Doernbecher Children's Hospital

Novel Interventions in Children's Healthcare

A group photo of OHSU's NICH Program staff.

Families enrolled in the Novel Interventions in Children's Healthcare (NICH) Program are dealing with a number of life challenges and psychosocial stressors that make it difficult to meet all the demands of their children's health while simultaneously meeting the demands of their day-to-day lives. As such, the NICH intervention is grounded in both developmental and systems theory. Attending to the "normal developmental demands" of youth with complex medical conditions is critical along with analyzing and understanding the impact of the various systems or contexts in which these youth live.

NICH services are for youth with complex and/or chronic medical conditions with the focus on the triple aim in healthcare reform:
  1. Improving our population's health
  2. Improving care
  3. Reducing costs

Youth and their families are assigned a NICH Interventionist  who will provide them with 24/7 real-time access in the form of (1) strategic family and systems interventions, (2) health systems integration and patient needs alignment, and (3) resource access for family and patient optimization. Services are delivered for up to 12 months, depending on the youth and family's needs and the circumstances surrounding the youth's health. NICH Interventionists are in constant contact with families via face-to-face meetings, text, phone, email, and teleconferencing. In addition, NICH provides services across all contexts in which youth and families are embedded including hospitals, clinics, schools, and homes.

Strategic Family and Systems Interventions

All interventions are strategic and plan-full and include a combination of family-based and systems-based interventions. Family-based interventions are grounded in empirically-supported interventions such as Behavioral Family Systems Therapy (BFST: Robin & Foster; Wysocki & Harris), Multidimentional Treatment Foster care (MTFC: Chamberline),Solution-Focused Brief Therapy (de Shazer & Berg), Parent Management Treatment of Oregon (PMTO: Patterson) as well as many others. The systems-based interventions involve role-stratification, provider coaching, and psychoeducation around the psychosocial and behavioral management of youth with medical complexity, chronic health conditions, and special healthcare needs.

Health Systems Integration and Patients Needs Alignment

Interventionists serve as a liaison between the youth, family and the medical team. Interventionists attend clinic visits, are often present for ED admits and hospitalizations, and attend care conferences. In addition, Interventionists problem solve around other aspects of medical care including transportation to and from appointments, ensuring families have adequate medical supplies, ensuring access to medical information, and problem solve around the youth's medical condition. Once a youth and his/her family are enrolled in NICH, primary care providers (PCPs), specialty providers, and any other persons involved in the youth's healthcare will be engaged as experts and will receive ongoing updates regarding the youth and family's progress in NICH.

Resource Access for Family and Patient Optimization

Interventionists will interact with the multiple systems in which the youth and family are embedded outside of the youth's healthcare needs. This would include interface with a variety of agencies and services including schools, social service agencies such as child protection, juvenile justice, mental health providers, employers, and any other important individuals who interact with the family. Interventionists will assist with resource access addressing problems with food, housing, employment, and economic in security. In addition, Interventionists will assist families and youth with navigation across cultural and language barriers.

Youth and families enrolled in NICH are assigned a NICH interventionist who will provide them with services for approximately 12 months, depending on the family and the circumstances surrounding the youth's health. NICH interventionists are in frequent (in some cases daily) contact with families during the initial stages of treatment and are available to families 24 hours a day, seven days a week. Interventionists provide services in the hospital, in clinic, at the youth's home, over the phone, and over the computer (via email and video chat). In order to maximize service provision and minimize costs, communicative technology is used whenever and wherever possible.

NICH serves youth (from birth to age 18+) with complex and/or chronic health conditions. The families who benefit most from NICH services have both medical vulnerability and social vulnerability which have led to challenges in adherence resulting in poor health outcomes. NICH will consider patients with any type of medical condition.

If you're unsure if your patient or family would be a good fit for the NICH program, please view the "Making a Referral" tab for contact information.

