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Programs & Projects

Title of Program or Project

ACCESS Mental Health CT

Web Site URL

http://accessmhct.com

Services

  • PCP education
  • PCP consultation
  • Care coordination
  • Patient/family education/self-management
  • Other

Service Site

  • Remote (phone or electronic)

Service Area

  • State-wide

Geographic Population

  • Urban
  • Suburban
  • Rural

Service Provider

  • Child & adolescent psychiatrist
  • Social worker
  • Other mental health professional
  • Other

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • State

Program or Project State

Connecticut

Program or Project Description

ACCESS Mental Health CT is a state funded program created to ensure that all youth under 19 years of age, irrespective of insurance coverage, have access to psychiatric and behavioral health services through contact with their primary care providers (PCPs). The program provides telephonic psychiatric curbside consultation to support PCPs in identifying and treating children with behavioral health issues.

Beacon Health Options contracts with three behavioral health organizations to act as Hub teams to provide support across the state. Each Hub team consists of board-certified child and adolescent psychiatrists, a behavioral health clinician, a program coordinator, and a half-time family peer specialist.

The primary function of the model is to provide real-time psychiatric consultation and individualized, case-based education to PCPs over the phone. Phone conversations may entail diagnostic clarification, psychopharmacology recommendations, counseling recommendations and support in connecting to community resources. The key feature is the immediate availability of a child and adolescent psychiatrist to support the PCP. A small, seasoned team of behavioral health specialists is also an important element helping to foster trusted relationships and rapport. Phone consultations can result in face-to-face assessment between patients and Hub staff for a one-time consultation with the psychiatrist or consultation with the Hub team therapist. In addition to phone based consultations, the Hub teams provide office based behavioral health training for enrolled PCPs and their practice staff.

Program or Project Leadership

Elizabeth Garrigan, LPC, Statewide Program Director, Beacon Health Options

Program or Project Evaluation

Reports are prepared by Beacon Health Options and submitted to Connecticut's Department of Children and Families on a quarterly and annual basis and can be found under the resources section on our website at: http://www.accessmhct.com

Second annual progress report

Program or Project Successes

In the first two years of programming (June 16, 2014 - June 30, 2016):

  • 83% of pediatric and family care practices with over 1,500 prescribing physicians enrolled statewide
  • 69% of enrolled practices used the program at least once since inception
  • Over 11,000 consults were provided supporting over 2,300 unique youth and their families
  • PCP satisfaction rate remains at 4.9 out of 5

Program or Project Curricula/Materials

Mental Health Toolkit

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Elizabeth Garrigan

elizabeth.garrigan@beaconhealthoptions.com

Title of Program or Project

Adolescent Behavioral Health (ABH) Project

Web Site URL

http://www.pamf.org/giving/needs/mentalhealth.html

Services

  • PCP education
  • PCP consultation
  • Care coordination
  • Patient/family education/self-management
  • Other

Service Site

  • Primary care clinic
  • Other

Service Area

  • Community

Geographic Population

  • Suburban

Service Provider

  • Advanced practice nurse
  • Child & adolescent psychiatrist
  • Social worker
  • Other mental health professional

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Adolescent
  • Parents
  • Family

Funding

  • Foundation
  • Other

Program or Project State

California

Program or Project Description

The Adolescent Behavioral Health (ABH) Project is a 5 year, grant funded program which is a joint venture between Mills-Peninsula Health Services and the Palo Alto Medical Foundation, partners in Sutter Health's Bay Region in Northern California. The project is both a quality improvement (clinical services) and a research program. The project components (enhanced usual care/resource categorization, distribution and training, behavioral health navigation, care management) are designed to integrate mental health into the primary care setting and expand community partnerships; and contribute to burgeoning research on mental disorders and integrated primary care.

Program or Project Leadership

Daniel Becker, MD, Medical Director, Behavioral Health, Mills-Peninsula Health Services

Kimberly Erlich, MSN, RN, MPH, CPNP, CPMHS
Project Coordinator and Pediatric Nurse Practitioner

Amy Heneghan, MD
Pediatrician

Ming Tai-Seale, PhD, MPH
Senior Scientist

Program or Project Evaluation

Palo Alto Medical Foundation Research Institute

Program or Project Successes

Project has potential to serve the >100,000 adolescent patients who receive their primary care within the Palo Alto Medical Foundation. This population represents a diverse base drawing from over four Bay Area Counties.

Our Navigation component has processed >3700 referrals within the first 2.5 years of operation.

