Mental Health U

Bringing Therapy Home: Veronica Laverde on Transforming Families with IHBT

• Bill Emahiser

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What if traditional therapy isn't enough to stabilize a family in crisis? Join us as we uncover the answer with Veronica Laverde, the dynamic manager of Unison Health’s Intensive Home-Based Treatment (IHBT) program. Veronica takes us through her inspiring journey from early intervention programming to spearheading a transformative initiative that brings therapy and essential resources right into the homes of families. Learn how IHBT fills gaps in conventional therapy by offering a robust blend of support services, from food and housing assistance to school advocacy and community barrier resolution.

This episode unpacks the innovative team-based approach of IHBT, designed to provide families with a simplified and cohesive support network. With frequent interactions, often multiple times per week, and around-the-clock crisis support, the program is tailored for those at risk of out-of-home placement. Veronica highlights the role of Ohio Rise and Aetna Medicaid in facilitating access to these life-changing services, emphasizing the importance of keeping families united for more successful outcomes.

We delve into the daily lives and rigorous qualifications of IHBT staff, showcasing the extensive training and support they receive to make a real impact. Veronica shares powerful metrics of success, such as reductions in hospitalizations and school disciplinary actions, underscoring the program's effectiveness. Listen as Veronica discusses her passion for community service and her vision for positive change in her new role. Be sure to stay tuned for a future follow-up where we track the progress of her impactful work in the community.

Veronica:

But, as I've worked with families in home-based services and even in therapy, in general I hear stories like I want my child to go to school and I want to get a good phone call from the school, or I want my child to just walk away when they're angry instead of punching a hole in my wall, things like that, and so we're going to be trying to measure the outcomes on both of those ends. But additionally, we're going to be gathering some client satisfaction outcomes and we really want to know that when we are going into somebody's home which is a special thing, it's a special thing and it's a privilege to be able to walk into someone's home and work with them that we are coming in as valued guests who don't outstay their welcome and who bring value to the family.

Bill:

Hello and welcome. I'm your host, bill Emmeheiser, and you're listening to Mental Health U, the podcast dedicated to demystifying and destigmatizing mental health issues. So if you or someone you know is struggling with depression, anxiety, trauma or some other mental health issue, then this podcast is for you. This episode is proudly sponsored by Unison Health, dedicated to making lives better through compassionate, quality mental health and addiction treatment services. Learn more at unisonhealthorg. Today on the podcast, we are joined by Veronica Laverde, the manager of the newly minted intensive home-based treatment program at Unison Health. With her extensive experience as a licensed independent social worker and her specialization in childhood and family treatment, veronica plays a pivotal role in shaping supportive services for families across Northwest Ohio. We're going to talk all about IHBT today, veronica. Welcome to the show.

Veronica:

Thanks for having me, Bill.

Bill:

Absolutely. I am delighted to have you, Veronica. If you could maybe start us out with a little bit of your professional experience and how you came to lead this new program.

Veronica:

Wow, my professional experience that goes back a little ways. I started at Unison in 2011 as a caseworker, going out to homes and working with children and families, and then over the years I went into therapy and I did some group therapy and I've done some private practice is what I've done in the therapy sphere.

Bill:

Absolutely. What made you decide because I know you were managing the early intervention programming and so IHBT is relatively new, at least for us in the Northwest Ohio area what made you decide to come on board as the leader, as the manager of the intensive home-based treatment program?

Veronica:

I guess it felt like going back to my roots a bit. I had been working in prevention for a few years and while I really enjoyed that program, I think my heart is always in therapy and in supporting therapists and working with families, and so it was a natural transition to go back to what I knew and start working with therapists and caseworkers, being in the home and boots on the ground kind of work.

Bill:

Very good, very good. Yeah, it's hard to. Sometimes you get used to doing something. It really gets into your blood and it's hard to give those things up. I, too, have a soft spot in my heart for intensive home-based therapy. I still do some home-based therapy myself, but maybe a little bit different than the program that you are going to be leading. Could you tell us a little bit about what is the IHBT program?

