CHES® Champions Initiate First Pediatric Behavioral Health Home Using Wraparound in the United States

As health education professionals, it may be easy to overlook the significance of the National Commission for Health Education Credentialing (NCHEC) Responsibilities and Competencies. This commentary discusses how Certified Health Education Specialists at one nonprofit organization brought the Responsibilities and Competencies to life as they planned, implemented and evaluated a novel integrated health program for youth with co-occurring behavioral and physical health needs. Through their commitment to high-quality demonstration of the NCHEC Responsibilities and Competencies, these Certified Health Education Specialists successfully introduced the valuable role of the CHES® certification to the multidisciplinary providers and diverse families within their community.

Alive and vibrant, have you ever used these words to describe the National Commission for Health Education Credentialing (NCHEC) Responsibilities and Competencies?[1] This article discusses the power of putting health education standards to practice.

Bergen's Promise is the designated Care Management Organization for Bergen County, New Jersey (www.bergenspromise.org). The organization serves youth ages 5 to 21, with serious emotional and behavioral health challenges, substance use issues and intellectual/developmental disabilities. Bergen's Promise mission is as simple as it is critical: to provide the support needed to keep these at-risk children safe and stable at home and in their communities. This is achieved through use of the Wraparound Model of Care (Wraparound).[2] Wraparound is a process that builds on the family's unique strengths, values, voice, and resources to create an individualized and sustainable plan of care.[2] A multidisciplinary team of formal and informal supports works in partnership with the family to maximize the use of sustainable resources to meet the youth and family's current and long-term needs in all major life domains. The resulting Wraparound plan of care incorporates a combination of services, informal supports, and community resources and is tailored to the family's individual needs, rather than service driven. In 2014, Bergen's Promise took a bold step by agreeing to pilot New Jersey Children's System of Care's first Behavioral Health Home; thus, establishing the first Pediatric Behavioral Health Home (BHH) in New Jersey, and the first to utilize the Wraparound model of care in the United States. This new method of integrated healthcare was developed to address health disparities facing individuals with behavioral health challenges. A Director of Health Services (board-certified family nurse practitioner, doctoral candidate) was employed to initiate the program. The Director knew that planning, implementation, evaluation, advocacy and communication would be the bedrock for a "first of its kind" Pediatric Behavioral Health Home. Were these skills not the very foundation of health and wellness education? After researching the NCHEC Responsibilities and Competencies, the Director recommended that a Certified Health Education Specialist was needed to "build the plane while flying it," that is, develop the Pediatric Behavioral Health Home from the start. So strong was the Director's commitment to this decision that she advocated that two Certified Health Education Specialists be hired to initiate this exciting, novel integrated health venture.

With only a general outline of the program's mission and design, the skills of the Certified Health Education Specialists in the responsibility area of planning[1] were essential in the process of developing this innovative program. The Certified Health Education Specialists reviewed the literature to gather information on intervention strategies used by other Behavioral Health Homes across the nation (see sub competency 1.2.3 Conduct a literature review). Armed with a list of designated qualifying conditions, the Certified Health Education Specialists researched evidence-based interventions for each (see sub competency 2.3.3 Assess the effectiveness and alignment of existing interventions to desired outcomes) and began building a toolkit which included assessments and tracking tools, educational resources, and literature on best practices (see sub competency 2.4.2 Develop materials needed for implementation). The Certified Health Education Specialists built a framework for the program which allowed room for the educational materials to be tailored to each youth and family served, reflecting the Wraparound principle of individualized care[2] (see sub competency 2.3.4 Adopt, adapt, and/or develop tailored intervention(s) for priority population(s) to achieve desired outcomes). During the planning process, the team also developed an evaluation plan that expanded upon that developed by the New Jersey Children's System of Care to further examine youths' health behaviors, skills, attitudes, and knowledge (see sub competency 2.4.4 Plan for evaluation and dissemination of results). The program policies and procedures developed by the Certified Health Education Specialists helped the organization earn exemplary status in its first accreditation through the Commission on Accreditation of Rehabilitation Facilities (CARF)[3] (see sub competency 2.4.1 Develop an implementation plan inclusive of logic model, work plan, responsible parties, timeline, marketing, and communication).

As the team developed plans and materials for the intervention, Bergen's Promise was training its multidisciplinary staff about the importance of integrated healthcare and preparing for initial referrals into the program. Soon the Certified Health Education Specialists were in the field putting their skills in the responsibility area of implementation[1] to work. Health education services were provided one-on-one in families' home (see sub competency 3.2.4 Deliver health education and promotion as designed). In accordance with Wraparound, individual intervention goals were strengths based, individualized, and reflected family voice and choice[2] (see sub competency 3.3.3 Modify interventions as needed to meet individual needs). The Certified Health Education Specialists used motivational interviewing and the transtheoretical model[4] to help families define SMART goals, and then applied evidence-based assessments and educational materials to help families achieve those goals (see sub competency 3.2.5 Employ an appropriate variety of instructional methodologies).

The Certified Health Education Specialists' skills in the responsibility area of evaluation and research[1] were integral to program improvement and accountability as well. Per the logic model developed during program planning (see sub competency 4.1.3 Use a logic model and/or theory for evaluations), goals and progress were regularly assessed on the individual level through quarterly progress updates and existing validated health behavior assessments (see sub competency 4.1.8 Adopt or modify existing instruments for collecting data), on a team level through monthly peer internal audits (see sub competency 4.3.4 Monitor data collection procedures), and on an agency level through quarterly review of outcomes within the organization's continuous quality improvement process (see sub competency 4.5.3 Identify recommendations for quality improvement). Certified Health Education Specialists were responsible for partnering with quality assurance and information technology teams to develop a database to track program outcomes (see sub competency 4.1.6 Develop a sampling plan and procedures for data collection, management, and security). The Certified Health Education Specialists trained all new team members on data collection (see sub competency 4.3.1 Train data collectors) and developed procedures for analysis (see sub competency 4.3.5 Prepare data for analysis). As data were analyzed, they developed reports, presentations, and executive summaries to communicate results with program stakeholders (see sub competency 4.5.1 Communicate findings by preparing reports, and presentations, and by other means).

Working in partnership with each family's interdisciplinary team, the Certified Health Education Specialists of Bergen's Promise BHH have helped hundreds of families achieve significant health behavior changes. Based on pre-post self-report data, nearly 80% of youth have improved their eating behaviors and two-thirds have become more physically active. Additionally, 70% of youth have reported higher self-esteem, and over 70% havereported improved health-related quality of life, reflecting improvements in physical, emotional, social, and school-related wellness. Health literacy assessment data demonstrate that over three-quarters of youth have gained skills in this area.

Today, Bergen's Promise well-established Behavioral Health Home incorporates medical expertise and health and wellness education into the Wraparound process to provide fully integrated and coordinated care for children with designated chronic medical conditions. The Certified Health Education Specialists of Bergen's Promise are essential to the development of effective individualized holistic plans of care. Daily, these exemplary professionals work diligently toward the ultimate goal of BHH: empowering children and families to successfully manage co-occurring chronic medical and behavioral health conditions. How satisfying to realize that the NCHEC Responsibilities and Competencies[1] would be the beacon "in real time" to accomplish such an innovative mission.

We thank Dean Pastras, CEO of Bergen's Promise, for the opportunity to implement innovative practices within Bergen's Promise Behavioral Health Home. We would also like to acknowledge Ellen Indoe, a founding Certified Health Education Specialist of Bergen's Promise Behavioral Health Home.

No potential conflict of interest was reported by the authors.