Program or Project Challenges

Data collection

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Kimberly Erlich

erlichkj@sutterhealth.org

Title of Program or Project

Adolescent Behavioral Health Home Plus Model

Web Site URL

http://www.ccbh.com

Services

  • PCP education
  • PCP consultation
  • Care coordination
  • Patient/family education/self-management
  • Other

Service Site

  • Specialty clinic
  • Community health center
  • School/child care
  • Other

Service Area

  • Community
  • State-wide
  • Other

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Physician assistant
  • Adult psychiatrist
  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker
  • Mental health counselor
  • Substance abuse counselor
  • Other mental health professional
  • Medical student
  • Other

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Adolescent
  • Parents
  • Family

Funding

  • State
  • County
  • Medicaid
  • Other

Program or Project State

Pennsylvania

Program or Project Description

Community Care Behavioral Health Organization is a behavioral health managed care company founded in 1996; part of UPMC and headquartered in Pittsburgh. It is a federally tax exempt non-profit 501(c) (3) with major focus is publicly-funded behavioral health care services; currently doing business in PA and NY. It is licensed as a Risk-Assuming PPO in PA; NCQA- Accredited Quality and Disease Management Programs. Community Care serves over 1.6 million individuals in 39 counties through a statewide network of over 1,800 providers. Community Care has created a comprehensive model of addressing physical health and wellness within the context of providing behavioral health care to individuals who have serious emotional disturbances. The Adolescent Behavioral Health Home Plus ( A- BHHP) model enhances the capacity of behavioral health providers to help individuals and their families to identify physical health and wellness challenges and to become better informed, more effective managers of their overall health. Community Care Behavioral Health utilizes the IHI (institute of healthcare improvement) learning collaborative implementation model to provide training in wellness coaching, member portal training, self-management toolkits and psychiatrist training. The model uses a modified version of a wellness coaching model developed by Peggy Swarbick, PhD focused on 8 domains of wellness including the physical health domain. Case managers and clinical team members serve as “health navigators”. In several of the agencies, registered nurses work as a “wellness nurse” assisting individuals and their families on coordinating their care, enhancing communication between providers, and providing wellness support and education to individuals and consultation to health navigators. The providers also use school nurses and lead health navigators to function as “wellness nurses/leads”. The service provider includes a “Virtual Team”: Individual and their family; Psychiatrist and other mental health clinicians; Wellness Nurse and Lead Health Navigator; health navigators; Primary Care provider; and Community Care Behavioral Health specialized care manager. The sevice recipients are Medicaid recipients, ages 14 to 20 years enrolled with Community Care Behavioral Health Organization and are receiving behavioral health services with a participating provider.

Program or Project Leadership

Suzanne Daub LCSW, Senior Director Physical Health Behavioral Health Integration ( PH-BH); David Dan LCSW, Senior Director, Children's Services; Melissa Michael RN, licensed pro care manager PH- BH; Leslie Washington LCSW, Director, PH-BH; Joel Brecht LPC, care manager, Children's Team; Kate Nicholson LCSW, Manager, Children's Team; Lyndra Bills MD, Regional Medical Director; Jaspreet Brar MD, Senior Fellow, Department of Psychiatry; Gail A. Edelsohn MD MSPH, Senior Medical Director, Quality; Vicki Martin MD, Regional Medical Director.

Program or Project Evaluation

Nine community based children's service providers are participating in a Learning Collaborative that supports implementation and assessment. An initial face to face learning session was held on November 17, 2015 with a second one held June 10, 2016.

Learning Collaborative Process Aims:

Process Aim 1: Wellness: By October 2016, 80% of participating adolescents will have documented physical and behavioral health coordination, including reciprocal communication between the BH Team and medical providers via letter, telephone contact, or personal visit.

Process Aim 2: Assessment: By October 2016, 80% of participating adolescents will have a completed physical health assessment with documented review by the psychiatrist or other prescriber.

Learning Collaborative Outcome Aims:

Outcome Aim 1: Involvement

By October 2016, 80% of participating adolescents will report being highly involved (rated a 9 or 10) in working with their behavioral health service provider on physical health and wellness as measured by a 10-point involvement question Providers/members will complete the question on a quarterly basis.

Outcome Aim 2: Confidence

By October 2016, 80% of participating adolescents will report being highly confident (rated a 9 or 10) in their ability to manage their physical health and wellness as measured monthly by a 10-point confidence question

Providers/members will complete the confidence question a quarterly basis.

Program or Project Successes

For the second quarter (March 2016-June 2016) as a collaborative 32.4% of individuals met Process Aim 1: Reciprocal Communication, 27.7% met Process Aim 2: Assessment, 33.9% met Outcome Aim 1: Involvement and 28.8% met Outcome Aim 2- Confidence. There has been 100% call attendance and 100% of monthly PDSA (Plan Do Study Act) submission. There is strong engagement by members and their families. Physical Health and wellness concerns become routine part of resiliency plan. CSBBH and case managers partner with nurses to address PH concerns.

