It takes a village to raise a child, and that village becomes critical when a child suffers a significant mental health issue that results in an involuntary hold.

More than 24,000 people under the age of 17 are subject to involuntary holds in Florida, including nearly 2,000 in Broward County, the second-most populous county in the state. For about 500 children, it isn’t their first hold.

When an involuntary hold occurs, a child’s clinical care team, behavioral professionals, and community supports that could help the child and their parents during those 72 hours are often not aware a mental health crisis is unfolding. Lack of support can lead to suboptimal outcomes and reoccurrences caused by not adequately addressing the issue the first time.

Using two health equity grants from Amazon Web Services, the Broward Data Collaborative partnered with Velatura Public Benefit Corporation to develop a proof of concept for a cross-sector data-sharing solution to rally community resources when they are most needed – not weeks afterward. The behind-the-scenes work is complete, and the pilot is ready to begin.

For her role spearheading the critical effort, Shelley Mannino has been named a DirectTrust Interop Hero. Still, Mannino, Velatura’s Vice President of Customer Affairs, quickly deflects any personal praise, naming other public agencies, health IT vendors, and individuals who contributed to this foundational effort.

“Having your health data available to the providers that you, as an individual, want to share it with, technically is not a huge challenge,” Mannino says. “The challenges are: Do we have the infrastructure in place? Do we have the legal agreements in place? And have we considered all of the privacy and aspects to make sure the patient has provided the consent to do so? But, I think we’ve hit on something that could really take off.”

Village of Community Partners

Velatura’s parent organization is the Michigan Health Information Network (MiHIN), which has developed modular and scalable interoperability products and services that are now being used across the country to solve interoperability challenges. Prior to transitioning to Velatura in 2022, Mannino spent an additional eight years as operations VP at MiHIN.

In her role at Velatura, Mannino helps healthcare clients, government entities, and social services agencies nationwide solve their interoperability challenges. The process starts with defining the larger challenge, then whittling away at the obstacles until a clear path forward emerges.

In this instance, that started with significant stakeholders in the Broward Data Collaborative, which included the Children’s Services Council (CSC) of Broward County, Florida Departments of Juvenile Justice and Children and Families, ChildNet, Early Learning Coalition of Broward County, Broward County Public Schools, Broward Behavioral Health Coalition, Broward County Human Services Department, and Broward College. Additionally, CSC had been using a grant from the University of Pennsylvania’s Actionable Intelligence for Social Policy (AISP) to work with local youth, parents, and care team members to define the problem and help inform a solution.

During the research phase, four challenges were identified:

  1. Lack of awareness that a youth had experienced a mental health crisis that resulted in an involuntary hold until well after the event.
  2. Lack of legal infrastructure to facilitate secure data-sharing about a mental health incident.
  3. Lack of technology to share information in a compliant and timely manner.
  4. Potential for recidivism due to lack of timely clinician and community support.

Fortunately, the team discovered that the Florida Health Information Exchange was already using admit, discharge, and transfer (ADT) messaging that could be received by API, VPN, or through Direct Secure Messaging. Those messages can then be transformed using FHIR into a dashboard view. Mannino lauds vendors IDENTOS, NinePatch, Ignyte Group, and Patient Centric Solutions for volunteering time and resources to build the dashboard.

“It’s wonderful to be able to show the community what is possible with the technology that’s available today,” Mannino says.

Looking to Expand After Pilot

Even before the pilot project has been officially implemented, the effort in Broward County to better support youth in crisis has drawn attention from other counties in Florida. There is also talk about other use cases in which the notification system could prove useful.

The overall goal, Mannino says, is to let youth and their parents know they aren’t alone at a time of crisis. “It’s an incredibly unique model that our legal workstream has developed — first and foremost, having it be family-oriented,” she says. “The process can be so overwhelming for a family. How can we use this opportunity to help that family know, ‘You are supported in this time of crisis. We are here for you. This must be terrifying, but here are some things that are available to you in the community that can help you so that in three days, when your youth is released back out into the community, you have a support system already in place to be able to continue on a healthy trajectory as opposed to having another crisis a few months from now.’”

Mannino stresses that, although this is a technology solution, it could not have been devised without active involvement of many people from different community sectors, as well as technology partners.

“I think Sue Gallagher (Chief Innovation Officer) and Carl Dasse (Senior Data Systems and Evaluation Manager) of the Children’s Services Council of Broward County and Silvia Quintana (CEO) of the Broward Behavioral Health Coalition share this honor with me by all means,” Mannino says. “They’re the true heroes for providing their resources, their guidance, their support, their network, to be able to create and facilitate an environment where we can really collaborate across sectors.”