utilized will be chosen based on demonstrated appropriateness for use with the pediatric population's cultural backgrounds, ages, and genders. The evaluation plan also outlines our participation in HRSA's Pediatric Mental Health Care Access Program evaluation activities, and how our efforts and evaluation will add value to our efforts to increase mental health care access in a very underserved region of Washington State.