Program or Project Challenges

  • Implementing Population Management
  • Ongoing Psychiatrist/Prescriber Involvement
  • Need for EMR (electronic medical records)
  • Some provider not having computer access
  • Staff turn-over and the need for additional wellness coach training
  • Provider and Member commitment to a new Wellness Culture

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Melissa Michael

michaelm@ccbh.com

Title of Program or Project

Behavioral Health Integration Program (BHIP)

Web Site URL

Services

  • PCP education
  • PCP consultation
  • Care coordination
  • Telepsychiatry
  • Integrated therapy
  • Operational support for behavioral health integration

Service Site

  • Primary care clinic
  • Remote (phone or electronic)

Service Area

  • State-wide

Geographic Population

  • Urban
  • Suburban
  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Developmental behavioral pediatrician
  • Other medical professional
  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker

Service Recipient

  • Pediatrician/adolescent medicine
  • Advanced practice nurse
  • Physician Assistant
  • Psychologist
  • Social Worker
  • Mental health counselor
  • Other

Funding

  • Other
  • Boston Children’s Hospital Payer Provider Quality Initiative

Program or Project State

Massachusetts

Program or Project Description

The Behavioral Health Integration Program (BHIP) is an initiative of the Pediatric Physicians' Organization at Children's (PPOC) and the Boston Children's Hospital (BCH) Department of Psychiatry. The BHIP includes participants from more than 90 pediatric primary care practices across Massachusetts, which include over 400 primary care providers, who care for more than 350,000 children and adolescents state-wide.

The BHIP initiative has three core components: (1) a learning community for the multi-disciplinary, practice-based, BH team (PCPs, BH therapists, care coordinators), (2) access to clinical and business consultation to support full BH integration, and (3) access to real-time psychiatric consultation. The two-year, 44-hour learning community course delivers sequenced clinical and operational training to participating practices. Content aims to support advances in the BH team’s knowledge and skills in assessing and managing mild to moderate presentations of common child and adolescent psychiatric disorders (attention-deficit/hyperactivity, anxiety, depressive, disruptive behavior, autism spectrum, substance-related, and stress- and trauma-related disorders). Formal education is supplemented by bi-monthly televideo clinical case conferences. The learning community delivers a total of 36 hours of Harvard Medical School-accredited CME to participating PCPs each year, and provides an advanced learning series for course “graduates.” Individualized operational and clinical consultation to each practice facilitates practice transformation and the integration of BH providers in the medical home. The CAP consultation component delivers rapid-response, telephonic consultation with a Boston Children’s Hospital (BCH) CAP to providers in the medical home. All education and consultation aims to extend the capacity of the medical home team to support the management of patients with BH needs, including: screening, assessment, brief therapy, and pharmacologic management; ongoing co-management of the patient; and referral to the specialty care setting as indicated.

Recent additions to the BHIP program are (1) telepsychiatry services to support the assessment and co-management of children and adolescents with serious psychiatric disorders who reside in under-resourced communities, and (2) integration of specialized substance abuse treatment services in the medical home.

Program or Project Leadership

Heather Walter, MD, MPH, Medical Director, Behavioral Health, Pediatric Physicians' Organization at Children's (PPOC) and Boston Children’s Hospital (BCH) Department of Psychiatry

Jonas Bromberg, PsyD, Behavioral Health Integration Program (BHIP) Manager, PPOC and BCH Department of Psychiatry

Oscar Bukstein, MD, MPH, BHIP Educator and Telepsychiatrist, BCH Department of Psychiatry

Paul Hammerness, MD, BHIP Educator, BCH Department of Psychiatry

Ellen Goodman, LICSW, BHIP Manager of Integration and Clinical Support, PPOC and BCH Department of Social Work

Jessica Barton, LICSW, BHIP Manager of Integration and Clinical Support, PPOC and BCH Department of Social Work

Program or Project Evaluation

Primary hypothesized outcomes being assessed include 1) increased identification of youth with BH problems through universal screening with a standardized rating scale; 2) specialty to primary care task-shifting (measured in PCP office visits for BH problems, practice-based psychotherapy office visits, psychotropic prescribing by PCP) for the assessment and management of mild to moderate psychiatric disorders; 3) increased use of empirically-supported psychotropic medications when indicated; 4) decreased BH utilization of the emergency department; 5) decreased total medical expense; and 6) patient and provider satisfaction with integrated care.

Program or Project Successes

Successes include 1) rapid scaling of Learning Community and CAP consultation across the state; 2) high provider participation in learning and consultation activities; and 3) favorable results across all outcomes assessed.

