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Bringing It All Together: Coordinating Care

Too often, pediatric mental health care is fragmented, without good communication between a child's various medical and mental health providers. Frequently, children are discharged after an inpatient psychiatric stay with a 30-day supply of medication but no follow-up plans or appointments.

With our broad network of more than 300 pediatricians, specialists, and surgeons in more than 40 locations throughout the region, CHKD Health System is in a unique position to address and improve care fragmentation. Our goal is to develop a coordinated continuum of care. Our new hospital will have space dedicated to partial hospitalization and intensive outpatient programs. These programs can serve as transitional levels of care after an inpatient stay so that child's reintegration to family and school has the best chance of success. For some children, partial hospitalization and intensive outpatient programs will provide an intensive, structured program with more focused time and resources than are available through weekly therapy appointments. Thousands of children each year will have their mental health needs met through an ongoing therapeutic relationship with our outpatient mental health team or their CHKD pediatricians who have been trained to recognize and treat the most common mental illnesses in children.

To further address the gaps in mental health services for children, we have developed programs to coordinate care for children with co-occurring medical and psychiatric needs, and a mental health crisis clinic, which will augment our emergency department and Level I pediatric trauma center in caring for children's emergent needs. Our new bridge clinic provides care to children who have recently completed an inpatient stay at a psychiatric hospital but do not yet have connections to ongoing mental health providers. The clinic also serves children who are in mental health crisis - until they can get an appointment with a community provider. 

In addition, CHKD is the region's partner for the Virginia Mental Health Access Program (VMAP), a statewide initiative that offers pediatricians real-time phone consultations with board-certified child and adolescent psychiatrists. VMAP also serves as a resource for pediatricians who are looking for mental health care for a child in the community.

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