A Lifeline for Primary Care Amid a Crisis in Youth Mental Health

Most mental health care in America doesn’t happen in psychiatrists’ offices – especially when it comes to children, teens and young adults.

Instead, young people with depression, anxiety and more turn to the same people they already go to for all kinds of other health issues: their pediatricians, family doctors, school-based clinics and other primary care providers.

But where do those providers turn when they need more help in handling the mental health concerns of their patients – especially more serious issues that they’re not trained to handle?

If they’re anywhere in Michigan, they can turn to the team at MC3.

For nearly a decade, the MC3 program has helped thousands of primary care providers throughout the state care for the mental health needs of young people up to age 26. It also aids providers caring for pregnant women and new mothers of any age who have mental health needs.

More than 16,000 times since 2012, MC3’s psychiatrists and pediatric behavior specialists from the University of Michigan have connected directly with more than 1,800 primary care providers by phone, for consultations about their patients.

Together, they’ve mapped out plans for handling ADHD in young children, suicide-prevention safety planning for teens and symptoms that might signal schizophrenia in young adults.

There’s no charge to providers or their patients, thanks to the program’s funding from state and federal grants.

For providers whose patients recently had a mental health emergency or are waiting for an appointment with a child psychiatrist or a psychiatric inpatient bed, the service can literally be a lifeline: one in five of the consults involve a patient who has expressed suicidal thoughts or harmed themselves.

How it Works

MC3 also offers video-based telehealth appointments to connect patients of participating providers with psychiatrists. U-M and Michigan State University experts have also created a wide range of training options for professionals available on the MC3 website.

Though the demand has grown in recent years thanks to the pandemic, the program has room for more Michigan providers to join the network and get access to its services.

Each connection starts by contacting one of the trained professionals in MC3’s network of Behavioral Health Consultants, located throughout the state. MC3 also works closely with the state-funded Community Mental Health agencies across the state.

“Only about 3% of the children, teens, young adults and moms that our participating providers have consulted with us about are in treatment with a psychiatrist. We’re providing access to specialist-informed care to young people who wouldn’t otherwise have it,” said Sheila Marcus, M.D., who heads the pediatric component of MC3 and is a professor of psychiatry at Michigan Medicine, the University of Michigan’s academic medical center.

“The reality is that no matter where they live and no matter what their family’s income level, most of these patients would not have easy access to a specialist because of the critical shortage of such providers,” she added. “In some counties, there are no local providers trained to provide this level of care.”

Primary care providers inside and outside Michigan can also access MC3’s free online resources, even if they’re not enrolled in the program.

These include prescribing guides for mental health medications and online provider education, to equip them to provide diagnosis and care that might not have been part of their formal professional training. Much of that training offers continuing education credits that can help physicians, nurse practitioners, physician assistants and certified nurse midwives keep up their license.

“For me, MC3 has been a game changer,” said Lia Gaggino, M.D., who first interacted with the MC3 team through her pediatrics practice in Portage, Michigan and now is the team’s consulting pediatrician. “Since its inception I have used their services for children and teens who presented with very complicated mental health concerns. I wished I had had a psychiatrist to help me and then MC3 appeared and offered me a lifeline. Their services changed my prescribing practices and improved my skills and I am so grateful for their advice and support. I encourage my colleagues to sign up and call –MC3 is there to help us!”

Local Care Amid a National Emergency

As the nation grapples with a national emergency of rising mental health concerns among young people, MC3 and similar programs in other states are expanding access to critical psychiatric services at a time when demand is soaring.

The national organizations that declared that emergency in October called for more support of mental health care in primary care settings, as well as efforts to overcome the national shortage of mental health specialists for young people, especially in rural and low-income areas.

That shortage is what drove the creation of MC3 in the first place.

Michigan is third from the bottom among all states in supply of mental health professionals for young people. Only Washtenaw County, where the University of Michigan is located, meets national population-based criteria for having enough mental health providers specializing in children and teens.

The pandemic has made matters worse across Michigan and the United States. A national report from November 2020 showed that anxiety and depression in pregnant women have more than doubled, and emergency department visits for mental health concerns in children had risen by double digits since the pandemic began.

Joanna Quigley, M.D., another MC3 consulting psychiatrist from Michigan Medicine, recently presented data at a national meeting showing that 30% of MC3 consults during 2020 focused on pandemic-related concerns.  

The pandemic has prompted MC3’s team to plan to offer extra training to help providers identify the needs and handle the concerns of children traumatized by experiences they or their families have had during COVID-19.