Program or Project Challenges

Challenges include: 1) scaling of integration of BH clinicians across all practices due to recruitment, credentialing, contracting, and revenue issues; 2) scaling of outcome measurement across a broader range of domains (e.g., symptomatic and functional improvement of patient; experience of care by patient and family) across all practices; 3) variation across practices in electronic medical record systems giving rise to challenges in systematic data collection; and 5) variation in the ability to retrieve billing data from all carriers.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Enhancing Pediatricians' Behavioral Health Competencies Through Child Psychiatry Consultation and Education.
Walter HJ, Kackloudis G, Trudell EK, Vernacchio L, Bromberg J, DeMaso DR, Focht G. Clin Pediatr (Phila). 2017 Oct 1:9922817738330. doi: 10.1177/0009922817738330. [Epub ahead of print] PMID: 29082768

Other Publications

Contact Name

Heather Walter, MD, MPH

Heather.walter@childrens.harvard.edu

Title of Program or Project

BeHiP (Behavioral Health in Pediatrics)

Web Site URL

http://www.tnaap.org/behip

Services

  • PCP education
  • PCP consultation
  • Care coordination
  • Other

Service Site

  • Primary care clinic
  • Remote (phone or electronic)

Service Area

  • Community

Geographic Population

  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Child & adolescent psychiatrist
  • Psychologist
  • Other

Service Recipient

  • Pediatrician/adolescent medicine

Funding

  • Commercial insurance

Program or Project State

Tennessee

Program or Project Description

There have been 3 phases of the BeHiP project. The first two phases were comprised of regionally held interactive educational sessions that taught providers (primarily pediatricians) how to speak with families about behavioral health concerns, screen for behavioral health conditions, make appropriate referrals to regional agencies, be aware of trauma and ACEs, and prescribe appropriate psychopharmacologic agents. Information taught in these two phases was converted to on-line educational modules. The third phase involves the development of a learning collaborative between pediatricians who care for children in foster care and their regional Center of Excellence for children in foster care. These physicians will participate in an intensive 1-day training that covers the content of the first two phases in greater depth and be connected with representatives from area agencies that can provide assistance in caring for their patients in foster care. T his will be followed by monthly video conferences that will connect the pediatricians with a pediatric/adolescent psychiatrist, as well as representatives from local DCS, BCBS, and area mental health services. The aim of the collaborative is to create a comprehensive system of care for children in foster care and to form a network of pediatricians who provide a higher level of care for this fragile population. Providers will also be taught proper coding for behavioral health and care coordination. Participating physicians will also be eligible to earn MOC part 4 credit.

Program or Project Leadership

This project is funded by a grant from BCBS BlueCare and created by the Tennessee Chapter of the American Academy of Pediatrics. Michelle Fiscus, MD FAAP is the medical director of the program. Heather Smith is the program coordinator. Michelle Fiscus, MD FAAP, Quentin Humberd, MD FAAP, Deborah Gatlin, MD, and Patty Van Eyes, PhD were content contributors.

Program or Project Evaluation

The first 2 phases were well-received by their participants (based on survey results). The third phase is in its early stages. Evaluation of this third phase will include surveys to assess change in practice culture, as well as data collected through TNAAP's quality improvement collaborative, PHiiT (Pediatric Health Improvement Initiative for Tennessee). We hope to demonstrate a decrease in inappropriate use of medication, improved f/u of patients in foster care, improved screening rates for trauma and behavioral health concerns, and improved rates of appropriate referral.

Program or Project Successes

Thus far the first two phases of BeHiP have been well-received by hundreds of participating providers. The providers who have been recruited to participate in the learning collaborative are extremely enthusiastic as there is great need for improved behavioral health services in this very rural area of the state.

Program or Project Challenges

As with most behavioral health initiatives, inability to obtain appropriate payment for services and limited access to mental health specialists are huge barriers to success.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Michelle Fiscus

shelley.fiscus@tnaap.org

Title of Program or Project

Boston Children's Hospital Psychosomatic Collaborative Services

Web Site URL

Services

  • Co-located therapy
  • Co-located psychopharmacology
  • Patient/family education/self-management
  • Other

Service Site

  • Specialty clinic
  • Hospital

Service Area

  • Community
  • State-wide
  • National

Geographic Population

  • Urban
  • Suburban

Service Provider

  • Child & adolescent psychiatrist
  • Psychologist

Service Recipient

  • Pediatrician/adolescent medicine
  • Advanced practice nurse
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Foundation
  • Other

