Same page, same team

New model aims for agencies to collaborate on whole-person approach to treating co-occurring diagnoses

When Kelly Ehrhart sought help for her intellectual disability, ADHD and depression, she hoped to get assistance from a program designed to treat multiple challenges. Instead, she was turned away.

“They said I was doing too well,” Erhart says. “They said I couldn’t be in it.”

Ehrhart, who works with a number of advocacy groups, including People First of New Hampshire and Advocate NH, among others, faced these challenges when she previously lived in Illinois and Virginia before receiving help for her autism when she moved to Nashua.

“I see a therapist, but even my therapist doesn’t communicate with my service coordinator,” she says. “They need to link together.”

Toward that end, a Continuum of Collaborative Care program, which helps agencies collaborate when treating co-occurring diagnoses, is targeting people with challenges similar to Ehrhart’s, and a newly awarded grant — along with efforts from two southern New Hampshire agencies — is making that happen.

The New Hampshire Council on Developmental Disabilities recently awarded the grant to the Center for Life Management and Community Crossroads, allowing the two agencies to replicate their work together to provide intersectional services for people dealing with co-occurring diagnoses. The grant — $50,000 a year for two years and the possibility for another two-year extension — was awarded in July.

The result, administrators hope, will be an approach to working with clients that will increase communication, eliminate redundancies and lead to a more efficient way of treating people with more than one challenge. The first step toward that goal, led by the Center for Life Management and Community Crossroads, has been taken.

“One of the things we’re trying to do is to focus on better identifying people who need to be diagnosed with co-occurring illnesses,” says Vanessa C. Blais, project assistant at the New Hampshire Council on Developmental Disabilities. “That’s an important part.”

“Currently, a doctor who will help with a developmental disability diagnosis may not be talking to the doctor treating a mental health issue. That complicates things for many reasons. Often times, people with mental health issues go undiagnosed because their behaviors or situations are thought to be part of their disability,” she said.

Co-occurring diagnoses (formerly referred to as dual diagnoses) includes individuals who are dealing with more than one illness — and quite often, multiple challenges can go untreated.

“(Challenges and illnesses) can run the spectrum,” says Julie Lago, coordinator for Collaborative Care at the Center for Life Management. “There are individuals diagnosed with both autism and schizophrenia. On the other end you may have individuals who have intellectual disability diagnoses and generalized anxiety disorder.”

Gaps in care can be attributed to a number of issues, including caregivers’ available bandwidth, and a lack of communication between agencies, Lago says, something she saw in the earliest days of her career.

“We saw a lot of redundancy — doing the same things in mental health services as in developmental health services,” she says. “So we used that opportunity to work with Community Crossroads, and Jennifer Chisholm, my counterpart there.”

The pair began discussions about reducing redundancies and improving communication.

“At first we thought, ‘let’s try to merge meetings,’” Lago says. “We thought we’d get everyone to the same table, and it wound up going from ‘let’s try it,’ to an expectation of care between our two agencies.

“It’s no longer a pilot program. We’ve been at it for a solid six years now.”

Work on the initial Continuum of Collaborative Care model stemmed from a relationship between the two agencies, and the work toward a more collaborative, whole-person approach, Chisholm, director of Clinical Services at Community Crossroads says.

“With both agencies working on this, we thought it could be a model that could be replicated throughout the state,” she says.

As the prevalence of dual diagnoses grew and the need for mental health services increased, referrals began to become more complex, Chisholm says.

“It really was always evident that there was a need for us to be talking with one another,” she says. “We collaborate with one another; support all aspects of the person instead of separate silos for care. We realized that if we’re on the phone talking to one another, working preventatively, we could avoid unnecessary hospitalizations. We can understand how to best support someone with a dual diagnosis.

“Informally, we saw less duplication of services, more efficiencies, improved communication, and what we saw was a really successful way to support somebody.”

Since the agencies started taking data on the model in 2014 there have been no unexpected or unnecessary psychiatric hospitalizations.

“We had a big improvement in people’s participation in meetings,” Chisholm says. “People were looking forward to them, and we had people wrapping around and embracing the person as a whole. The individual feels more supported and the team feels more supported and better prepared to handle crises.”

What would success look like, then? Widespread adoption. The New Hampshire Department of Health and Human Services divides the state up into 10 developmental regions, serviced by 10 non-profit agencies. The hope, according to Lago, is that the Continuum of Collaborative Care model will be adopted by all 10 of those regions.

“Success would be for this project to become the expectation of care as opposed to the exception throughout the state of New Hampshire,” Lago says. “We’ll have teams focusing on a proactive approach with consistency throughout the various areas of New Hampshire.”

Though there are challenges — people move and change caregivers, for example — the Continuum of Collaborative Care model would help with maintaining consistency, communication and contact.

“It’s not this grand idea that took forever to build,” Lago says. “What it does is it makes things more efficient and client-centric.”

That type of adoption, and focus on the client, would satisfy Erhart’s concerns.

“We should work to prevent crises rather than wait for them to happen,” she says. “We need to fill in the gaps.”

Bill Burke is the managing editor for custom publications at McLean Communications.

Categories: Real Stories, Stepping Stones NH