Pediatricians and behavioral health practitioners in a Lane County coordinated care project are helping parents ensure their children are mentally, emotionally and physically healthy.
The Trillium Integration Incubator Project, or TIIP, was created in spring 2014 by Trillium Community Health Plan, Lane County's coordinated care organization. One of the CCO's project sites, at Eugene Pediatric Associates, integrates children's physical health and behavioral care in one place.
It is one of eight project sites funded by Trillium CCO with start-up funding from Oregon Health Authority transformation grants and additional funds from Lane County. Trillium covers operational expenses through its revenue streams.
Kathryn "Katie" Ravitch, Ph.D., a psychologist resident for Thrive Behavioral Health, says she has seen families get real-time help at their integrated clinic with Eugene Pediatric Associates (EPA).
When a medical exam reveals possible behavioral issues, the pediatrician can immediately refer a patient to Thrive personnel.
"What's really great is that we're right there on site, so the doctors can introduce them to us, and often we can meet with them for a few minutes right then," Ravitch says.
Onsite case manager Jordan Burbee acts as liaison between the clinic's pediatric and behavioral services.
"My job as the case manager for both Thrive and EPA is to help families with any support they need," Burbee says. "This could be referrals or information about services or resources in the community, coordinating care amongst agencies or medical facilities for medically fragile kids, or helping families navigate the state system, which to families in crisis can seem confusing and frightening."
Ravitch, Burbee, and Ravitch’s clinical supervisor Jennifer Mauro, Ph.D., a licensed psychologist, work with the parents as well as the young patients.
"The immediate contact with me as the case manager allows families to feel like not only the child’s needs have been addressed, but also the needs of the entire family," Burbee says. "Our model and idea of caring for the whole family through our integrated clinic and on-site case manager has allowed us to care for kids and families in a whole new and exciting way."
In more complex cases they help parents work with schools and other institutions, connect them with legal resources, and help them learn how to advocate for their child on an ongoing basis, Ravitch explains. And if medication is necessary, they can teach medication management skills.
"We give them information about their child's diagnosis and then brainstorm and problem-solve with them about possible interventions they can use to manage the behavior," Ravitch says. Often a few sessions can get a family on track.
For example, the team met with one Eugene family whose child was struggling in school academically and socially – unable to make friends. "We suspected autism spectrum disorder; after preliminary testing with our developmental pediatrician, we were able to refer them for more comprehensive testing, which confirmed the diagnosis," Ravitch says. They helped the family learn about autism, practiced social skills with the child, and taught family members to use social-emotional coaching with him on a daily basis.
"The child was able to really be successful in a couple of social situations," Ravitch says. "He had never had that before, never been able to interact with other kids at school and have that be an enjoyable experience. He made some friends, and the family was able to stop coming in regularly after about four months because he was progressing so well.
"Now they check in as needed, every two months or so," Ravitch says. "But the child really seems to be thriving."
"It is so rewarding when we see all of the pieces come together," Burbee says, "allowing families to become self-sufficient and confident in their ability to create safe and stable environments where their children can thrive."