Trauma-informed care is also important for children who even before the pandemic experienced very disruptive life events.

Terri Rosel, NP-C, a nurse practitioner at Cherry Health in northern Michigan, wrote to the MC3 team: “I work in a small student health center in Cedar Springs and am the sole provider in the office. Since starting this job four years ago I have had the pleasure of seeing so many students with mental health concerns. I felt ill-equipped at times to help them with my degree as a family practice nurse practitioner. I would utilize MC3 often to help with treatment plans for these wonderful kids who needed help but could not get into psychiatric services soon enough.”

As the program continues to grow, it will partner more with schools through a direct connection with the TRAILS program that offers mental health awareness and support services.

Positive Feedback from Providers

The MC3 team has surveyed participating providers and found that 99% agreed with the statement that “following phone consultation(s) I felt more confident that I could effectively treat patients’ behavioral health problems.”

The team published other findings from its survey of providers, and responded to feedback by making changes.

The quotes they received from providers are equally compelling.

“This service has been absolutely ‘practice- changing’,” said one. “As we have more and more patients with mental health issues and limited local resources- we are essentially the only option for these kids. Having MC3 support helps us make good treatment decisions and is also ‘on the job training’ which we can apply to future patients.”

In fact, MC3 data show that 25% of the interactions help the patient avoid a higher-level of care that may be difficult to access, such as a psychiatric hospital bed or emergency psychiatric visit.

One of the maternal health providers who joined MC3 recently said, “I can’t even express how this service has enhanced the care I can provide. In the past, we’d screen and diagnose and then send moms out. We’d place referrals and hope that folks could navigate the complex system. Now, with MC3, I can collaborate with psychiatry, start meds or treatment, and access community resources that I am confident they will be able to access. It’s really been invaluable.”

What is Green Social Work?

web3
The Urban Renaissance Center of Civic Park Neighborhood in Flint is a new field placement area for social work students this Fall.

Whenever something is called ‘green’ many of us tend toward skepticism. Let’s be real, when something touts itself as environmentally friendly, so often it’s just trying to hide a toxic underbelly.

So, green social work … is it just hype?

Hardly. It’s the real deal. It’s a reframing of how we talk about social issues, the planet, and the intersection between the two. It’s as green as they come.

In 2010 the Council on Social Work Education declared sustainability the number one social justice issue of the new century. Since then, the area of green social work has evolved and come into its own.

Green social work is a branch of social work that deals with the impact of the faltering environmental stability upon human populations. It is essentially a broadening of the definition of environment, sociologically speaking, from referring exclusively to someone’s immediate surroundings to referring to the planet that we all share.

After the CSWEs 2010 announcement, it became quite clear that social workers globally were eager to enter a realistic conversation about how climate change affects people, impoverished groups in particular, and that they were ready to take action.

There was no more denying that the extreme flooding, hurricane damage, or broken levees of the age impacted people beyond reason.

Annie Muldoon, MSW, of Carleton University has very poignant reasoning behind her belief in the need for green social work: “Attempts to improve social conditions may be lost,” she said, “if society itself lacks clear air, drinkable water, and adequate food.”

This newfound awareness in the social work field was met with an air of embarrassment. Experts began acknowledging that social work had always had an ambivalent understanding of its relationship to the natural world. And that while their work had always been based upon a “person-in-environment” principle, it had long neglected the “environment-in-person” aspect. There was a certain level of rose-tinted metaphor to the whole thing: the flaws of the field of social work were represented within the flaws of the human condition. In short, we all waited too long to see the inevitable truth about global warming and it was our collective responsibility to do something about it, fast. 

Soon the conversation shifted from revelation to action.

In the Aftermath

Arguably the most profound impact of the new green edge to the field of social work comes in the form of professionals on the ground in the aftermath of a natural disaster. They flood to the South after devastating hurricanes; they establish shelters for people who are forced to evacuate their homes; they provide aid plain and simple. Social workers fill the need for emergency management that focuses on people instead of their insurance policies.

According to Case Western Reserve University, another benefit of having social workers on the ground during the aftermath of a devastating natural disaster is that they are able to address poverty and other structural inequalities at the same time as they’re working to enhance the quality of life of the residents. A social worker stationed in a region prone to hurricanes, for example, will build relationships with local families and be better equipped to cater to their particular needs – like helping the parents of a child with disabilities prepare for the hurricane before it hits. The simple fact of the social workers’ proximity to affected peoples and issues makes them better advocates.

