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September 2010
Putting the Pieces Together
By Heather Head

     Mélange Health Solutions provides holistic, community-based, culturally competent mental and behavioral health services that fit Charlotte’s neediest populations, specifically, the young and the underserved. To help a child, they believe in working with the family, the teachers and any others who impact his or her daily life.

     It all began about 10 years ago when Gardner Hawkins left his high-stakes New York financial services position and headed to Charlotte for a job paying $7 an hour. Everyone thought he was crazy, including his wife (who supported him anyway).

     “I was at a crossroads in my life,” Hawkins explains, “asking the question ‘Why am I here—is it just to pay bills?’”

     Hawkins had grown up in a public housing development with his single mother and no contact with his father. His upbringing, business experience and strong Christian faith combined to draw him into the mental health care field, where he could help young people in situations like the one he grew up in.

     He earned a master’s degree in special education with a concentration in emotional-behavioral disabilities from UNC Charlotte and began working for the State of North Carolina’s Vocational Rehabilitation Services, but he yearned to do more.

     He talked to his grandfather, Albert Hawkins Sr., who had inspired him to seek higher education as a child. His grandfather, having owned several small businesses, encouraged his grandson to pursue his entrepreneurial passion.

     “So, I went through the SBA and their loan program, drafted business plans, and did everything in a very conventional way. I began to hear a lot of ‘Nos’, and had to get creative,” Hawkins says.

     He converted a laundry room into an office, and garnered a contract from Mecklenburg Area Mental Health Services. In August of 2000, he obtained his first client.

     “I gave that one client all I possibly could,” he remembers. “And then built that to six, then seven clients and added a part-time employee.”

     At that time the company was called Guiding Shepherd. Between 2005 and 2006, the number of clients exploded. Hawkins brought Thomas Thaggard into the business as a partner and began to build new business strategies, including a name change to Mélange Health Solutions.

     “The word ‘mélange’ means a group of different elements,” explains Hawkins. “It reflects the fact that we approach every case from a holistic point of view, addressing mind, body and spirit with a variety of services and support.”

 

Providing Consumer Choice

     About the same time that Thaggard joined the business, North Carolina changed its health care policies in favor of a consumer choice model. Formerly, the county, as an agent for the Medicaid insurance plan, would assign each client to a mental health provider. Now, Medicaid clients would get to choose their own providers.

     The change created an enormous opportunity for Mélange, so Hawkins and Thaggard invited their friend and former Bank of America co-worker, Mark Brown, to join the company.

     “Prior to consumer choice, there was a preponderance of providers in the network who were not culturally competent—not connected with the particular needs of the population they treated,” Brown explains.

     He chuckles as he remembers the conversation with Hawkins: “We came together and said, ‘Let’s get this straight. We’re going to compete against a bunch of companies that are used to having business handed to them, that don’t know the communities and markets they’re serving, and have never been engaged with their clients except by getting referrals. I think we can do this.”

     Brown’s prediction proved accurate. In 2005, Guiding Shepherd was serving about 50 families; in 2010, that number is closer to 400. Mélange’s revenues roughly approximate $6 million, and they employ 125.

     Last year, they brought in Damon Scott as chief operating officer, and three months ago moved from a small office on South Boulevard to an 8,000-square-foot location on Scaleybark Road. They have an additional office in Durham, and are in the process of expanding into Gaston, Union, and several other counties.

 

Holistic Care

     To address the physical component of mental health, Mélange maintains both a physician and psychiatrist on staff and engages with social services providers. As part of each case management plan, a doctor runs screening tests for potential physical factors. They also address diet, physical environment, and other related issues.

     Hawkins recalls an instance in which a child was refusing to sit, and when he did, he was falling asleep in class. He had been diagnosed with ADHD and prescribed drugs by previous providers, but had failed to improve. The previous therapy had addressed only the child’s behavior, but Mélange’s “mind, body, spirit” approach uncovered the fact that the mother was crack-addicted and the child was waiting up, in a home with no furniture, for her to come home every night.

     Having uncovered the physical contributors to the child’s behavior, Mélange was able to treat the sleep deprivation by working with the mother and providing the child a safe environment in which to sleep at night. They also matched the family with community services that provided furniture for them. Training helped the child to sit for increasingly long periods of time eventually resulting in his being able to cope appropriately in a school environment without the assistance of medication.

