Programs like FAST Forward allow kids to remain at home while accessing care


Monitor staff

Published: 05-30-2023 10:35 AM

Gavin Dubois sometimes doesn’t have the words to express how he feels. But when he picks up a pair of drumsticks, he can read his emotions as clearly as notes on a sheet of music. Amid the sounds of the snare, the melodies of his marimba, his rage turns to rhythm.

Music is a common thread for the 17-year-old high school student. He’s played drums since he was a toddler. He’s in the band at school and took an African drumming class as one of his course electives.

For the past year, he’s attended weekly music therapy sessions through the FAST Forward program – a state-wide service that helps coordinate a comprehensive plan to aide young people dealing with behavioral and mental health challenges.

Typical therapy sessions entail conversations across couches. For Dubois – his weekly counseling involves some chatter, juxtaposed with breaks to bang, crash or tap whatever instrument is in reach.

It’s the first time in a while that therapy has clicked for him. He’s found a new sense of calm – he’s now open with his peers and teachers and is productive in school.

“I’ve always loved music. I’ve played it since I was 3 years old,” he said. ” I’ve always struggled with finding a therapist. I’ve never connected with a therapist. … It is an amazing resource that I don’t think I would have done if it wasn’t for the program.”

For years, conversations about behavioral health in New Hampshire didn’t focus much on children. Now the state-run bureau of Children’s Behavioral Health brings both youths and their families to the forefront of individualized care.

Building a team

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Unlike many of his peers, Dubois has a full semester of credits to complete.

In some ways, he doesn’t mind because everything is clicking now.

Sophomore year, his path to graduation looked like a dark, long tunnel. He’s finally seeing the light at the end.

Dubois is quick to admit that year was tough – he was a new student at a new high school where he simply did not want to be. He flunked his classes while moving out of his parent’s home. His aunt, Renda Brooks, who he didn’t know well at the time, became his guardian.

“I despised that school. I could not stand it. So not only was I dealing with the stuff with my mom, but I also was in a school I just genuinely didn’t like,” he said. “I was just kind of losing it.”

Those were major life changes that would be difficult for anyone to deal with, never mind if you are a 15-year-old boy, who in bouts of anger didn’t know how to process his emotions.

It wasn’t until Dubois ended up in the hospital one night that Brooks was given information about FAST Forward, a Medicaid-funded program overseen by the state’s behavioral health division for children.

In essence, FAST Forward is a way for kids to remain in their community – attending school, living at home – while finding necessary resources to address life’s challenges.

Oftentimes mental health services, school counseling or education plans and family support systems are a giant puzzle in New Hampshire – with different pieces lying in each corner of the state, with their own waitlist, intake process and communication system.

FAST Forward provides services for youth with behavior health needs through a team unified by a central coordinator. Rather than a collection of solo services, it’s like an orchestra, said Jennifer Altieri, the regional director for NFI North – which is one of two care management entities that the state contracts with to run the program.

“The facilitator is the conductor and then family peer support has a role, the other people have a role, so they’re each their own instrument,” said Altieri. “We can’t do any of it without each other.”

On Dubois’ team is Brooks as his caregiver, his grandmother, one of his closest friends, a handful of school administrators – including his music teacher Nikki Luciano-Bourgeois – his music therapy provider, a support person for Brooks and his coordinator.

Together, they meet monthly at the public library – where Dubois can talk about frustrations or they can celebrate small wins – and work through a care plan that typically lasts 12 to 18 months.

It was through this team that Dubois was able to access music therapy. It’s not something he, nor his aunt, would have thought of, if it wasn’t for his coordinator initially asking about his interests, strengths and what makes him happy on a day to day basis.

“You get all these people that see him in different facets of his life. All giving advice and brainstorming together,” said Brooks.

Formerly fragmentedsystem

This team approach to youth services is a far cry from what the system used to be. In fact, there was no system or centralized focus on children’s mental health from the state. Susan Stearns knows this to be true, both as a parent and director of the National Alliance for Mental Illness of New Hampshire.

When her own son, who is now an adult, was in the midst of a mental health crisis, it was her problem to solve.

She was the coordinator, scheduler, chauffeur between appointments – and above all, she was also a mother, watching her son face a catastrophic mental health crisis and trying to find solutions to help.

“I’m probably being generous by saying the system was fragmented at that time,” she said.

Stearns was better suited than most to speak up for her son, working in the nonprofit sector and the mental health field. And even then it was hard.

“There was no real cohesive system. I was the conduit between them all,” she said. “I was incredibly isolated. And I had to be a fierce advocate.”

At the time, the state had a 10-year mental health plan through the Department of Health and Human Services that outlined the current system of care in New Hampshire and provided recommendations for improvement. But one key group was missing from this document in 2009 – children.

Now youth are included in the most recent version, which was presented to the governor in 2019.

