Growing Mental Health Access Through Systems Change

Six years ago, I sat in a room in Chicago with some of my staff, a funder, and a group of mental health providers, contemplating the dilemma we were facing and decided enough was enough. Since the opening of our Children’s Advocacy Center in 2001, we saw a persistent problem: there simply wasn’t enough mental health provider capacity to meet the needs of the children coming through ChicagoCAC for sexual abuse investigations.

We had always had a large number of children we were trying to connect to mental health treatment who weren’t getting served. Many of them were forced to wait for several months before being connected to a mental health provider. Our own mental health team had only therapists, and although we had a large group of referral agencies, they also were struggling to meet the needs of the large number of children exposed to violence and in need of trauma-informed therapy. We really had no idea what the capacity was at any given time, and we had no system of referring children other than first-come, first-serve. All we knew for sure is that hundreds of children in need of mental health treatment were languishing on waiting lists and we were losing touch with them through the process.

Fixing this problem, though, would require more than improved efficiency of our existing system—it would require systemic change to increase the capacity of mental health services and ensure the children who had the greatest need did not have to wait months for treatment. ChicagoCAC led a small steering committee of staff and other mental health partners to develop what came to be known as the PATHH (Providing Access Toward Hope & Healing) Collaboration. We worked with a unique collaboration of private funders who were also interested in systems change and mental health access, and jointly provided flexible funding to cover the various costs of systems change, capacity building, and creating a learning community.

The result of our work was the creation of an entirely new way of screening children and families at the time of the initial forensic interview to triage and refer the neediest children for therapy first. We then created a process of determining system capacity and a real-time understanding of where there are referral openings so we could effectively match clients to providers (including our own Family Hope Center). We created a centralized waitlist and personally reached out to each family on an ongoing basis to check in, and to reassure them while they were waiting for a therapy slot to open. Finally, we hired an outside evaluator and used our data to convince funders that we needed to increase mental health services and thus were able to bring in funding to more than double our own mental health staff.

As a result, PATHH is now institutionalized into our work, and we have improved capacity, decreased overall wait times, educated hundreds of therapists on trauma-informed practice, and our model has been studied by other CACs and other referral systems within Chicago.

Children’s Advocacy Centers are in an ideal position to function as an avenue to mental health services and improving the systems that increase access and capacity to services. As a requirement for accreditation, most CACs already have a mental health network and many have internal mental health programs. Since implementing PATHH, we have presented our model at the Urban Forum, at the NCA Leadership Conference, and have worked directly with Project Harmony and Baltimore Child Abuse Center to provide technical assistance.

So how can your CAC create similar systems change? While it will take months and years of work, I suggest you start creating your plan based on the following steps:

• Gather your network of mental health providers to create a steering committee of committed professionals who want to increase access;
• Identify a leader within your organization who can facilitate discussions and lead the efforts;
• Identify potential funders (in our case, private foundations) who would be interested in increasing access and systems change
• Train your advocates on the triage tool, which prioritized the highest-need children for immediate referral.

We are, of course, always happy to help our peers in the CAC movement and are available for conversations and we are happy to share our program documents. Feel free to reach out to crivette@chicagocac.org.

Char Rivette has served as Chicago Children’s Advocacy Center’s Executive Director since 2009. In addition to overseeing the operations of the not-for-profit entity, she facilitates the Multidisciplinary Leadership Team housed at ChicagoCAC, which includes members of Chicago Police Department, Department of Children & Family Services, Cook County State’s Attorney’s Office and Cook County Health and Hospitals System.