 

Community-based Care

     “A lot of people talk about community-based mental health care,” says Brown, “and all they mean is that they have an office that’s easily accessible. That’s not what it means for us.” For Mélange, community-based means that the counselors, case managers, and other staff become directly involved in the client’s community, seeking solutions and providing help wherever necessary to return the client to good physical, mental and emotional health.

     At the beginning of each school season, Mélange’s case managers meet with each client’s family to make a plan. Then they meet with each child’s teacher and learn about classroom routines and management style. They educate the teachers on best practices for each child’s specific needs. Case managers and therapists spend time in the child’s environment, meeting with pastors, family members, and even teammates and playmates, to better understand and treat the client.

 

Cultural Competence

     The company’s emphasis on cultural competence is almost unique among mental health care providers. “A lot of people fall back on credentials and lose the most fundamental aspect of what’s important,” says Scott.   “But the research says that the client-therapist match is the most important ingredient in the success of the relationship. That match has to be there.”

     And it’s not about having a black therapist for a black client, or a white therapist for a white client. “If anything,” says Scott, “my young black client may be more resistant to me because I’m black too. He wants to know where I’m from, my age, why I speak the way I do, where I went to school. Am I authentic. Cultural competence,” he explains, “is about finding out where the client is, who he is, and making a meaningful connection.”

     Scott cites one example where the Mélange therapist successfully treated a child with significant anger management issues by playing basketball. The child was losing his temper and becoming violent primarily in situations with his peers, which posed a danger to his own safety and caused him to become increasingly isolated.

     Other therapists had urged him to avoid certain situations, such as contact sports, since they were such a critical trigger for him. The Mélange counselor, himself a former college basketball player, saw that forbidding sports was not realistic. Instead, following some traditional therapy in the office, he took the child to the basketball court and worked with him in his natural environment.

     “Anybody can act right in the office,” says Brown. “But in his social environment, somebody’s going to elbow him for no reason; in some cases he’s going to have a right to be angry. But that anger is going to increase his isolation and put him at risk. So you have a trained counselor able to navigate that natural environment, go visit him at school during lunch, and help him navigate the very real perils in his daily life.”

     Mélange has two doctors plus additional staff who speak both English and Spanish. They carefully match clients with therapists who work best with that age group, cultural and socio-economic background, and specific issues. They maintain a diverse staff well trained and comfortable in navigating multiple cultural environments.

 

Making It Work

     If the work Mélange does sounds like the realm of a non-profit, that’s because for most providers, it is. Mélange, however, generates enough revenue to fully support its own operations with a revenue stream. Its success is due, in no small part, to the business background of its principals, all of whom worked in banking and financial services.

     Brown says that occasionally other private practices are lured into the business by the fast pay cycle, compared to the 30- to 90-day pay cycle in most industries. But they often fail because they don’t realize how much work goes into the bureaucracy and compliance before they can begin to collect.

     For instance, Medicaid clients can lose their health care coverage very quickly due to minor changes in their lives, so care providers like Mélange must check coverage at every visit. Additionally, it’s possible for the company to invest a large number of resources into a case only to discover months later that the adult who authorized services was not a legal guardian and the payments must be refunded. It takes resources and insight to avoid the many bureaucratic pitfalls.

     In addition, everything the company does is impacted by changes in laws, regulations, and government budgets. The current budgetary crisis resulted in an 8 percent across-the-board payment cut to all mental health service providers, plus additional restrictions on the types of care that are covered by Medicaid.

     As a result, Mélange has had to find new efficiencies, institute pay freezes, and reduce part-time staff. It’s painful, but the principals agree that part of the reason they survive and

thrive is that they are willing to swallow the pain along with their employees. “We never ask our employees to make a sacrifice we’re not willing to make ourselves as leaders of the Mélange organization,” says Brown.

 

Looking Forward

 

     And they are thriving. In the next five years, they expect to begin filling in the populated areas from Fayetteville to Raleigh with Mélange offices. They also expect to expand their services from primarily child and family therapy, to veterans and adults. They have also considered opening assisted living facilities to provide transitional services for adults being released from psychiatric hospitals.

     In addition to their paid services, Mélange leads and participates in many community activities. Their pro bono offerings equal approximately $100,000 annually. They partner with community organizations, schools, the housing authority, and non-profits to provide services that aid families, adults, and children in becoming healthy and self-sufficient.

     The principals of Mélange Health Solutions credit their faith and commitment for success in putting the pieces together—providing holistic, community-based, culturally competent mental and behavioral health services into solutions that fit Charlotte’s neediest populations.

 

 

Heather Head is a Charlotte-based freelance writer.
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