Latest / Becker's Healthcare Behavioral Health / Whole-person Autism Care: Rethinking Coordination, Transitions and Outcomes

Transcript

Whole-person Autism Care: Rethinking Coordination, Transitions and Outcomes · Becker's Healthcare Behavioral Health

• 0:00
  - Well, hello, everyone. This is Erica Spicer Mason
• 0:02
  - with Becker's Healthcare. Thank you so much for
• 0:04
  - tuning in to the Becker's Healthcare podcast series.
• 0:08
  - Today, we're going to talk about whole person
• 0:10
  - autism care and how organizations
• 0:13
  - are rethinking coordination,
• 0:14
  - transitions,
• 0:15
  - and outcomes.
• 0:17
  - And joining me for this conversation, we have
• 0:19
  - doctor Cleo Booker, the general manager of emerging
• 0:22
  - behavioral health solutions at Carillon Behavioral Health. Doctor
• 0:26
  - Booker, it's great to have you with us
• 0:28
  - today. Thanks so much for being here.
• 0:30
  - Thank you, Erica. I'm really excited to be
• 0:32
  - here today and very excited about this this
• 0:34
  - topic and conversation that we're about to have.
• 0:37
  - Yeah. Likewise. It's a really important one. So,
• 0:40
  - doctor Booker, before we get into it, do
• 0:42
  - you wanna share just a little bit more
• 0:44
  - about yourself, your background, and your work in
• 0:46
  - health
• 0:47
  - care? Yeah. My background is interesting and unique.
• 0:50
  - It's a combination of clinical as well as
• 0:52
  - operations and product development.
• 0:55
  - I've been in the health care space now
• 0:56
  - for a long time. Not gonna really say
• 0:58
  - total years because then I'll I'll date myself.
• 1:00
  - But my background, I'm a licensed clinical psychologist
• 1:04
  - by background, but I quickly kinda fell into
• 1:07
  - the operations
• 1:08
  - realm and working within
• 1:10
  - legislation
• 1:11
  - and licensing and government and as well as
• 1:14
  - manage behavioral health care for,
• 1:17
  - for some time.
• 1:18
  - I have led large operational teams with managed
• 1:22
  - care operations. I've worked directly in the client
• 1:26
  - delivery care space with... As a start up,
• 1:28
  - developing programs from scratch,
• 1:31
  - ranging from,
• 1:32
  - you know, treating individuals
• 1:34
  - that are low on the spectrum to high
• 1:37
  - acuity needs,
• 1:38
  - substance abuse, mental health, developmental
• 1:41
  - needs, and so forth.
• 1:43
  - My specialty area, I like to say, is
• 1:45
  - in innovation.
• 1:46
  - I love to innovate. I love to grow,
• 1:49
  - transform. So throughout my career, I've always been
• 1:51
  - in the innovation space, and I have a
• 1:54
  - unique opportunity now where I'm working
• 1:57
  - with Carolina behavioral health and particularly how we're
• 2:00
  - innovating around the autism spectrum disorder
• 2:03
  - population as well as those that may be
• 2:05
  - receiving ABA.
• 2:07
  - So that's just a a little bit about
• 2:09
  - me and my background.
• 2:11
  - But as you can tell, I'm really passionate
• 2:13
  - about health care in this area and integration
• 2:16
  - of care. And so really excited about what
• 2:19
  - we have in front of us today as
• 2:22
  - an opportunity,
• 2:23
  - particularly with this population and how we can
• 2:25
  - improve health care.
• 2:27
  - Well, doctor Booker, thank you so much for
• 2:29
  - sharing a bit more about
• 2:31
  - the perspective that you're bringing to the conversation
• 2:33
  - and definitely the passion. I can certainly hear
• 2:36
  - that in your voice, and I love the
• 2:38
  - note that you mentioned about,
• 2:40
  - having a specialty in innovation. So
• 2:43
  - eager to hear how how that mindset is
• 2:45
  - applying to autism care.
• 2:47
  - But let's go ahead and start first with
• 2:49
  - talking a little bit about ABA or applied
• 2:52
  - behavior analysis.