The best part is that all of this is just a matter of course. If social workers place themselves at the scene to help, their training just kicks in.

Environmental Justice

Another beneficial outcome of the advent of green social work is Environmental Justice.

It is defined by the EPA asthe fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.”

Once social workers started examining the real-world participation and understanding of environmental programs in their communities, it became clear that many barriers still exist.

Dawn Philip and Michael Reisch outline some of these barriers in “Rethinking Social Work‘s Interpretation of ‘Environmental Justice’: From Local to Global.” The issues range from not having the resources to access vital health and environmental data to not being able to afford the technical supplies that help social leaders communicate environmental concerns to the community.

Before the introduction and focus of green social work, these issues would just get lumped into the broad category of general organizational dysfunction. It’s quite clear though that health concerns of this magnitude are something entirely different. Think Flint, Michigan.

Environmental Refugees

In this era of environmental catastrophes that knock out entire regions, entirely new social issues have become a reality. For example, the 1951 Geneva Convention defined “refugees” as people who are outside their home-state due to race, religion, nationality, political opinion, or membership of a particular social group. But, as noted by Melahat Demirbiek in his paper “Environment, Environmental Refugees and Green Social Work,” high-level environmental degradation – aka sea level rise, flood, drought, desertification, and deforestation – has created another kind of refugee. The environmental refugee.

There is no proper technical classification to aid this sort of person.

While political refugees are entitled to food and shelter, environmental refugees are not yet recognized by international law. It is the job of green social work to shed light on this problem and support the people caught in its crosshairs.

All in all, green social work is a movement that has been a long time coming. And I hate to say it, but we were a little late to the game. It’s time to be of help however we can. Someone needs to empower the communities most affected by climate change – because these environmental disasters are happening whether we’re ready for them or not – and social workers are some of the best equipped to do so.

Want more? Read Lena Dominelli’s book Green Social Work: From Environmental Crises to Environmental Justice.

Have you seen green social work in action firsthand? Please, share it in the comments!

Being Black at the University of Michigan

Black students at the University of Michigan have come together to make demands on the administration this week. After bringing national attention to the injustices faced by Black students at the University through the top-trending hashtag #BBUM (Being black at UM), the students have taken the first step toward alleviating those injustices. They announced their demands to the University administrators on Monday the 20th, Martin Luther King Jr. Day, in what they’re calling an extension of the original Black Action Movement (BAM) at the University.

#BBUMThe demands center around moving Black students in from the margins – provide affordable housing nearer to campus, move the multicultural center nearer to campus, increase the number of Black students enrolled at the University to 10%. The current percentage is 6.4, well below state and national representation.

Meanwhile, the University of Michigan reaffirms its commitment to affirmative action as a 2006 constitutional amendment banning the policy in the state is being reviewed by the Supreme Court. The University’s commitment to diversity and affirmative action has always been driven by the student demand for it, as the Black Action Movement of the 1970’s demonstrated.

As stated in their demand letter,

“From the White House to Teach for America to the Peace Corps, on ever point of every corner of the globe, the legacy of Michigan is the audacity to be ambitious about its pursuit of social justice.  View in Full

The University’s own Provost recently cited current Black students’ efforts as a part of this legacy in a letter released to the University community last week.

“This commitment is longstanding and fundamental to who we are as an institution. And yet, there are times we have not lived up to our highest aspirations. Last term, we saw this in public displays of racial and religious insensitivity and in the daily aggression our students so eloquently described in the #BBUM (Being Black at UM) Twitter dialogue.” Read More

So what of this legacy? Why does a University that proclaims from all aspects to be committed to diversity struggle to create an environment where Black students can come in from the margins? And if they can’t do it – after court case after court case, after task force after task force – who can? And what does that mean for the growing racial gap in access to education in our country?

Last week at North Carolina State University, President Obama renewed the country’s commitment to providing a robust and accessible education for our young people. We can only hope that his message will trickle down to the institutions of higher learning struggling to increase their numbers and improve their climate or those institutions flat out refusing to do so.

In the meantime, we must be grateful to students who continue to push the envelope and pave the way for their younger brothers and sisters. At first glance, the ‘Black Wolverines’ demands seem extreme, but upon further reflection you realize that it is only this audacity that moves us forward. Many of us professionals once dared to dream that big as students.

Our hope now is that Black students at UM have the courage to expand the dialogue to include other students of color and marginalized communities. As a direct result of legacy of activism by Black students at Michigan, they have a voice that other communities of color do not have and perhaps, therefore, and obligation to lift others’ voices alongside their own.

