Mindful Teen program a ‘hub of care’ for adolescents

In 2012, Bradley Hospital launched its Mindful Teen program, which teaches teens the skills needed to manage a myriad of psychological challenges. Two years later, the program moved to a stricter, full dialectical behavior therapy (DBT) model and in 2016, the program became a hub for care.

Kerri Kim, Ph.D., program manager for the Mindful Teen program, explained that staff underwent intensive training before implementing the existing Mindful Teen model.

She noted that an increase in the number of teens admitted to the inpatient units at Bradley and other area hospitals provided the impetus to enhance the program.

Some teens had cycled through several hospitals and many have had at least one suicide attempt, according to Kim.

The program runs for 18 weeks but actually begins with several informational sessions four to six weeks before the groups start meeting that emphasize the importance of committing fully to the program.

Kim reported that there are no inclusion criteria, although the primary diagnosis is usually severe and recurrent major depressive disorder coupled, at times, with secondary anxiety disorder.

A key to success is parental participation in the program. Parents attend a weekly meeting that addresses multiple family skills and also sit in on the group sessions, Kim said. This enables parents and children to “…learn a common language” and develop “…common coping skills.”

Kim said that DBT is at the core of the program and may include different strategies, such as exposure or cognitive therapy, depending on the individual. As suggested by the name, mindfulness is a core skill that fosters engagement in other components of the program.

Each week, teens participate in an hour of individual therapy and a two-hour group session with 24×7 telephone coaching that offers additional guidance, support, and coping skills when trying to manage a difficult situation.

Since January 2016, 41 outpatients have been enrolled; 37 have completed the program and nine are currently enrolled, according to Kim.

To make the program accessible to more patients, Bradley Hospital worked with Blue Cross Blue Shield Rhode Island (BCBSRI) to create better insurance coverage.

Rena Sheehan, LICSW, managing director of Behavioral Health at BCBSRI, reported that the Mindful Teen program did not “fit” into the traditional benefit categories.

“Given that the program involves multiple visits per week, categorizing it as an office visit would have required the member to make a separate copayment for each appointment or visit,” she said.

Also, the program did not qualify as intensive outpatient since it wasn’t “…a structured three-hour-per-day program for three days per week,” Sheehan added.

BCBSRI’s billing department collaborated with Bradley Hospital to create a financial model that captures all weekly services into one code, then bundles the weekly codes into a monthly bill.

This method decreases the member cost share so the program is more accessible, Sheehan noted.

Additionally, the BCBSRI plan allows a member who has already been authorized to remain in the program until the provider discharges the member; concurrent review has been eliminated.

Kim noted that the program has achieved a degree of stability and she would like to expand and separate it out to middle versus high school children in the future.