Program or Project State

Massachusetts

Program or Project Description

The Boston Children's Hospital Psychosomatic Collaborative Services represent the psychologists and psychiatrists who provide psychiatry clinical services, training, and research through other BCH Departments or Institutions. These staff members have been co-located in these Departments/Programs for nearly 3 decades providing integrated BH services. Currently, there are 74 psychologists and 3 child psychiatrists embedded in: 1) Department of Anesthesia (Pain Treatment Service); 2) Department of Cardiology (Cardiac Neurodevelopment Program); 3) Department of Medicine (Adolescent Medicine & Young Adult Division, Adolescent Substance Abuse Program; Children's Hospital Primary Care Center, Developmental Medicine Center, GI and Nutrition, Infant Follow-up Program, Gender Management Clinic; 4) Department of Neurology; and 5) Department of Otolaryngology (Hard of Hearing-Deafness Program); and 5) Solid Organ Transplant.

Program or Project Leadership

Eugene D'Angelo, PhD and David R DeMaso, MD

Program or Project Evaluation

Program or Project Successes

Each program has had numerous trainees as well as peer reviewed academic publications and grant funding in their specific areas.

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

David DeMaso

david.demaso@childrens.harvard.edu

Title of Program or Project

CapitalCare Pediatrics Troy

Web Site URL

http://www.capcare.com/find-a-doctor/CapitalCare-Pediatrics-Troy_18-location.htm

Services

  • Co-located therapy
  • Care coordination

Service Site

  • Primary care clinic

Service Area

  • Community

Geographic Population

  • Urban
  • Suburban
  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Developmental behavioral pediatrician
  • Physician assistant
  • Social worker
  • Mental health counselor
  • Other mental health professional

Service Recipient

  • Child
  • Parents
  • Family

Funding

  • Commercial insurance

Program or Project State

New York

Program or Project Description

General pediatric medical home with emphasis on children with special needs. Our practice has our mental health counselor and also co located therapists from Unified Services, the mental health program for our county. We have rapid access to child psychiatry and high level case services where needed. This model has been successful for 5 years.

Program or Project Leadership

Anthony Malone M.D.

Program or Project Evaluation

Multiple articles, presentations, book

Program or Project Successes

Very early identification of socio-emotional-behavioral issues with directed short term interventions. High need psychiatric issues treated rapidly and with high level care. High level of family satisfaction.

Program or Project Challenges

Reimbursement for mental health services is poor.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Anthony Malone M.D.

amalone@capcare.com

Title of Program or Project

Child Trauma Training Center (CTTC)

Web Site URL

Services

  • PCP education
  • Care coordination

Service Site

  • Primary care clinic
  • Other

Service Area

  • Community
  • State-wide

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant
  • Other

Service Provider

  • Pediatrician/adolescent medicine
  • Other medical professional
  • Psychologist
  • Mental health counselor
  • Other mental health professional

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Federal

Program or Project State

Massachusetts

Program or Project Description

The University of Massachusetts Medical School (UMMS) Department of Psychiatry proposes to maintain, expand, and enhance the Child Trauma Training Center (CTTC) with the aim of improving identification of childhood trauma, increasing trauma responsiveness among youth-serving professionals, and expanding access to evidence-based practices (EBPs), including the dissemination of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), the EBP with the strongest research on effectiveness for childhood trauma. CTTC's population of focus will be children and adolescents (including transition-age youth) who have been exposed to trauma, ages 0-21 years, throughout the Commonwealth of Massachusetts (MA). Our priority population is Court-Involved Youth (CIY) and the project will focus its efforts on the most underserved and high risk groups within CIY and across our population of focus: transition-age youth, youth with substance abusing parents, lesbian, gay, transsexual, bisexual, and questioning (LGTBQ) youth, commercially sexually exploited children (CSEC), and youth in military families. CTTC has three primary goals: (1) To provide trauma-informed care (TIC) training to develop, enhance, and strengthen the capacity of 10,600 front-line youth-serving professionals (e.g., within pediatrics, courts and other local and state agencies) to identify, screen and/or assess for childhood trauma, to implement trauma-responsive practices, and to provide referrals to EBPs; (2) To strengthen and enhance an innovative and EBP neutral, statewide Centralized Referral System (LINK-KID) to improve access to care for traumatized youth by providing referrals, statewide, to EBPs for approximately 4,000 youth during the grant period; and (3) To provide TF-CBT to youth ages 3-21 by training clinicians statewide through intensive learning communities. These efforts will be informed by advances in implementation science and include specialized trainings for clinicians working with CTTC's priority and underserved populations, a TF-CBT pilot for transition-age youth (18-21 years), and a pilot of TF-CBT Prep, a short-term service to support and engage youth and families until they are able to receive full EBP treatment services. CTTC will train 600 mental health providers from mental health agencies, all 12 Children's Advocacy Centers in MA, and School Based Health Centers, ultimately providing TF-CBT to 6,520 youth. The CTTC evaluation will include a comprehensive external implementation and outcome study, examining outcomes for 1,520 youth and families receiving TF-CBT. CTTC will utilize NCTSN products and SAMHSA's Ten Guiding Principles of Recovery across all training and treatment efforts. The project will provide leadership, training, and products for underserved populations to the NCTSN. CTTC will continue to serve as a unifying hub for NCTSN sites in MA and New England by connecting Category II and III sites thro ugh LINK-KID and by linking families to EBPs disseminated by NCTSN sites. Taken together, CTTC's efforts will provide trauma-informed services across multiple systems and impacting 50,000 youth annually and 250,000 youth throughout the life of the project.

