ASPIRE — short for After-School Program Interventions and Resiliency Education — is an eight-week program for teens and young adults designed to teach mental health coping strategies and provide counseling in a group-based environment.
The contract has a twofold purpose. Not only does it defray the cost of providing services through ASPIRE to Medi-Cal patients — as commercial insurers have been doing for years — but it also formally adds ASPIRE to the list of mental health care services available to Medi-Cal patients in the county. These patients can now be referred directly to ASPIRE by the county health system.
The partnership has been a long time coming, and is the result of years of effort navigating through bureaucratic red tape and restrictions on how federal Medicaid money — and by extension county Medi-Cal funds — can be spent on mental health services. It took some creativity to make ASPIRE fit the stringent billing structure.
"For the first time ever, kids of modest means who rely on Medi-Cal will have benefit to the same critically needed services as kids who have resources, either because they have commercial insurance or because they can pay out of pocket," Santa Clara County Supervisor Joe Simitian said at the meeting.
The result is a contract that could pave the way for similar partnerships, both here in Santa Clara County and across the state. Up until this point, no other county had brokered a Medi-Cal contract for intensive outpatient services, making the deal between El Camino Hospital and the county the first of its kind, according to Michael Fitzgerald, the hospital's executive director of behavioral health services.
"Everyone came to the same conclusion — this program is working, it has a great reputation, why isn't it available to Medi-Cal kids and what would it take to get there?" Fitzgerald said.
Since its launch in 2010, ASPIRE has grown to six concurrent "programs," with each holding up to 10 people. While the program launched with a narrow scope of supporting teens, it has since expanded to include young adults up to age 25 and middle-school students.
While many of the patients coming to ASPIRE are referred to El Camino by school counselors, Fitzgerald said the program received an unexpectedly large number of teens coming directly from the hospital seeking a step-down service from inpatient and residential care. ASPIRE now has an interim two-week "prep" program for teens ages 13 to 18 whose symptoms are still too acute for them to participate in the mainstream program.
The program is hosted at El Camino's Mountain View and Los Gatos hospital campuses, but can serve people "as far as the car can take them," Fitzgerald said. Families have been willing to commute to participate in the program, from South San Francisco and Livermore to Santa Cruz County. Since the program's inception, ASPIRE has served roughly 1,000 young people, currently an average of 48 per day, according to hospital officials.
ASPIRE isn't the only intensive outpatient program for youth in Santa Clara County. Other nonprofits launched similar programs in recent years, but ASPIRE has a leg up in that it's a hospital-based program with a medical component. Teens enrolled in the program see a physician once a week, and receive psychiatric evaluations to understand exactly what patients are going through from a biological, psychological and social point of view, according to Dr. Dan Becker, chief medical director of mental health and addiction services at El Camino.
Becker said extending these services to families of all income levels marks a big step forward for El Camino, which has a responsibility to serve patients regardless of income.
"Our point of view as a community hospital is about equitable access, that everyone in the community can make use of services," he said. "When you talk about being equitable, that's always the toughest at the margins of society."
The Medi-Cal contract is the latest in El Camino's triumphs over bureaucratic hurdles. In 2015, ASPIRE received accreditation from the Western Association of Schools and Colleges (WASC), which means teens who sign up for the program can receive academic credit for the hours they spend receiving mental health treatment through the program. Fitzgerald said it took a year of "very hard work" to get cleared for six years of accreditation, which he said legitimizes the program as an education resource for children and young adults.
"It destigmatized the treatment into what we really like to think it is, which is learning skills to manage symptoms and learning skills to manage stress," Fitzgerald said. "And you can get credit for it, too — why wouldn't you?"
The contract between El Camino and the county was done without the use of a competitive bidding process, which raised some eyebrows within the network of mental health nonprofits in the area. Representatives from Children's Health Council, Uplift, Community Solutions and Asian Americans for Community Involvement urged supervisors at the Aug. 14 board meeting to use a more transparent process that opens the door for other nonprofits to provide intensive outpatient services to Medi-Cal patients, rather than hashing out a direct deal with El Camino Hospital.
County Supervisor Cindy Chavez said she didn't want to hold up this particular contract — noting a sense of urgency in expanding mental health services — but said the county should hammer out a "work plan" as soon as possible so that other nonprofits can get the same opportunity given to El Camino Hospital.
Simitian said the county went through a huge amount of effort to put together a contract unlike anything else in the state, and that trying to emulate that for other nonprofits in the county should be seen as a next step.
"It's taken us an awfully long time ... to break through the bureaucratic walls and say 'You know what? We're going to able to help half a dozen kids with Medi-Cal funding,'" he said. "Let's celebrate that for about 15 seconds, move forward and then say how can we do even more to involve other partners in the community."
El Camino Hospital's mental health services rely partially on philanthropic funding from the community. More information on how to donate can be found at elcaminohospital.org/promise.
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