As we know from experience in and outside of college activism, you can push faster and farther with more people beside you, and all our students deserve the chance to be leaders and the best.

[youtube]http://www.youtube.com/watch?v=C4Bt_RkjBfc[/youtube]

Using GIS Mapping to Tell a Better Story

Social Workers and other nonprofit professionals are regularly called upon to improve transparency and prove that their work is having some effect on the communities that they serve. It is also important that nonprofit professionals understand the needs and influences of those communities. Gathering this data can be tedious ,and analyzing it can be even more of a challenge. Once you overcome those hurdles, it creates a pathway to reporting the information in a way that tells an effective story, and GIS mapping is one of the tools that can assist you with this process.

What is GIS Mapping?

Example of a GIS Map
Example of a GIS Map

GIS Mapping is a tool that many other disciplines use for a wide variety of purposes. Programmers use the software to develop maps for games or simulations. Ecologists use it to study plant and wildlife populations and migrations. Human service providers can use GIS maps to learn about the communities that they work with.

GIS Maps can show a great deal of data in a way that is easily recognizable and understood. You can track the number of people who live in a set radius that use your services. You can track demographics- age, race, gender, income, etc. You can even track other service providers in the area to identify assets and gaps. The picture posted with this article shows access to green spaces for minorities in LA. If it’s geographically based- you can track it and tell about it.

Where does the information come from?

Many nonprofits are already using database software, such as SalesForce or Raiser’s Edge, to track demographics and statistics of their clients, volunteers, and donors. Adding those numbers to a GIS Mapping software is as simple as exporting the file from a database (or creating your own using Excel) and uploading it. Sure, there’s more to it than that but essentially- that’s all it is. The file needs to be structured a certain way (e.g.: [street address], [city], [state], [zip]) and it has to be the right type (.csx). The SalesForce database I personally work with does this automatically. It’s likely that many others do as well.

Your agency’s personally gathered information is then layered onto a special geographical map file called a ‘shapefile’.  Shapefiles contain geocoded information including: GPS, streets, boundaries, and more. Those shapefiles are available on many government databases for free. For example, to find a shapefile for San Mateo County, a quick Google search of ‘san mateo county shapefile’ led me here. The Census hosts a large wealth of information broken down into just about any possible way you’d want it- and pretty much all of it is possible to export into a GIS Map. Data broken down into counties, cities, jurisdictional districts, and even neighborhoods is available for your use.

What Can Nonprofits Use This Information For?

GIS maps are able to show impacts, needs, and assets. They can help you answer questions such as:

  •  “What is the relationship between service provider’s locations and the population they serve?”
  • “What public transportation options are available for my service community?”
  • “Where have we lost consumers? What’s different about their locations?”
  • “What problems do people in this neighborhood report that the next one doesn’t?”

Maps are easy to understand and show more information. Showing someone a pie-chart of the cities you serve isn’t as powerful as being able to break it down by neighborhood. Readers can point to where they live and think- “Wow, people I live near need these services too”. Maps click with people in a way that graphs and charts can’t.

Where Can I Get GIS Mapping Software?

Probably the most popular and potentially most versatile platform is Esri’s ArcGIS.  You can use this on a computer or mobile device. It’s about $2,500 a year for what most nonprofits will use- discounts may be available for 501c3’s.

There are other Open Source projects that are free, and sometimes provides support through an online community of users. A popular Open Source GIS program is QGIS : http://www.qgis.org/en/site/

You can see a great comparison of popular GIS software on Wikipedia.

Shapefiles and data files are available all over the place. The Census has a wealth of information on demographics. Local (or not so local) universities collect data in their Urban Planning departments that they are usually generous in sharing. I can speak to the University of Michigan offering this information to non-students. You can usually find specific state or county shapefiles on their government websites. If the geographical file is too large, you can only find a state shapefile despite needing a county shapefile, you can cut out the parts you don’t need and use geocoded information such as census tracts.

What are the Downsides to GIS Mapping?

GIS mapping requires the ability to use a computer. It requires time and an understanding of the information you’re trying to display. Some people are turned off by having to learn newfangled things.

GIS Mapping is limited to geospatial data. If you’re trying to show an outcomes that isn’t somehow tied to a geographically based variable, GIS is not for you.

Esri has taken the time to write a little report specifically on the uses of GIS in human services. If you’re interested in learning more, I suggest you check it out.

Exit mobile version