Program or Project Leadership

PI: Jessica Griffin, PsyD., Assistant Professor of Psychiatry and Pediatrics, University of Massachusetts Medical School, Department of Psychiatry

Collaborators:

Heather C. Forkey, MD, Associate Professor of Pediatrics, University of Massachusetts Medical School, DIvision Director, Child Protection Program

Genevieve Kane-Howse, LMHC, Project Director Child Trauma Training Center, University of Massachusetts Medical School, Department of Psychiatry

Jessica Dym Bartlett, MSW, PhD|Senior Research Scientist, Child Welfare & Early Childhood Development, Child Trends

Program or Project Evaluation

Pending, start 10/1/16

Program or Project Successes

Pending, start 10/1/16

Program or Project Challenges

Pending, start 10/1/16

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Heather Forkey

heather.forkey@umassmemorial.org

Title of Program or Project

Children's Hospital of Pittsburgh/Children's Community Pediatrics Behavioral Science Division

Web Site URL

http://www.chp.edu/our-services/behavioral-healthww

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Telepsychiatry
  • Patient/family education/self-management
  • Other

Service Site

  • Primary care clinic
  • Specialty clinic
  • Hospital
  • Community health center
  • Remote (phone or electronic)
  • Other

Service Area

  • Community
  • State-wide

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant

Service Provider

  • Pediatrician/adolescent medicine
  • Developmental behavioral pediatrician
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker
  • Mental health counselor
  • Substance abuse counselor
  • Other mental health professional
  • Medical student

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Commercial insurance

Program or Project State

Pennsylvania

Program or Project Description

Children's Hospital Behavioral Science Division/Children's Community Pediatrics Behavioral Health Service is a collaboration of Children's Hospital of Pittsburgh, Children's Community Pediatrics, and Western Psychiatric Institute and Clinic. We provide services to children and adolescents throughout Western Pennsylvania and beyond. We have over 40 licensed therapists and 5 child and adolescent psychiatrists working alongside over pediatrician primary care clinicians/specialists in Children's Community Pediatrics and Children's Hospital of Pittsburgh

Program or Project Leadership

Ken Nash, MD Vice Chair Chief of Clinical Services Western Psychiatric Institute and Clinic
Vice Chair for Clinical Affairs Department of Psychiatry
Martin Lubetsky MD, Chief Behavioral Science Division, Children's Hospital of Pittsburgh
Abigail Schlesinger MD, Clinical Director Behavioral Science Division, Children's Hospital of Pittsburgh
Jennifer Dee MHA, Vice President of Ambulatory Services, Western Psychiatric Institute and Clinic
Sheri Goldstrohm PhD Director of Ambulatory Services, Children's Hospital of Pittsburgh
Monique Jackson MA, Director, Ambulatory Services- Behavioral Health Children's Hospital of Pittsburgh of UPMC

Program or Project Evaluation

Program or Project Successes

Bronze Award at the Fifth Annual Fine Awards for Teamwork Excellence in Health Care
Sponsored by The Fine Foundation and the Jewish Healthcare Foundation (JHF)

Hospital Association of Pennsylvania Award in Patient Care Early Access to Integrated Behavioral Health Services in the Pediatric Medical Home Innovation Award Early Access to Integrated Behavioral Health Services in the Pediatric Medical Home

American Psychiatric Association Achievement Award: Silver Early Access to Integrated Behavioral Health Services in the Pediatric Medical Home

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Abigail Schlesinger

schlesingerab@upmc.edu

Title of Program or Project

Children's Mental Health Resource Center

Web Site URL

http://www.mentalhealth4kids.org

Services

  • Patient/family education/self-management

Service Site

  • Hospital

Service Area

  • State-wide

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant
  • Other

Service Provider

  • Child & adolescent psychiatrist
  • Social worker

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • County
  • Foundation

Program or Project State

Virginia

Program or Project Description

Our family navigators provide information and support to parents and providers in navigating the children's mental health services system. Our searchable database of nearly 500 Virginia child mental health service providers allows us to serve as a "GPS" for families seeking services. Both families and providers can call our Resource Center at 804-828-9897 for help. We also have agreements with nearly 100 local PCP offices who refer their patients and families to us for support and referral assistance. We also provide pediatric PCP consultations to help PCPs feel more comfortable with medication management for their patients, as there is a shortage of psychiatrists and long waitlists for psychiatry services.