Veronica:

So IHBT stands for intensive home-based treatment. It is a old model made new. So we used to do home-based treatment quite a bit, even circa 10 to 15 years ago. That was something that a lot of child and family therapists were doing. They were going to the home, but we recognized that there was this huge gap of children and youth that just weren't benefiting from the kind of the once a week therapy model going into the office, seeing your therapist and working with them.

Veronica:

Not that isn't an incredibly beneficial service for the right folks. It is incredibly beneficial, but it probably wasn't meeting the needs of some families that needed something more, and so intensive home-based treatment is increasing the intensity of that therapy service as well as bringing in case management, because a lot of the families that are identified for this particular program they need more than family-based treatment therapy-wise. They need food resources, they need housing stability, they need to address some of the community barriers that they're experiencing. They need support at their child's school with helping, advocating for them, getting an IEP instead of just getting sent home every other day. So they need some of these supports that weren't necessarily available to them in a more traditional model, and even though we try to do coordinated care between therapists and case managers.

Veronica:

It's incredibly labor intensive, and so this model says, hey, what if we take some of those challenges and we reduce those challenges by giving people a very small caseload and we actually have them work in teams, and so they're constantly working together on the same cases. The therapist and the case manager share maximum 12 cases and they are working very intensively with these families for a short period of time up to six months. So it's just like, hey, let's throw everything at it for a short period of time, really stabilize the system and really help the family, wrap them in some support and then working on some step down later on in treatment. That's a long answer to a short question, but hopefully that answered it.

Bill:

No, I think that's great. You mentioned that this is not a typical. Obviously, the thing that makes it one of the things it's a team approach. It's not just a therapist, but it's a therapist and a case manager and it's not an outpatient setting. The setting is at home. You mentioned that these are families that need far more than just therapy once a week. Can you talk a little bit about the frequency that the case manager and the therapist might actually interact with the family?

Veronica:

Absolutely so. It's one of those services that it's not going to be for every family, because some families are going to be like I don't need this much, right? It's for those families that are probably calling their therapist multiple times a week saying this happened and are often in crisis mode Right, because they just can't get ahead of the problem, because they don't have enough support two, three, four times a week, sometimes for multiple hours, up to eight hours with them on any given week, depending on the level of need. And so that's something that we're constantly evaluating in this process is just like how much do they need us? How much can we start stepping back? How much more do we need to step up in order to get them through this particular crisis or this particular barrier?

Bill:

Yeah, and so the intensity of these folks, I'm going to guess, just knowing what I know about mental health, does not work on a nine to five basis. Does this program accommodate those kinds of scenarios? Yes, Absolutely.

Veronica:

There is a 24-7 crisis component to this program and so anytime one of the IHBT families calls with a crisis, that crisis line is going to be answered by an IHBT team member. So it's not we're not sending them to another agency to address the issue. It's going to be addressed by people who probably know, to some extent, their case fairly intimately. As a team, we're going to be discussing and working on these cases and so, yeah, and it's going to be someone who knows where to look for their stabilization plan. It's they know how to get in contact with me if anything's going awry.

Veronica:

We're really trying to reduce the family's need to go to multiple different support networks. We're trying to eliminate some of that. And it's a bit of a paradigm shift because sometimes in mental health, we think more is better. Right, if I just send them to one more provider or to one more service, them to one more provider or to one more service, and before you know it, people are leaving their assessment with six different referrals for six different services and things like that. And one of the things that we know with families who are experiencing crisis and trauma is that it's hard to organize, and so it's like what if we said, hey, this is your team, this is your therapist, this is your case manager, maybe this is your doctor, if that's something that's indicated, and we are going to get you through this and then we're going to decide where you go from there.

Bill:

Mental Health? U is brought to you by Unison Health. Unison Health making lives better is brought to you by Unison Health. Unison Health making lives better. And I agree, I think sometimes the families that you're working with or that you're going to get referrals for this program probably already do have multiple systems involved, lots of different folks, and it can be overwhelming, especially when you're in a crisis.