• 2:54
  - Anyone in health care, especially in the behavioral
• 2:57
  - health space, knows that this has been a
• 2:58
  - foundation of autism care for a long time
• 3:01
  - now.
• 3:02
  - So as you're seeing the field evolve,
• 3:04
  - what should the next phase of that care
• 3:06
  - look like, and how do you think ABA
• 3:08
  - fits in within a broader
• 3:10
  - whole person model?
• 3:12
  - Yeah. The future is very exciting for this
• 3:15
  - population
• 3:16
  - and also for ABA.
• 3:19
  - For the longest time, ABA was
• 3:22
  - the number one only kinda evidence based solution
• 3:26
  - that
• 3:26
  - even our medical practitioners
• 3:29
  - knew about.
• 3:30
  - And now it's evolving
• 3:32
  - to show that it's not just ABA,
• 3:35
  - but it should be viewed upon as a
• 3:37
  - whole person solution.
• 3:40
  - For the longest time, individuals that were diagnosed
• 3:42
  - with, you know, neurodevelopmental,
• 3:45
  - delays and or developmental
• 3:47
  - disabilities and or within autism spectrum,
• 3:50
  - they were isolated to only being able to
• 3:53
  - receive behavioral health services. But as we look
• 3:55
  - forward to the future and where we see
• 3:57
  - things evolving,
• 3:59
  - we're realizing that it's no single treatment that's
• 4:02
  - gonna make the biggest difference for this population.
• 4:05
  - It's actually a whole person solution that pulls
• 4:08
  - together
• 4:09
  - physical health services, behavioral health services, and even
• 4:13
  - some vocational and social determinant of health interventions
• 4:16
  - that need to happen.
• 4:18
  - It's really important for this next phrase... Phase
• 4:21
  - of, you know, autism spectrum disorder and how
• 4:24
  - we're viewing ABA
• 4:26
  - to think about what are we actually trying
• 4:28
  - to change here. What is the impact that
• 4:30
  - we wanna have on individuals' lives, and how
• 4:33
  - should we actually be measuring the progress differently
• 4:36
  - or measuring the population?
• 4:38
  - It's really important for us to act now
• 4:41
  - versus waiting to make this future
• 4:44
  - present and not too far,
• 4:46
  - in advance. We see now that the population
• 4:50
  - diagnosis is growing at an enormous rate faster
• 4:53
  - than what we probably actually seen any other
• 4:56
  - behavioral health diagnosis grow
• 4:58
  - in the past ten years.
• 5:01
  - Right now, CDC is estimating that one in
• 5:04
  - thirty one children
• 5:05
  - have a diagnosis of ASD, and we've actually
• 5:08
  - seen most recently,
• 5:10
  - CMS came out with an ABA toolkit,
• 5:13
  - that was released this year that they showed
• 5:15
  - one in twenty nine actually had a diagnosis
• 5:18
  - of ASD. So with some populations, the diagnosis
• 5:22
  - is even more prevalent than the general population.
• 5:25
  - And then in regards to the use of
• 5:27
  - ABA services, because that diagnosis and that population
• 5:31
  - is being identified more frequently,
• 5:33
  - we're seeing a significant growth in the use
• 5:36
  - of ABA services upwards to almost 300%
• 5:40
  - growth in the use of ABA.
• 5:42
  - And so it's only fair, and it is
• 5:45
  - our responsibility
• 5:46
  - as industry experts, as industry leaders to really
• 5:50
  - make sure that we're not underutilizing
• 5:53
  - ABA services and or overutilizing
• 5:56
  - ABA services. But the key here
• 5:59
  - is making sure that the population is receiving
• 6:02
  - all services that are appropriate
• 6:04
  - to help them get
• 6:06
  - to, being successful,
• 6:08
  - healthy, and whole.
• 6:09
  - Mhmm.
• 6:10
  - Yeah. Doctor Booker, appreciate you sharing some of
• 6:13
  - those statistics too. I mean, I'm I'm still,
• 6:16
  - yeah, absorbing the fact that now as many
• 6:18
  - as one in twenty nine children,
• 6:19
  - they have a diagnosis of ASD and and
• 6:22
  - what that means for,
• 6:24
  - ABA services. When you're seeing a 300% growth,
• 6:27
  - I mean, that's just...
