Behavioral Help for At-Risk Youth

Kathryn Hunter only needs nine words to describe the positive effect of Collier County’s Health Under Guided Systems (HUGS) program. “Families are so overjoyed that somebody else gets it,” she says.

Since the HUGS program’s inception in 2010, the families of more than 3,000 low-income, at-risk children and youth in the Florida county have lent truth to those words.

HUGS is administered by NAMI of Collier County, a Naples-based affiliate of the National Alliance on Mental Illness (NAMI). Hunter is the organization’s CEO. The program provides universal screening and early identification of children who have or may develop behavioral health problems.

Nationally an estimated 79% of children with mental health disorders do not receive treatment. HUGS seeks to reduce that percentage locally by targeting low-income and at-risk children up to age 18. Children are screened in 16 Collier County public schools and six community partner sites, including YMCAs and child care centers. In 2013–14, 98% of all Collier County children enrolled in Head Start were screened. Overall, more than 1,600 children were screened in 2013.

NAMI Collier County offered its first screening services in a converted recreational vehicle parked outside pediatric clinics. It continues to operate a “HUGSmobile” vehicle to provide mobile screening in addition to the schools and other sites.

In just four years, the HUGS program has achieved a positive reputation for its effectiveness. “Ninety-eight percent of families with children who score at a threshold level for care seek care for their child,” Hunter says. “That’s what we’re the most proud of.”

Due to the program’s success and the overwhelming community response, parents are referring other children for screening. “Moms ask all the time,” Hunter says. “They will call us and say, ‘I know something’s wrong, but nobody’s listening to me.’ Their children are having behavioral problems, but so far they’re not serious enough to warrant emergency room visits.”

Children are screened using the Ages and States Questionnaire-Social Emotional (ASQ-SE) screening tools. These tools can accurately identify children at risk for developmental or social-emotional delay. ASQ-SE screens children in multiple domains: communication, gross motor, fine motor, problem solving, personal-social, and social-emotional development.

Nationally approximately 20% of children screened by ASQ-SE show signs of needing further evaluation by mental health professionals. In Collier County the rate has been 24%. Hunter says NAMI Collier County is studying four years’ worth of HUGS program data to see if they can identify the reasons for the higher incidence locally.

The HUGS program uses system navigators to perform the initial screening of the children. If warranted, they will arrange a mental health assessment. The navigators then guide children and their families through the mental healthcare system. They assist with access issues, developing relationships with service providers, and tracking interventions and outcomes.

Navigators build a team that includes the child, family, schools, clinicians and support groups. They develop long-term and sustainable plans for family success, attend meetings and therapy appointments as needed, and engage other community services to support the family and ensure success.

Navigators who are selected for the program are culturally competent and have a proven ability to relate to the children and families entrusted to them. All navigators have mental health professional credentials and are bilingual in English and Spanish. Parents are free to choose the navigator for their child. 

“Many of our navigators have children of their own who have a diagnosis,” Hunter says. “They understand what the family is going through.” The goal is to build a care team that will work cooperatively on the child’s behalf. We know that personalizing this process is a key to its success.”

The focus on the child’s care also includes assistance to the rest of the family as needed. Care will be more challenging for a child who continues to live in a stressful home environment. Services are made available for parents dealing with their own mental health problems, depression, marital stress and other issues. The end result is a healthier family and home environment for all.

In addition to facilitating care, navigators also break down any barriers to children receiving the help they need. NAMI Collier County has its own van to overcome transportation obstacles. Child care is available for siblings so parents and children can keep appointments. Partial funding for initial medical management is provided, along with help securing ongoing funding from outside sources such as pharmaceutical companies.

Once a family is satisfied their needs have been met, they can end their active participation in HUGS. However, the program remains available to them should a new need arise.

Hunter offers an example: “If, in three months, Johnny gets suspended and mom calls, we’re right back in there,” she says. NAMI personnel are always ready to step in again when a parent contacts them because “Parents are the experts on their children’s behavior.”

HUGS operates on $350,000 in annual funding from the Naples Children & Education Foundation (NCEF). Among other things, this funding covers staffing costs for the system navigators and helps defray costs of removing transportation, child care and other barriers to treatment.

HUGS is part of a larger local children’s mental health initiative called Beautiful Minds that seeks to decrease the instance of serious mental illness through screening and access to appropriate care. It partners with several organizations, including NCEF, Healthcare Networks of Southwest Florida, the David Lawrence Center, Florida State University’s School of Medicine, Collier County Schools, Head Start, YMCA and Boys and Girls Club.

Through early screening identification, system navigators, team-oriented care and comprehensive services that include the entire family, HUGS has grown and impacted the lives of thousands of children in Collier County. It continues to surpass its goals for outreach, screening and provision of comprehensive services. 

Take-Home Points

• System navigators perform initial mental-health screenings for low-income and at-risk children in schools and elsewhere.

• They guide those needing assistance and their families through the care system, leading a team that includes family, schools, clinicians and support groups.

• Care is also offered to parents with their own mental health problems, depression, marital stress and other issues.

Ed Mund began his fire and EMS career in 1989. He currently serves with Riverside Fire Authority in Centralia, WA. Contact him at mund.ed@comcast.net.