Program or Project Leadership

Administrative oversight for the program is provided by the Virginia Treatment Center for Children (VTCC). The Virginia Treatment Center is the Child and Adolescent Division of the VCU Department of Psychiatry and a service under the Children's Hospital of Richmond at VCU (CHoR). A program manager oversees staff and day-to-day operations of the program.

Program or Project Evaluation

Our success is measured in a multitude of ways and on an on-going basis. We conduct follow up calls and satisfaction surveys with each family to see if they were able to access care and if they liked the provider. We also survey families on their experience to ensure we are meeting their needs.

Program or Project Successes

We serve 1700 providers and families each year, helping them find appropriate, available mental health services for their children and patients.

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Sharon Alexander

sharon.c.alexander@vcuhealth.org

Title of Program or Project

Crystal Run Healthcare MHAT (Mental Health Assessment Team)

Web Site URL

http://www.crystalrunhealthcare.com/

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Telepsychiatry

Service Site

  • Primary care clinic
  • Other

Service Area

  • Community

Geographic Population

  • Urban
  • Suburban
  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker
  • Substance abuse counselor

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Medicaid
  • Commercial insurance
  • Other

Program or Project State

New York

Program or Project Description

Patients are referred to the Mental Health Assessment Team (MHAT) by the Primary Care Provider. The team consists of a Care Manger, Primary Care Provider, consulting Psychiatrist, and the patient/family. This team provides direct communication to the Primary Care Provider and the patient regarding treatment recommendations, managing side effects, diagnostic clarity, psychoeducation, etc. Please use to the contact below for additional information.

Program or Project Leadership

Gail Schonfeld, MD,FAAP

Program or Project Evaluation

Program or Project Successes

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

https://www.ncbi.nlm.nih.gov/pubmed/25617247

Other Publications

Contact Name

Nicholas Batson, MD

nbatson@crystalrunhealthcare.com

Title of Program or Project

DC Collaborative for Mental Health in Pediatric Primary Care

Web Site URL

http://www.dcmap.org/about/dc-collaborative-for-mental-health-in-pediatric-primary-care/overview/

Services

  • PCP education
  • Other

Service Site

  • Other

Service Area

  • State-wide

Geographic Population

  • Urban
  • Inner city

Service Provider

  • Other

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Other

Funding

  • State
  • Foundation
  • Other

Program or Project State

District of Columbia

Program or Project Description

The DC Collaborative for Mental Health in Pediatric Primary Care aims to improve the integration of mental health in pediatric primary care for children in the District of Columbia. Children's National is the administrative home for this city-wide, public-private initiative, which is aimed at supporting health care providers and families, and affecting change in public policy. Although this is a comprehensive push to meet the needs of all youth, the Collaborative is most focused on early diagnosis and intervention, and thus has a special interest in early childhood mental health.

Program or Project Leadership

Director: Lee Beers, MD
Assistant Director: Leandra Godoy, PhD
Program Manager: Sarah Barclay Hoffman, MPP

Program or Project Evaluation

We aim to evaluate specific project initiatives, such as our Quality Improvement Learning Collaborative (manuscript under review).

Program or Project Successes

  • Child & Adolescent Mental Health Resource Guide: The goal of this comprehensive resource guide is to increase pediatric provider knowledge of community-based mental health resources to which they can refer their patients and families: http://www.dchealthcheck.net/resources/healthcheck/mental-health-guide.html
  • Quality Improvement Mental Health Screening Learning Collaborative: The DC Collaborative led a 15-month web-enabled QI Learning Collaborative aimed at improving mental health screening practices. Screening rates among the participating practices increased from 1% at baseline to 74% by project’s end.
  • Development and Oversight of DC MAP (Mental Health Access in Pediatrics): The DC Collaborative provided the infrastructure and planning support to launch DC MAP, the District’s child mental health consultation program. Additionally, the DC Collaborative successfully advocated for local legislation to support DC MAP (http://lims.dccouncil.us/Download/31208/B20-0676-Introduction.pdf)
  • Toolkit for Pediatric Providers on Trauma-Informed Care: The DC Collaborative developed a toolkit to support primary care pediatricians in providing trauma-informed care.