Bill:

I think of anybody who's experiencing a great deal of anxiety or discomfort, that part of your brain that can problem solve and think about what am I supposed to do next, If we can, just for these families, just give them one number, give them one set of team members to connect to, to reach out to that, like you said, know their family intimately, know their case, can help them walk through and get them what they need intimately, know their case, can help them walk through and get them what they need. You've been talking about these families and I can tell that they have a great deal of intensity that come along with them. But what are the actual eligibility requirements? How does a family, what are some of the qualifiers that gets a family, into the IHBT program?

Veronica:

The main qualifier is that they are at risk for any kind of out-of-home placement, and there's a variety of things that we have to do in order to determine that, including CANS assessment and getting them enrolled in OhioRISE. But that criteria of being at risk of out-of-home placement these are families where kids are at risk for parents having to surrender custody because they don't know how to safely manage their child's behavior, or the child's at risk of being incarcerated for their behaviors. They're at risk of hospitalization or any kind of long-term residential treatment. We're trying to say, hey, let's keep these kids in their home. Their families want them, they want them there, but they don't know how to do it safely. What if we really help them be in the most normative environment, which is the family home, and we just support the system, the family, and we support the child, we give them skills, we help them stabilize the family unit and all that good stuff.

Bill:

We know that families that stay together tend to do the children tend to do better when they can stay in placement. Now you mentioned Ohio Rise. So what is the connection between Ohio Rise and IHBT?

Veronica:

So we love Ohio Rise. Ohio Rise has really stepped in the gap and said, hey, what are some services that folks really have not been able to get access to because insurance is a barrier? And Aetna? Ohio Rise is like, hey, we're going to pay for these services again. So IHBT is a service that Ohio Rise will pay for, as long as the family meets criteria for it. Families can get into Ohio Rise through getting and qualifying through a CANS assessment. They can go onto Unison's website and get an appointment for that right off the website. It generates a referral for them. But that is the starting place to getting into IHBT. It doesn't mean that everybody in Ohio Rise is going to be appropriate for IHBT, but it's definitely the starting point and it is the gateway to getting into this service.

Bill:

So is it my understanding that, because Ohio Rise is a Medicaid program and, as I understand, is facilitated through our partners at Aetna, that other insurance private insurances would disqualify somebody from the IHBT program? They need to be have Aetna, have Medicaid and be in the Ohio Rise program to qualify. Is that correct?

Veronica:

Exactly.

Bill:

Yeah, that's what I thought. Just want to make sure I'm tracking here. Ohio Rise is a great program, there's a lot to it. What I thought Just want to make sure I'm tracking here. Ohio Rise is a great program, there's a lot to it and there's some podcasts that we've done with some of our managers and some of our care coordinators to talk a little bit more about that. So if folks are interested, I'll put a link in the notes so that folks can find those podcasts. But thinking again back to the IHBT program now, I know you're supposed to start up here soon in July, and as I'm thinking about the intensity of these programs, if I'm a therapist or a case manager in this program, what do you think a typical day might look like? And I know I'm asking you to read the tea leaves a little bit on this, but what would their typical days look like as they're interacting with families?

Veronica:

Yeah, that's a great question. And again, yes, you're right, it's a little bit reading the tea leaves and it's a little bit of one of those like fun answers of like depends. But I think in general people could anticipate coming in, maybe doing some case notes, maybe doing some phone calls, collaborating with their partner whether it be the caseworker, the therapist, whoever it is that is on their team, discussing some families and some cases and what their plan is for maybe the day or the week. But then it's going out and hitting the pavement, going to the family's houses, going to the schools, maybe meeting with some teachers, it might be taking the family to JFS to getting them set up for food stamps or some other kind of service. So there's never going to be a dull day. So if someone is like, hey, I don't want the monotony of sitting in an office all day, then IHBT is the program for you, because it's going to really change from day to day depending on what the family's needs are and who you're working with and all that good stuff.

Bill:

Yeah, this is not going to be a dull job, that's for sure. I think it sounds like something that's going to come along every day. It's going to be a little bit different, a little bit unique in what the expectations are and some problem solving skills. So I'm interested in being a therapist or a case manager in the IHBT program, because I do believe there's still some openings. What kind of support and training does your team receive to ensure they're going to be feeling confident and competent to provide effective home-based care?

