Children had long wait times for appointments for initial assessment in behavioral health clinics in San Bernardino. It was brought to my attention when I had a family member who needed services quickly. There were efficient teams, but they were overwhelmed with the adult population, substance use disorder recovery services, and other programs within the clinic. I was not sure how to address this until I did those interviews with other stakeholders and realized there was an opportunity to build a children’s wellness center separate from our regular behavioral health clinics.
In 2021, direct care staff turnover in our agency was close to 35%. We are a treatment foster family agency and residential therapeutic program for youth and families impacted by the child welfare and juvenile justice systems. In a field where stability and consistency of healthy relationships is vital to the success of our clients, this was a crisis.
Mental health needs in our communities are soaring, especially in our high school students. Adolescence is a time when young people are struggling to fit in, socially and emotionally. They are especially vulnerable to bullying, family dysfunction, problems in school, and trauma. Any of these situations may trigger a mental health issue. Mental health problems can affect a student's energy level, concentration, dependability, mental ability, and optimism.
The crisis in adolescent mental health was highlighted in 2021 bulletins from the Surgeons General of California and the United States. Even before COVID, the incidence of adolescent major depression, suicidal ideation, and emergency room visits was on the rise. The profound death toll, sense of fear, economic disruption, and social isolation exacerbated the unprecedented stresses facing American youth. Communities of color were particularly hard hit by the twin pandemics of COVID-19 and systemic racism.
People in Monterey County with complex physical health, behavioral health, and social needs often experience fragmented and ineffective care, leading to poor outcomes and high service use and cost. In response to improving health outcomes for our Monterey County residents, Monterey County Behavioral Health launched the Monterey Integrated System Transformation Initiative. This countywide initiative is designed to help all services become aligned with our most important values for the people who need our help the most.
Contingency management (CM), which involves paying people to use less meth or engage in treatment, is the most effective treatment tool for methamphetamine use disorder. Compared to CM, other treatments (like medications, counseling, detox, and rehab) do not work well for meth use.
The overall purpose of this CHIP was to implement a measurement-based care (MBC) program, utilizing four validated assessment tools: the PHQ-9 (depression), GAD-7 (anxiety), ACEs (trauma), and BAM-7 (addiction and social determinants of health). This program had two phases: (1) establishing a common data collection platform across a diverse range of (largely rural) behavioral health providers, and (2) providing targeted clinical summaries and connection to educational opportunities for clinicians participating in this program.
My CHIP project is Trauma Informed Transformation of a Student Health Center and Universal ACEs screening. I am currently an Assistant Professor of Clinical Obstetrics and Gynecology in USC Student Health. Prior to joining USC in 2018, for 10 years I was Chief physician of an Ob/Gyn department in a Federally Qualified Health Center in South Los Angeles. Our service planning area had some of LA County’s highest rates of STIs, Teen pregnancies, Preterm deliveries, Low birth weight babies, and all cause morbidity and mortality rates.
In January 2023 the DEA and SAMSHA announced elimination of the X-waiver as a requirement to prescribe Suboxone (buprenorphine/ naloxone) for opioid use disorder which presented an opportunity to reduce one barrier to treatment, access to X-waivered providers, among patients at a suburban community health center. This project looked at the willingness of primary care providers not previously X-waivered to begin prescribing Suboxone for patients on a stable dose before and after a peer-led training.
Los Angeles County (along with California and the remaining United States) is in the worse overdose crisis in our history, driven by fentanyl and methamphetamine. No community is unimpacted by overdose, which spares no racial, ethnic, socioeconomic status, or age group. The historic response to substance-related crisis – to encourage people who use drugs to seek substance use treatment – is a necessary but insufficient response with when not paired with robust prevention and harm reduction initiatives that reach the people most in need.