There are plenty of obstacles to treatment for children, teens and other members of lower-income families struggling with mental-health issues, not the least of which is a lack of access to professionals who can see them on a timely basis. Simply getting an appointment to see such a doctor can take weeks or longer given the chronic shortage of facilities that offer such services and the overwhelming demand on those that do. And delays in care under such circumstances can have fatal consequences.
That's why Devereux Colorado is trying something new. Every Tuesday from 8:30 a.m. to 3 p.m., the company's Denver outlet, at 3801 East Florida Avenue, Suite 107, is an open-access clinic, where potential patients in need of psychological care — particularly young people accompanied by parents or guardians — can walk in without an appointment and be seen on a first-come, first-served basis.
According to Megan Vogels, a counselor and director of community programs for Devereux, this flexibility can mean the difference between a person getting or not getting the help they desperately need.
"A lot of people who come to us have received services from other agencies or clinics, but their case has been closed because they're not able to get to those appointments," Vogels says. "It's a huge disruption for them to find another facility, and as a result, their medications stop. And families on Medicaid often have more significant challenges than folks with other socioeconomic statuses."
Examples include "patient issues, job issues," she continues. "The parents may be separated and they don't have child care. And sometimes our families are working with other significant systems, like child welfare, parole and probation, which have a number of requirements they need to take care of. A lot of times these folks are juggling multiple appointments. Sometimes they may make an appointment and when they don't show up, we hear they forgot or the baby got sick or they had to go see a probation officer. And many of them don't have cars, and if they're having to take buses, that in itself can make it hard to get somewhere on time."
On Tuesdays, though, none of that matters.
"We opened the program this past spring," Vogels reveals, "and since April, we've been up and running. We're focusing on adolescents who have Medicaid, and the idea is to catch people — the underserved and the vulnerable — who need services sooner. Because when people aren't able to access services immediately, they're more at risk for needing higher levels of care."
Many of these clients are children who haven't even entered elementary school yet.
"For kids that young, we often see tantruming behavior," Vogels allows. "Any kid that age will have tantrums, but these may last an hour or two hours and there are multiple issues daily. They may not fall asleep or barely sleep, they may be refusing to eat most kinds of food or hurt themselves. There may be some head banging, or hitting and kicking parents far outside the realm of a typical kid. And what we often see behind that is trauma — kids who have experienced trauma based on moving, having been abused or parents having such a strain in their personal lives that they're not able to provide the structure children need. They may be dealing with housing- and job-insecurity, so they're going back and forth between a couple of homes. And that has an effect on kids. Most of the time under those circumstances, we bring the whole family in and have an assessment and talk about what's going on. In most cases, parents are going to need support and kids are going to need therapy."
As for the adolescent population of patients at Devereux, "we're seeing a number of common threads," she explains. "Depression is the top one, with a fair amount of suicidality and self-injurious behaviors alongside that. Suicide is the number-one cause of death of ten- to 24-year-olds in Colorado. Suicide rates are really high in the Rocky Mountain region, so we're doing a lot of assessments and risk mitigation. That can involve various combinations of medication and working on family systems, which can have a huge impact on children and create changes that are more sustainable."
Anxiety "is probably our second-most-common condition," Vogels continues, "and a lot of times, those two — anxiety and depression — go together. There can be a lot of ADHD, a lot of trauma or post-traumatic stress disorder adjustment issues. And we're also seeing emerging thought disorders and many other conditions that definitely need to be addressed."
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Problem is, the expense of providing such care is driving plenty of mental-health clinics out of business.
"We hear about competitors closing all the time," Vogels acknowledges. "I know some of them have really struggled. And people can't always attend appointments. Nationwide, an 80 percent show rate is considered successful. But we're still paying staff and electrical bills, and we can't charge Medicaid clients if they don't show up; it's against federal Medicaid law. So we're always trying to find a balance by having a model that works for us, and I feel we're pretty well positioned to combine the business knowledge and the financial analysis with providing high-quality service."
Even so, the bottom line for Vogels doesn't have to do with dollars and cents. "Most of us get into this profession because we really want to help people. And with our open-access clinic, that's what we're trying to do."
Click to learn more about Devereux's Tuesday open-access clinic in Denver.