Report to the VNA Foundation 2019
VNA Narrative
The demonstration project of tele-behavioral health in five Chicago Public Schools was an exciting first step in providing behavioral health care to a seriously underserved student population. The project identified financially sustainable business models in four CPS high schools and one elementary school. Over 100 students and their families were connected at their school to behavioral health providers at remote locations. The project was successful because it:
- invested in the needed education of providers, school and clinic staff, students and family;
- used Psychiatric Mental Health Nurse Practitioners as qualified, reliable and economical providers;
- used reliable equipment and software integrated into the organization’s larger IT and medical records system;
- identified a Medicaid reimbursement issue and effectively presented this issue to policy makers and statewide advocacy groups likely leading to a change in Medicaid reimbursement; and
- explored opportunities to expand to other school-based health clinics and schools without clinics.
PMHNP
Availability of behavioral health providers for the students was a challenge. We had two psychiatrists leave during the demo period. Departure led to delays. Psychiatrists are in huge demand. Use of Psychiatric Mental Health Nurse Practitioners (PMHNP) was more stable and economical. The use of PMHNP’s is encouraged by a recent Illinois law which allows for Medicaid reimbursement for telepsychiatry provided by PMHNP’s. (P.A. 100-0790 effective 8/10/18).
Type 56 Clinics
Rush’s SBHC’s do not qualify for Medicaid reimbursement for providers of both onsite and tele- behavioral health services. This is a major impairment to a financially sustainable business model for school-based telebehavioral health (TBH). The Illinois Health and Hospital Association and EverThrive-IL have advocated with the Illinois Department of Healthcare and Family Services to designate a needed CPT billing code to allow for reimbursement of Type 56 school-based health centers. We are hopeful that the new administration will support this effort.
Equipment
Selection of equipment and software set-up delayed the launch of the project because it involved organizational tech departments who sought to blend the project equipment/software with that of the larger organization. Additionally, unreliable WiFi systems in CPS schools limited use of certain types of equipment and TBH visits beyond initial project expectations.
Education
The project anticipated the lengthy time needed for educating stakeholders. We built in time and funding for Rush and Erie to:
- Conduct presentations to the students, family, school staff, teachers, provider organization staff, community agencies and community groups;
- Hold team meetings in TBH workflow processes and evaluation;
- Attend meetings with Information Systems to provide social work perspective on template development and software buildout;
- Develop materials for staff training and
- Develop and manage evaluation dashboards.
Elementary Schools
Erie found operating in elementary schools to be much easier than high schools, particularly when involving family members who need access to the school.
Expansion to other schools
Erie took the initiative to expand the project beyond their two schools to another SBHC they operate, Mary Ward Elementary School. Rush also took the initiative to contact nearby schools without clinics to explore possibilities for TBH services to their students.