“As an entire behavioral health community, we’ve learned a lot about what works and what doesn’t and having the commitment to continue to look at that,” said Rebecca Ross, the current bureau chief for Children’s Behavioral Health, which was created in 2016. “So we have a lot more information to work from now.”

Back in 2016, 27 youths were enrolled in FAST Forward. Since then, enrollment in the program has grown exponentially. At the start of 2023, enrollment was at 490.

For parents like Stearns, this individualized care from trained facilitators – and a holistic approach to helping their child – is a night-and-day difference to what many experienced 10 years ago.

Stearns now sees the coordinated care implemented by the Bureau for Children’s Behavioral Health through her work with NAMI-NH. The nonprofit is also a partner in services, providing family peer support for FAST Forward families so they can connect with someone who’s been through the process themselves.

“I know all too well as a parent who’s gone through this, the emotional challenges for a parent going through this are profound,” she said. “On a very personal level, it means a great deal to me.”

Family peer support

There’s nothing that Terri Clyde’s clients can tell her that will be a surprise.

An episode in public? She’s seen it with her own children. Calling the town police in the midst of crisis? Her local department knew her family by name.

As a parent, she helped her son navigate severe mental health challenges. When he returned home from a residential treatment program, they enrolled in FAST Forward to continue his care within the community.

These days, Clyde helps other families navigate this same process as a family peer support specialist with NAMI-NH.

She’ll attend school meetings walking through a student’s individualized education plan. She’ll go to court for moral support. She has a list of providers in the area if families need nutritionists, therapists or other supports. And above all, she’s just gets it.

“I’m able to truly understand what a family feels when their child is in crisis or they feel that people are looking at them strangely or they have a meltdown in the grocery store and they don’t know what to do,” she said. “Nothing is going to bother me, because I’ve been through almost all of it.”

When Clyde’s son first started the FAST Forward program, he had a slew of counselors and appointments. But each operated in their own sphere.

“For us it was amazing because we had people that were working with us, but they were all working in their own little siloed entities,” she said. “In the FAST Forward program, it was great because they brought all those people together to the same table and everybody was on the same page.”

For her son, the team he built through FAST Forward was also a reminder that he had a community of support behind him.

His program formally ended a few years ago. But three years later, his team still checks in monthly with a Zoom call.

In bouts of anger, he used to punch holes in the wall or rip the door off its hinges. Now he’s able to tell Clyde what he needs when these feelings arise.

“We don’t have to call the police or right rapid response very often. So there is hope,” she said.

And that’s something she can tell families. She’s seen the process through start to finish. She knows what it’s like to be overwhelmed trying to access care for a child. And she also knows what it’s like to still feel apprehensive of what’s next.

“It’s not going to be perfect. There’s always gonna be those ups and downs, even after you finish FAST Forward, but now you’ll have the tools,” she said.

Building more resources

Next year, Dubois thinks he’ll going into the trades, perhaps working at the Portsmouth Naval Shipyard. He will soon reach the end of his FAST Forward program – rolling off of regular meetings with his team and coordinator.

For Brooks, it’s reason to celebrate – for their last meeting she envisions a pizza party, commemorating how far her nephew has come.

When Dubois first moved in with his aunt two years ago, it was a reset. Together they built a relationship. His aunt became a central support system. His three cousins, Brooks’ kids, became friends to lean on as well.

Without FAST Forward, both Dubois and Brooks don’t even want to think about what the year would have entailed.

She went into guardianship with Gavin with resolve.

“I’m not leaving this. I’m not leaving him. I’m not gonna give up on this,” she told herself. “But holy cow, just the amount of avenues that you think you know how to navigate, and the pandemic didn’t help anybody, and the fact that so many places just don’t have help or can’t get back to you. … It was really easy to feel like we’re getting nowhere.”

For Brooks and Dubois, FAST Forward broke down what resources were available. The Bureau for Children’s Behavioral Health wants both parents and providers to be able to navigate the landscape of services together.

In June, a Children’s Behavioral Health Resource Center will launch. It’s a new online tool that aggregates multiple services, like a menu of counseling and state programs available for youths and their family, constructed in partnership with the University of New Hampshire’s Institute of Disability.

“A lot of these systems were structurally in place since before there were cell phones and internet. So it makes sense that it’s time to bring them together,” said Ross.

Often, that’s the first barrier to access – just knowing where to start.

In the future, it hopefully won’t take a child’s trip to the hospital in a moment of crisis to connect with programs like FAST Forward. Beyond that, advertising and outreach can encourage others to ask for help.

Clyde knows the benefit of doing so. And now she can start each meeting with clients by giving them credit for doing the same.

“It’s OK to say you need help, and it’s OK to share what you need to share. I spent a lot of years hiding because I was afraid. One day, I realized I can’t help anybody, and no one can help me, if I don’t tell them what’s really going on,” said Clyde. “Once we started FAST Forward and really solidified all of that, he really got support.”