Funded Projects

Problem:

The future for vulnerable children and teens in Washington, DC does not always look promising. Only 72.6% of DC public and charter students graduate from high school in 4 years; 23.9% of all DC children under 18 years old live below the Federal Poverty Level; and public school data reported to the U.S. Department of Education during the 2018-2019 school year shows that an estimated 6,858 public school students experienced homelessness over the course of the year. Each of these factors alone can lead teens into risky behaviors that can then turn into unplanned pregnancies. In combination, there is near certainty that teens will behave in ways that put them at risk physically and emotionally, resulting in unplanned pregnancies and STIs. A Title V needs assessment conducted in early 2020 found that nearly one third of children ages 12-17 have at least one reported mental, emotional, developmental or behavioral problem -- and that data was collected before schools closed and families began to isolate in response to COVID-19, events that only contributed to further trauma.

Goals and Objectives:

Project goals and objectives center around identifying and supporting children and teens who are experiencing depression and anxiety. This effort aligns with the purpose and requirement of the Healthy Tomorrows program and fits into Mary's Center's larger "Social Change Model" of multi-dimensional, family-oriented care. Goals of the proposed project include: 1) Increase the number of children and adolescents screened for depression and anxiety; 2) link children and youth with a positive screening for depression and anxiety to a behavioral health therapist; 3) link families whose children are managing depression and anxiety to a family support for engagement in educational and other social services needs; and 4) engage youth managing depression and anxiety with internal support programs.

Methodology:

Mary's Center's Social Change Model integrates health care with psychosocial supports, and the project we propose in this application focuses that integrated approach on our child and adolescent programming, building on our currently funded teen health project to address behavioral health needs among a broader range of ages. Young people who have suffered adverse childhood experiences have less healthy coping mechanisms and are more prone to take chances and/or seek self-medication or participate in behaviors which can lead to unintended pregnancies and STDs. The proposed project will build on our existing child and adolescent health services to address the behavioral health needs in our pediatric/teen population by strengthening our workflow for pediatricians' screening of our children and adolescents through improvements in screening capacity. Using evidence-informed screening tools for depression and anxiety that are age appropriate, we aim to identify those children who would benefit from behavioral or social health supports to meet their needs and prevent long term anxiety, depression or more serious behavioral health concerns. Family Support Workers are included in the programming model to link youth and their families to the appropriate care and correlated social supports and educational needs.

Coordination:

This new effort to include behavioral health services in our comprehensive pediatric care program will connect existing Healthy Tomorrows work to our network of School-Based Mental Health clinics, to our internal early childhood behavioral health program, as well as to our collocated Behavioral Health services. These additions will increase our capacity to offer behavioral health services at our comprehensive clinics in the District of Columbia. Every teen who comes to one of our clinics or enters after-school or summer programming meets with a Family Support Worker for an intake process that includes screening for depression using the PHQ-2 and PHQ-9 screening tools, as well as screening for anxiety, tobacco, alcohol and drug use, and intimate partner violence. Anyone found to be in need of individual or family support will be referred to a variety of evidence-based and evidence-informed programs offered by Mary's Center (or to external supports where necessary). When appropriate, the SAMHSA evidence-based approach, SBIRT (Screening, Brief Intervention, and Referral to Treatment) is used, and all of our clinicians and family support workers are trained in this protocol.

Evaluation:

Evaluation plans include the creation of an inter-disciplinary team to review Healthy Tomorrows program data, clinical quality outcomes, and workplan data, on a quarterly basis, to assess Mary's Center's workflow bottlenecks and challenges with service delivery. The team will monitor and analyze depression and anxiety screening and behavioral health referrals data, on a monthly basis, to assess the number of participants identified with a need and the number of participants who have been referred for mental health support. Additionally, the team will track linkage to support services and behavioral health data, on a quarterly basis, to determine the number of participants referred for support, the number of individuals who were successfully linked and connected to the needed supports.