Examples of Medical Vulnerability:

  • Type 1 Diabetes
  • Seizure disorders
  • End Stage Renal Disease
  • Cancer
  • Failure to Thrive
  • Pre/Post Transplant
  • Cystic Fibrosis
  • Hemophilia
  • Chronic pain
  • Cardiovascular problems
  • Morbid obesity

Examples of Social Vulnerability:

  • Financial insecurity
  • Housing insecurity/Houseless
  • Food insecurity
  • Domestic violence in the home
  • Refugee status
  • Single-parent homes
  • Incarceration of a parent
  • Parents/Caregivers who do not speak English
  • Parents/Caregivers with mental health concerns
  • Parents/Caregivers with substance use concerns

While most health care services fall under the category of fee-for-service, NICH operates using an alternative payment model (APM). This means that NICH relies on contracts with insurance companies to cover the cost of NICH services for each patient. Insurance companies pay a flat fee, upfront, that covers the cost of NICH for 12 months. There are no direct costs to the patients or families for this service.

We are fortunate to have several contracts with local insurance providers however, we still receive more referrals than we can actually serve. Funds are always needed to help cover the cost of the program for children who do not have insurance that covers NICH. Additionally, NICH relies on donations to ensure that patients and families in the program have their basic needs met.

There are three ways to donate to NICH:

  1. Donate money: Monetary donations can be made to NICH's Foundation account at www.ohsu.edu/nich/donate
  2. Donate new or gently used items: Many NICH families benefit from new or gently used infant/child/adult clothing, baby items (e.g. diapers, bottles, etc.), safety devices (e.g. helmets, cabinet locks, car seats) and other essentials. NICH also uses incentive programs to help motivate children to complete their medical regimens - toys, gift cards, and other fun gifts can be great incentives. If you're unsure if your item/s would be appropriate for NICH, please email nichprogram@ohsu.edu to find out.
  3. Donate your expertise: NICH is always looking for individuals with skills that can help the program grow, and serve more families. Individuals with skills in marketing, design and fundraising would be a great fit. If you're interested in volunteering your services, please email nichprogram@ohsu.edu

Awards

  • Pediatric Excellence Award, 2017. Press Ganey; Inaugural award recognizing a standalone pediatric hospital, hospital within a system, or unit that has demonstrated extraordinary commitment to the delivery of pediatric care.
  • Clinical Care Innovation (CCI) Challenge Award, 2015. The Association of American Medical Colleges; Improving Value through Clinical Transformation, Education and Science Meeting, $5,000
  • Trillium Community Health Plan Coordinated Care Organization Transformation Grant, 2014. Pilot funding to assist in innovative programs that will help create a new system of healthcare. $177,500
  • CareOregon's Care Support and System Innovation (CSSI) Grant, 2011. Pilot funding that fosters a culture of evidence-based practice and continuous improvement in provider organizations. $115,000

Symposia

  • Intervention for Youth Repeatedly Hospitalized with Complex Medical Conditions: NICH Work. Annual meeting of the American Psychological Association. Div54 Symposium. (2014, Honolulu, Hawaii).
  • Pediatric Psychology's Efforts in Bending the Curve: Treating Youth with Medical Complexity Who Are Repeatedly Hospitalized. SPPAC Annual Conference: New Frontiers in Pediatric Psychology: From Innovation to Application (2015, San Diego, CA).

Join NICH for the 2nd Annual Hike for their Health! This year participants will have the option to hike two different trails and, yet again, 100% of the proceeds will go directly to supporting NICH patients and their families!

When: Saturday, September 28, 2019 at 3:00 p.m.

Where: Tryon Creek State Natural Area

Registration information will be posted shortly. For questions, or to be added to the Hike for their Health newsletter please contact Cat Dennis at dennica@ohsu.edu

Contact us

For questions, please contact

Cat Dennis
503-494-3245

To make a referral, please contact

Brian Jones
Operations & Referral Coordinator
jobriane@ohsu.edu
503-418-1162

Kim Spiro
Clinical Director
503-964-9983

Make a donation

All donations will go towards supporting our most vulnerable youth.