• 6:28
  - It's so significant that I I'm excited to
• 6:31
  - dig more into what the innovation piece looks
• 6:33
  - like here because I know that's what you're
• 6:35
  - really driving forward and what you specialize in.
• 6:38
  - And you mentioned something earlier about how you're
• 6:41
  - viewing this as and other stakeholders in the
• 6:44
  - ABA space agree that no single treatment will
• 6:47
  - make the biggest difference for this population. So
• 6:50
  - we're seeing autism care really span providers, therapists,
• 6:54
  - schools, and community organizations.
• 6:57
  - I'm curious what you think it takes to
• 6:58
  - create a more integrated continuum of care, and
• 7:02
  - where do you see payers playing a role
• 7:03
  - in helping in helping to strengthen that coordination?
• 7:07
  - Yeah. You know, integrated care first starts by
• 7:10
  - recognizing that the person and family experiences one
• 7:13
  - life event. It's not
• 7:15
  - separate events. We're not talking about,
• 7:18
  - a person that's only an ASD individual. Right?
• 7:21
  - Like, no one wants to be referred to
• 7:24
  - as someone with just a diagnosis,
• 7:26
  - but they are
• 7:28
  - individuals experiencing life. And our goal is to
• 7:31
  - first recognize that
• 7:33
  - it is a
• 7:35
  - a life event that they are happening. It's
• 7:37
  - not just, like, one one thing.
• 7:39
  - The system often divides
• 7:42
  - us into pieces.
• 7:43
  - We have the school person. We have our
• 7:46
  - health care resources. We have spiritual care.
• 7:50
  - The system often makes us feel as if
• 7:52
  - we are not integrated in whole. And so
• 7:55
  - the first thing we have to do is
• 7:56
  - just recognize that in order to make an
• 7:58
  - impact, it... We have to bring all those
• 8:00
  - pieces, all those systems together.
• 8:03
  - And it may sound more complicated than it
• 8:06
  - really is, and I'm probably, you know, probably
• 8:08
  - gonna be one of the very first ones
• 8:11
  - to make it sound like it's easy. But
• 8:14
  - in some sense,
• 8:15
  - the way that we have access to data
• 8:18
  - and how we're able to see the whole
• 8:20
  - person
• 8:21
  - moving through the system right now gets especially,
• 8:25
  - health plans like CareLawn and Advantage to
• 8:28
  - really make a difference in individuals' lives and
• 8:31
  - bring that entire system together.
• 8:34
  - We're able to see when someone's receiving school
• 8:37
  - based services
• 8:39
  - via our claims data. We're able to see
• 8:41
  - if someone is actually receiving physical health,
• 8:45
  - services such as speech therapy or occupational therapy
• 8:48
  - or GI specialist.
• 8:50
  - A lot of times with individuals with with
• 8:53
  - a diagnosis of autism and or receiving ABA
• 8:56
  - services,
• 8:57
  - they need,
• 8:58
  - additional services such as a GI specialist.
• 9:02
  - A lot of people don't realize that young
• 9:04
  - children, prior to the age of seven years
• 9:07
  - old diagnosed with ASD often have a GI
• 9:10
  - related issue as well. Think about how complicated
• 9:13
  - it is for the behavioral health intervention to
• 9:16
  - actually be effective when a child's stomach is
• 9:18
  - hurting and in pain. And the parents can't
• 9:21
  - really understand how to how to respond to
• 9:23
  - that because the child is not very communicative.
• 9:26
  - We see that information within our data. So
• 9:30
  - it is our, like I said, our responsibility
• 9:33
  - as payers to use that information
• 9:36
  - to let the providers know, hey. We're actually
• 9:39
  - seeing... When you submit your authorization request, so
• 9:42
  - we're seeing within data, this child is experiencing
• 9:45
  - stomach aches, but we're not actually seeing within
• 9:48
  - our data that they're receiving GI care. So
• 9:51
  - that... That's an example of how we have
• 9:54
  - the ability to
• 9:56
  - bring the entire system together by sharing that
• 9:59
  - insight that we have at the individual level
• 10:02
  - as well as at at the system level
• 10:04
  - to
• 10:05
  - help us create a more comprehensive continuum
• 10:09
  - of care.
