The San Diego Center for Children has been transforming what it means to holistically serve a community for over 133 years. We chatted with Dr. Moisés Barón, their President and CEO, to learn a bit about their recipe for success. Here is what he had to say:
The context of San Diego County is shifting as is the approach we are taking to meet the needs of children, youth, and families in our community. For example, about 20% of children and youth suffer from mental, emotional, and behavior disorders. This can include a wide array of challenges including depression, suicidal ideation, anxiety, phobia, post-traumatic stress, behavioral and attention-deficit problems, and an increase in referrals to Special Education. Close to 80% of those affected are not getting the help they need. This can have an impact on nearly every aspect of their functioning including their ability to do well in school, reach their full capacity and potential, as well as contribute to a host of psychosocial challenges–especially when these issues are not identified and addressed in a timely manner. We also see indicators to suggest that these problems are becoming more acute and moving in the wrong direction. Concerningly, suicide has become the 2nd leading cause of death of children and youth in our communities. We are also seeing a significant increase in the number of psychiatric emergencies. Rady’s Children’s Hospital has reported an 800% increase over the past 8 years. What these examples illustrate is that there is a great need in the community, and what we are doing today as a community doesn’t seem to be working to provide children, youth, and families the help they need. While the work of the San Diego Center for Children focuses specifically on these needs across San Diego County, we also take part in broader conversations and efforts as we are seeing these trends represented statewide and nationally.
A lot of people ask the question of “Why? What is going on?” While there are a variety of factors, one point that we find particularly concerning is the challenges families face in maneuvering health and support services. This can depend on whether or not they have insurance, what kind of insurance, and what type of services they can access with their provider. Families often find it confusing to figure out who to contact. This problem is compounded by the fact that systems of care are very siloed. 50-55% of children and families in San Diego are receiving coverage through Manage Care Medical “Medicaid” which has its own network of providers. The county provides other more intensive mental health supports, however, there are various eligibility requirements that are not always clear to understand. Navigating the systems of care is hard for families, but also for providers when it comes to making referrals. The American Academy of Pediatrics has been sharing that pediatricians are seeing an increase in diverse mental and emotional needs but are challenged when determining where to direct their patients.
Here at the San Diego Center Center for Children, we believe that early identification and intervention are key and that you not only need to support the child or youth but also their family by conducting a thorough assessment and providing integrated family-centered services. We address this through 8 main programs, some of which include outpatient services through two clinics in East County, applied behavioral analysis and interventions for students on the autism spectrum, school partnerships providing behavioral interventions side by side with educational staff, in-home therapeutic support, a residential treatment facility for youth, and educational services through our accredited non-public school (See our website for more information). At our school, we serve 90-95 students at any given time from all school districts across San Diego who benefit from our more holistic therapeutic and educational support. Through our 8 locations across the county, we touch the lives of ~1,000+ individuals each day and approximately 8,500 per year providing services ranging in duration from a few days to a few months or years.
We also are committed to thinking about how we can create better access to services and support prevention efforts. For example, we just launched a partnership with Children’s Primary Care Medical Group, San Diego largest pediatric group. What this involves is for us to place some of our clinical staff into pediatric practices so that when pediatricians identify youth or families that might require some assistance they can refer right there on the spot to our clinicians. We are also using a proprietary web-based assessment tool that allows us to better understand the needs of the youth and family so we can develop a comprehensive action plan that would include not only the clinical interventions but also educational ones and a way of tracking their progress.
Another example is the recent partnership we have in collaboration with the Dallas Pugh Foundation in East County providing a range of preventative and therapeutic services at a high school. Our hope is to show the positive effects of having a more integrative approach using a public health model embedding aspects of primary, secondary, and tertiary prevention into the educational experience. We employ the idea of partnerships because we do not believe that “business as usual” model is going to work, and that we need to support families in learning how to maneuver what is a complex system of care. We also want to leverage technology to do so more effectively.
Leadership is key in all of our work, and we approach it through three main foci:
1. Being responsive to the needs of the community and attend to the “here and now.”
2. Focus on sustainability by working in partnership with broader systems of care.
3. Have a lens into the future to anticipate needs to chart courses of action.
Currently, the San Diego Center for Children is building upon the last two in partnership with Rady Children’s Hospital to pilot a system of providing integrated services to children, youth, and families. In this way, we can leverage philanthropic dollars to innovate and demonstrate the effectiveness of these types of programs as a means of advocating for systemic changes that are needed in the field. We believe that it is only through these partnerships and drawing upon the strengths and resources of different organizations that we are going to be able to have a longer-term, systemic impact.
It is clear that the San Diego Center for Children works hard to nourish a synergetic relationship between the community and diverse systems of prevention and care across the county. They also are incredibly responsive to the shifting needs of the community and the context–a skill that we hope will keep them around for the next 100+ years. We look forward to learning more about these new partnerships and what comes next for them in the near future!