Expanding the definition of “provider” could ease the youth mental health crisis

Published May 2, 2024

An innovation is tripling the number of kids one practice can treat

As a social worker, Sarah Fleury anguished as she watched the growing list of children waiting to access mental health services.

“If you call around to 10 to 15 providers trying to get your child in to see a therapist, you're repeatedly told there’s a three-to-six month wait.”

That experience shaped her approach to her current role, the managing director of behavioral health at Blue Cross & Blue Shield of Rhode Island (BCBSRI). She’s now focused on driving innovative solutions to help more kids access the care they need.

An innovative partnership

The BCBSRI team began to look at an organization called Braver. It was launched by child and adolescent psychologist Abbe Garcia, Ph.D. and psychiatrist Brady Case, MD, Ph.D. in 2021 with a mission to help kids get better faster.

Specifically, the team used exposure therapy to help kids with obsessive compulsive disorder (OCD) and anxiety, who often repeat behaviors as a way to avoid uncomfortable feelings.  This therapy helps patients gradually reduce the behaviors by confronting the discomfort one small step at a time.

Traditionally, a mental health care provider administers the treatment in an office, but the Braver team knew the practice could be more effective if it offered treatment in the community. What’s more, with back-to-back appointments and long patient wait lists, the Braver team knew they could use this method to reach more kids where they were.

Special coaches help expand access

The method: a team-based approach that is built around coaches. They all have a bachelor’s degree but don’t need therapy licenses to work with kids each week at home or in an outside environment, tackling a different challenge each time. The Braver team trains and supervise the coaches, as well as assesses the kids regularly. Rounding out the treatment program is a regular group therapy session. On the wall in the group session meeting room is a bulletin board where kids tack up colorful sticky notes about something brave they’ve done that week.

Owen’s story: how a coach helps this teen with debilitating OCD reclaim his life.

“The use of non-licensed providers is the single most innovative thing that Braver is doing,” says Garcia in her sunny office in East Providence, Rhode Island. “We are using people that other disciplines don't use to deliver the core ingredients of this treatment.” They can train a Braver coach in eight weeks.

“It really triples the number of kids that we can see, because if I am working independently as a psychologist, I can only see the number of kids that I can fit in my own schedule,” says Garcia. That might amount to eight patients. “When I have three coaches reporting to me, we meet one hour a day as a team, each coach gets an hour of individual supervision with me and the rest of the time they are directly delivering care.”

When Braver started, there was just one catch: no insurer would cover the services of a non-licensed professional. That’s when BCBSRI’s Sarah Fleury saw an opportunity to get creative.

Paying for innovative treatment requires innovative health insurance

“For everything in health insurance, you need a code and a benefit that that code ties back to,” says Fleury. “Sometimes you have to get creative with how you fit things into a member's benefits.” With Braver, she and her team brainstormed how best to serve their members. They factored in the coaches’ training, how much time they spent with clients, travel time and even growing expertise. “We came up with a formula that would allow Braver coaches to be reimbursed at the same rate as a licensed clinician,” says Fleury. The health plan was the first in the state to cover Braver’s services and helped the practice get off the ground.

What’s at stake with a shortage of mental health care workers

“Remember, there's a war going on outside,” says Case, Garcia’s partner in Braver. “Kids are suffering. And we're losing the war every day we lose another kid.”

That’s why, Case says, health care must move on innovations faster and deliver effective treatment. “We’re on the hook for both.”

Blue Cross & Blue Shield of Rhode Island is a licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.