BY B.G. GREGG
The Cincinnati Enquirer
Courtney Fry, 4, plays at the East End Health Center.
(Jeff Swinger photo)
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When Patty Brogan needs to take her grandniece and grandnephews for medical care, she takes them to the nearby East End Health Center.
When she needs to take the children, who have a troubled past and are temporarily in her custody, somewhere for mental health treatment, she also takes them to the East End Health Center.
Seems simple. Combining medical care and mental health care for children in the same spot, so doctors and therapists can talk back and forth about a child's problems and needs, is a logical situation. But it is an uncommon concept in medicine, and Cincinnati is possibly the first and only place in the country where it is occurring citywide, with a plan to spend $1.5 million over the next four years integrating mental health services and pediatric medicine at eight clinics.
"It is the only place, to my knowledge, that it is being attempted on a citywide basis," said Dr. Thomas Curtin, associate vice president of the clinical affairs department at the National Association of Community Health Centers Inc.
"It is a common-sense idea that medicine got away from over the last 20 or 30 years because of specialization."
Mental and physical problems often go hand-in-hand, even for kids. Too much stress can lead to headaches, tense muscles or even heart problems. Wetting the bed could be a manifestation of a mental problem. Poor behavior in school can lead to poor performance, and vice versa.
Decades ago, parents would take their children to the family doctor for answers to all kinds of issues, including mental problems. But soon, doctors realized they didn't have the time, expertise or resources to answer questions, and specialists popped up, Dr. Curtin said.
While family doctors still can't answer all the questions, they do realize the value of at least having someone in their office to deal with mental health issues, said Craig A. Brammer, director for special projects for the Cincinnati Health Network Inc., a lead partner in integrating the services at the city's eight clinics. "Everybody goes to their primary care physician for help, and the physician may know there are underlying problems, but doesn't have the knowledge, time or resources to treat them," he said. "So they refer them somewhere else for help. Generally, kids who are referred by pediatricians for mental health care will not follow through and get the care they need.
"In this situation, we have them co-located, so all the kid has to do is go down the hall to another office. But they're not just co-located. We want them to integrate and talk to each other." The three children Ms. Brogan cares for are examples of how the system works. They came to live with her about 1 1/2 years ago. Hamilton County's Children's Services Division removed them from their parents' home.
Larry, 9, Aaron, 7, and Courtney, 4, were not well-adjusted, she said.
"I wasn't sure what they needed, but I knew they needed help," she said. "They didn't know how to bathe themselves, they had no manners whatsoever, and they hit each other."
Not knowing what to do, she took them to the local clinic and a doctor and asked for help. She told Ms. Brogan there was a mental health professional on-site, and had the children visit him.
They now visit with the therapist once a week, and Ms. Brogan has noticed a difference in their behavior, and adjustment to being separated from their parents.
The visits have been especially helpful for Aaron, who suffers from a rare disease that causes problems with the blood vessels in his head. He is scheduled for life-threatening surgery in about a year, and talks with behavioral health specialist Mike Robinson have calmed his fears.
"He used to always say, "I wish my head was fixed,' " Ms. Brogan said. "But he doesn't worry so much anymore."
The visits all take place in the East End health clinic, where the children make their normal doctor's visits.
"If it were somewhere else, where I would have to drive far, it would be a problem because I am running so much," Ms. Brogan said. "Between hospitals, dental visits and doctor's offices, I have taken them somewhere 60 times since February."
Clinic manager Elaine Pennington said having Mr. Robinson in the clinic has been very helpful to the neighborhood children, because they have someone to talk to about their problems.
More important, she said, "the wonderful thing about Mike being here is there are very few powerful male role models around here."
Mr. Robinson said he hopes the trend of integrating behavioral services with medical treatment catches on.
"This is the most logical way," he said. "I've been in the field for a lot of years, in a lot of different systems in several different states, and this is the most logical process. It just makes sense."
Mr. Brammer said it is already becoming common for adults in California to have both types of services available at their doctor's office.
"This is a managed-care-driven thing because it saves money," he said.
Dr. Curtin hopes it will catch on around the country, too, and he invited Mr. Brammer to speak at the Primary Care - Behavioral Healthcare Summit in St. Louis in November, explaining what Cincinnati is doing, so it might be duplicated in other cities.
"You may have a different cultural base in Cincinnati than in Boston, but the key problems are similar," Dr. Curtin said. Mr. Brammer's first hope is to expand the idea in Cincinnati, from eight clinics to 16. The program is paid for with a large grant from the Robert Wood Johnson Foundation, money from the Hamilton County Mental Health Board and a donation from the Health Foundation of Greater Cincinnati. Mr. Brammer said more money is needed, and he is looking for new donors.
