Bradley outpatient expansion meeting a growing need

PERSONAL TOUCH:  Hannah Mekuto, 18, a student at Bradley Schools' Providence location, is seen with Dr. Dale Radka, director of Bradley Schools. / COURTESY  LIFESPAN
PERSONAL TOUCH: Hannah Mekuto, 18, a student at Bradley Schools' Providence location, is seen with Dr. Dale Radka, director of Bradley Schools. / COURTESY LIFESPAN

In the early 1990s, before joining Lifespan, Bradley Hospital was a very different place than it is today. It sometimes maxed out its credit line, operated in a 1930s-era building and offered a narrow line of services – inpatient hospitalization, a small outpatient program and one school, recalled Dan Wall, president and CEO. When Wall joined East Providence’s Bradley in 1988, “We might have seen maybe 1,000 families in … a year.”

In contrast to many Rhode Island behavioral-health facilities that reduced or eliminated pediatric outpatient mental health programs, 80-year-old Bradley, which built a new building for $31 million in 2009, significantly expanded such services. “That’s where the biggest demand is,” said Wall. “We’re not in the outpatient world to make money… [but] to serve families and hopefully be able to get reasonable rates to [remain] viable.”

With an annual net budget of $80 million – which does not include some $10 million in annual research funds – Bradley serves about 4,000 children each year. In addition to the Bradley Schools, which treat 400 children each day, it has more than a dozen outpatient programs for patients, some from as far as San Francisco, domestically, and the Philippines, internationally, said Henry Sachs, Bradley’s medical director and a clinical assistant professor at Brown University’s Warren Alpert School of Medicine.

Beatriz Medeiros came to the Bradley Schools in 2011 in crisis – with suicidal ideation, cutting, panic attacks and hospitalizations. The schools, which support children suffering academic and psychiatric challenges, helped Medeiros effectively manage her emotional turmoil and academics, which suffered due to her emotional state. “I feel blessed to be living an easier and healthier life. … The Bradley staff … never gave up on me.” Medeiros graduated from high school and no longer harms herself.

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With sites in East Providence, Portsmouth, Providence, Westerly and Montville, Conn., the schools serve approximately 300 students, with another 100 students taught in embedded classrooms in more than a dozen Rhode Island public schools, said Dr. Dale Radka, the schools’ director and a clinical assistant professor, department of psychiatry and human behavior at The Warren Alpert Medical School of Brown University. “[Traditional public] schools have school psychologists who aren’t trained on the clinical side; our [staff is] able to meet [students’] behavioral needs at the school levels,” he said. Children in embedded classes are slowly reintegrated back into the traditional classrooms and we’ll give them the support they need, said Radka, who envisions expanding the schools nationally.

In the past, no one expected Bradley, which has been part of Lifespan for 20 years, to educate children. The focus in the past was on “taking care of their behavior,” said Sachs, who lauded Radka and his team. Bradley Schools, with a wide age range of students in any classroom, said Radka, have invested heavily in computer-based curricula to enable students to advance at their own pace.

“We’ve seen tremendous results in the past three or four years,” said Radka. “We used to have a zero percent return on [completed] homework; now some 85 percent [of students] are going home and working on their own – without instruction from us to do so.”

What could make these outpatient systems even better?

Tele-medicine, asserted Sachs and Radka, would allow pediatricians and school psychologists to consult readily with mental health providers, who could also talk with kids in crisis screen to screen. Rhode Island is “the worst in the country” for tele-medicine, said Sachs.

Ask pediatricians what their top 10 needs are, and six of them will be around behavioral health, he added.

With ongoing dramatic changes in health care, Sachs predicted that population health management is the wave of the future, whereby Lifespan, for example, will be allocated a fixed sum of money to manage a population’s medical and behavioral health needs. That would encourage creative approaches to preventive health and addressing issues as early as possible, rather than during a crisis, which is the most expensive, he said.

“If we’re not there five years from now, we’re in big trouble as a system [and] as a country, because otherwise costs will just keep going up,” he added. •

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