Veronica:

IHBT is probably one of the most well-trained of the programs that I've had the benefit of working in. There is just a library of trainings that are available every month regarding the model itself, as well as how to engage families, even animal-assisted therapy in the home, just on a variety of different topics and how to do this work well given by people who work in intensive home-based treatment models, and so it is just a very well-resourced program. But on top of that, one of the things that is really emphasized is something called reflective supervision, and that is that every team has to participate in supervision, and supervision that goes beyond what's your caseload and who have you called and how many discharges have you done today. But the supervision that talks about okay, you're working with this family. How has that impacted you?

Veronica:

What are some of the barriers that you're experiencing from your own point of view, with working with this particular family or on this particular issue? What issues does that bring up for you and how are you going to, as a licensed therapist, work through those things in order to provide good services to your families? And there's going to be that component. And they keep the teams small and I can't have more than eight people that I'm supervising at any given moment, because they anticipate that I'm going to be doing that and I'm going to be really supporting the staff in the work, in the difficult work that they're doing, so that they're not wondering where their supervisor is. I'm on call to them 24-7 as well. So just like there's an on-call phone for our clients, I'm the on-call phone for my staff so that they never have to in a difficult situation. They always have somebody they can call to consult with, so that they don't have to wonder am I doing the right thing?

Bill:

Yeah, it sounds like. The IHBT philosophy, then, is one that I've heard before, and that is if you take care of your staff, then your staff can take care of the clients.

Veronica:

Absolutely.

Bill:

Sounds like a lot of support. You're on 24 hours a day available to them to answer questions and give them that support and that supervision, which I don't know. Any other program that I'm aware of that provides that level of supervision and training and consultations. I just have a couple more questions for you before we wrap up today, as I'm thinking about this program as a whole. How do you measure success? You said this is a short-term program, up to six months, that somebody could be in it. What kind of outcomes do you focus on? How do you know that the person has moved from point A to point B and is ready to shift to a different level of care?

Veronica:

I think if we talk to the Ohio Department of Medicaid versus if we talk to our families, that answer would be really different. And I think, as a manager of this program, we have to hold both of those stories. And from the Ohio Department of Medicaid standpoint, we want to see reduced hospitalizations. We want to see reduced school disciplinary involvement organizations. We want to see reduced school disciplinary involvement. We want to see reduced long-term care needs, reduced out-of-home placements in terms of, like foster care and things like that.

Veronica:

If we were talking to the families, I think some of those things would be the same. We want to keep our child in our home and things like that. But as I've worked with families in home-based services and even in therapy, in general, I hear stories like I want my child to go to school and I want to get a good phone call from the school, or I want my child to just walk away when they're angry instead of punching a hole in my wall, things like that, and so we're going to be trying to measure the outcomes on both of those ends. But additionally, we're going to be gathering some client satisfaction outcomes and we really want to know that when we are going into somebody's home, which is a special thing.

Bill:

Yes.

Veronica:

It's a special thing and it's a privilege to be able to walk into someone's home and work with them. Walk into someone's home and work with them, that we are coming in as valued guests who don't outstay their welcome and who bring value to the family.

Bill:

That's great. It sounds like an amazing program. I'm really excited for it to get off the ground. I know you're speeding towards it. You've been working on it for a bit now intensively. July is right around the corner. If people are interested in learning more information about IHBT, where can they go?

Veronica:

unisonhealthorg forward slash IHBT. You can go there and it will answer a lot of your questions. If you are an IHBT nerd, then you can go to IHBTohioorg and they will. There's just so much more information about the program there as well. Both of those are great resources for anybody who's interested.

Bill:

Absolutely, and if it's all right, I'd like to make a plug. If there's a therapist out there or a case manager out there that is interested in working this program, you can go to unisonhealthorg forward slash careers. Veronica, thank you so much for being on the program and talking about this. I am going to right now extend an invitation here in a few months to check back in with you and see how things are going once you're up and running.

Veronica:

Absolutely.

Bill:

I love it and I know you're going to make lives better for all those that you serve, so thank you so much. Thank you, Bill for all those that you serve. So thank you so much. Thank you, Bill. This podcast has been brought to you by Unison Health. Unison Health is a non-profit mental health agency dedicated to serving the Northwest Ohio community for the past 50 years.