• 10:10
  - Mhmm. It's such a good example of tying
• 10:12
  - this back to whole person care as well,
• 10:14
  - doctor Booker. So appreciate you sharing that example
• 10:17
  - of co diagnoses that could be happening,
• 10:21
  - such as GI issues. I think it's a
• 10:23
  - really resonant example for many of our listeners.
• 10:26
  - And I wanna go back to something that
• 10:27
  - you also mentioned, and that was around,
• 10:30
  - families and and their relationship with their child
• 10:33
  - that may have ASD.
• 10:35
  - You know, many families describe the transition
• 10:38
  - into adulthood as this kind of cliff where
• 10:41
  - services and support tend to fall away after
• 10:44
  - the childhood years. So where are the biggest
• 10:46
  - gaps
• 10:48
  - you're seeing today, and what do you think
• 10:49
  - needs to change to better support autistic individuals
• 10:52
  - across their lifespan?
• 10:55
  - Yeah. That's a great question, and that cliff
• 10:57
  - is so real.
• 10:59
  - Even when we see lots of reports coming
• 11:02
  - out right now, a lot of people are
• 11:04
  - focused on the children.
• 11:06
  - And, yes, that is very important, but there's
• 11:09
  - also a significant
• 11:11
  - change that happens during young adulthood.
• 11:13
  - These individuals that was once supported by the
• 11:16
  - school system, by their parents, by health care
• 11:19
  - professionals,
• 11:20
  - by specialty services and supports and plans, these
• 11:24
  - these plans and these support systems go away.
• 11:27
  - And we're left with individuals that are expected
• 11:31
  - to operate life. Like I said, this is
• 11:33
  - this is life we're helping people navigate, not
• 11:35
  - just health care.
• 11:37
  - We're expecting these individuals to navigate
• 11:40
  - life very independently with the loss of those
• 11:43
  - pediatric systems.
• 11:45
  - What's key here is, like I said before,
• 11:48
  - number one, first recognizing it. So now that
• 11:50
  - we recognize that there's a cliff that we
• 11:53
  - need to support,
• 11:54
  - our job is not to admire that cliff,
• 11:57
  - but to put in the right supports to
• 11:59
  - actually help people
• 12:01
  - climb up the cliff and stay on top,
• 12:04
  - and not drop. The key to that is
• 12:06
  - making sure that during the times where there
• 12:09
  - are those systems, those health
• 12:11
  - care,
• 12:12
  - kind of, like, services in place when they...
• 12:15
  - Prior to them becoming an adult is doing
• 12:18
  - that transitional care planning and not waiting till
• 12:21
  - the last minute. That transitional services and care
• 12:24
  - planning can happen as young as, you know,
• 12:27
  - 14, 15, 16. Right? If we know that
• 12:30
  - individuals are gonna carry a particular diagnosis, often
• 12:34
  - ASD
• 12:34
  - does not necessarily go away, it... We can
• 12:38
  - start doing that transition care planning coordination
• 12:41
  - prior to that cliff happening,
• 12:44
  - making sure that they are connected to ongoing
• 12:47
  - services.
• 12:48
  - It may not necessarily be applied behavioral analysis,
• 12:52
  - but, potentially, it's ongoing
• 12:54
  - cognitive behavioral therapy or making sure that they're
• 12:57
  - connected to a vocational
• 12:59
  - opportunities,
• 13:00
  - continuing with physical health therapy or speech therapy
• 13:03
  - even as an adult to make sure their
• 13:05
  - communication
• 13:06
  - skills,
• 13:07
  - stay,
• 13:09
  - enhanced and or continues to improve. So
• 13:12
  - once again, it's it's making sure that individuals
• 13:15
  - are,
• 13:16
  - a part of a planning process
• 13:18
  - prior to that cliff happening and not just
• 13:21
  - sitting back and saying, hey. It's it's gonna
• 13:23
  - occur. Their their loss of services is happening.
• 13:26
  - But being planful, working with the whole family,
• 13:29
  - working with the member, and putting those things
• 13:32
  - in place,
• 13:33
  - even practicing what it's gonna be like once
• 13:35
  - they hit that cliff and making sure that
• 13:37
  - they're able to navigate life successfully.
• 13:41
  - Absolutely.
• 13:42
  - Doctor Booker, so powerful what you said about
• 13:45
  - not getting stuck admiring the problem and that
• 13:47
  - it's there, but
• 13:48
  - acting on it, giving folks the resources,
• 13:51
  - proactive transitional care planning, all sounds so essential
• 13:54
  - here.
• 13:56
  - Before I let you go, I wanted to
• 13:58
  - kind of get just your your forward looking
• 14:01
  - view of where you think whole person
• 14:04
  - health in the autism space is really headed
• 14:06
  - here. You know, as you think about moving
• 14:08
  - toward that whole person approach, what outcomes matter
• 14:11
  - most
• 14:12
  - to autistic individuals and also their families?
• 14:15
  - I love this question, and it gives me
• 14:17
  - an opportunity
• 14:19
  - to make a public statement.
• 14:20
  - I hope that we start to measure outcomes
• 14:23
  - not just based upon the utilization of services,
• 14:27
  - but really based upon
• 14:29
  - how an individual
• 14:31
  - is functioning in life,
• 14:33
  - how their communication
• 14:35
  - has improved.
• 14:36
  - Is there greater safety that they're feeling? Is
• 14:40
  - there better participation
• 14:41
  - in schools and community events? Does the caregiver
• 14:45
  - still support it, confidence,
• 14:48
  - sustainable? Meaning, do they have the skills to
• 14:50
  - support the individuals of autism spectrum disorder?
• 14:54
  - And, ultimately,
• 14:55
  - are we seeing this population
• 14:58
  - use emergency departments?
• 15:00
  - Are there less crisis that's needed, less crisis
• 15:02
  - support?
• 15:03
  - This is how we measure outcomes.
• 15:06
  - I hear and see too many conversations happening
• 15:09
  - right now that they're measuring outcomes just based
• 15:13
  - upon utilization of services.
• 15:16
  - And an individual
• 15:17
  - may need a significant amount of services in
• 15:21
  - order to get them to what I just
• 15:23
  - spoke of, where they are feeling safe in
• 15:25
  - the community. They're engaging.
• 15:27
  - They're able to pay attention in schools and
• 15:30
  - get something from it. They're more social. The
• 15:32
  - caregiver still support it.
• 15:35
  - So that utilization of services,
• 15:37
  - yes, it it helps us understand what's needed
• 15:40
  - in order to get them to high quality
• 15:43
  - life.
• 15:44
  - However, it is not the end all be
• 15:46
  - all in regards to how we measure
• 15:49
  - outcomes.
• 15:51
  - Well, love everything you just said, doctor Booker,
• 15:54
  - and appreciate your insights throughout this conversation
• 15:57
  - in how you're seeing something like ABA that
• 16:00
  - may have felt relatively narrow in scope at
• 16:03
  - one point of time, but how it's really
• 16:04
  - broadening into this,
• 16:06
  - more holistic picture of the patient and their
• 16:09
  - needs and and how you're viewing that, not
• 16:11
  - just in care utilization as a metric of
• 16:14
  - success, but really what it means to the
• 16:15
  - patient and their families and and the ways
• 16:18
  - that they're able to thrive in their life.
• 16:19
  - So just wanna thank you again for your
• 16:21
  - time and for such a passionate conversation.
• 16:24
  - You're so welcome, and thank you. This has
• 16:26
  - been a great conversation.
• 16:28
  - And we also wanna thank our podcast sponsor
• 16:30
  - for today, Carelawn Behavioral Health.
• 16:33
  - Listeners, be sure to tune in to more
• 16:35
  - podcasts from Becker's by visiting our podcast page
• 16:37
  - at beckershospitalreview.com.