Program or Project Challenges

Our main challenge is ensuring continued funding to make efforts sustainable and to ensure that efforts are well-coordinated with ongoing work in the city.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Leandra Godoy

lgodoy@childrensnational.org

Title of Program or Project

DC MAP (Mental Health Access in Pediatrics)

Web Site URL

http://www.dcmap.org

Services

  • PCP education
  • PCP consultation
  • Care coordination

Service Site

  • Hospital
  • Remote (phone or electronic)

Service Area

  • State-wide

Geographic Population

  • Urban
  • Inner city

Service Provider

  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker
  • Other

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family
  • Other

Funding

  • State

Program or Project State

District of Columbia

Program or Project Description

The goals of DC MAP are to: Increase collaboration between pediatric primary care providers and child mental health specialists; Promote mental health within primary care; Improve the identification, evaluation and treatment of child mental health problems; and Promote the rational utilization of scarce specialty mental health resources for the most complex and high-risk children.

DC MAP provides the following services: Primary care clinician telephone consultation with child mental health specialists (within 30 minutes, M-F 9am-5pm); Community resource referrals and face-to-face consultations as clinically indicated; Mental health education and training in primary care; Child mental health resource guide maintenance (http://dchealthcheck.net/resources/healthcheck/mental-health-guide.html); and Quarterly medication reviews flagged by the Psychotropic Monitoring Group.

DC MAP is staffed collaborative by Children's National Health System and Georgetown University Hospital. Directed by Dr. Lee A. Savio Beers, a general pediatrician, the DC MAP interdisciplinary team includes child psychiatrists, psychologists, licensed clinical social workers and a care coordinator.

Program or Project Leadership

Director: Lee Beers, MD
Assistant Director: Leandra Godoy, PhD
Georgetown Clinical Team Director: Jeffrey Bostic, MD
Children's National Clinical Director: Lisa Cullins, MD

Program or Project Evaluation

We regularly evaluate basic aspects of program functioning and success (e.g., number of encounters with PCPs), though are in the process of completing a more rigorous evaluation of the program.

Program or Project Successes

Feedback from pediatric providers who have used DC MAP has been highly positive (e.g., "Speaking with the psychiatrists from DC MAP has helped me manage patients with difficult mental health diagnoses who otherwise wouldn't get care. They have been a game-changer for me as a primary care pediatrician!" and noting that DC MAP is "the best thing that happened to pediatrics in DC in 10 years!"). Within the first 16 months of starting the program, over 300 encounters with DC MAP had been initiated.

Program or Project Challenges

We face challenges in the following key areas: 1) How best to engage and support PCPs, particularly in making regular use of DC MAP and the full array of professionals on the DC MAP team. For example, most of our callers are interested in care coordination resources with approximately one third expressing interest in psychiatric consultation and less than 5% expressing interest in consultation with the psychologist or social worker. We are also seeking new ways to increase engagement among smaller practices within the District. 2) How to better connect families in need of community-based services with those supports. We find that many of the families we refer to community based mental health providers have difficulty accessing these services for a variety of reasons. Thus, we are piloting ways to better support families in this process, such as use of family navigators.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Leandra Godoy

info@dcmap.org

Title of Program or Project

East End Pediatrics, P.C.

Web Site URL

Services

  • PCP education
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Telepsychiatry

Service Site

  • Primary care clinic

Service Area

  • Community

Geographic Population

  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Child & adolescent psychiatrist
  • Social worker

Service Recipient

  • Child
  • Adolescent
  • Parents

Funding

  • Foundation
  • Medicaid
  • Commercial insurance

Program or Project State

New York

Program or Project Description

Several part time social workers, and a part time pediatric/adolescent psychiatrist have been hired by a small private pediatric practice to work on site as employees of the practice to service the mental health needs of the patients of the practice. The group meets monthly to review patients and develop the program. The social workers make house calls as needed and they, as well as the psychiatrist provide telehealth visits also on an as needed basis. The scheduling, billing and credentialing are managed by the pediatric practice. The staff uses the EMR to record their notes as well as intranet messaging about patients. All providers have remote access to the EMR. Contract negotiations are managed by the managing partner of the practice to obtain enhanced payments for services to reflect the physician oversight of the mental health workers. The goal of the project is to become financially self sustaining via payments from the insurance companies. App roximately half of the patients who receive services have Medicaid insurance.

Program or Project Leadership

Gail Schonfeld, MD,FAAP

Program or Project Evaluation

Program or Project Successes

Marked decrease in ER use, hospitalizations and specialists evaluations

Program or Project Challenges

Finding adequate staffing and contracting with major commercial HMO's.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Gail Schonfeld

gschonfeld@eastendpediatricspc.com

Title of Program or Project

GATE Utah

Web Site URL

https://www.gateutah.org/

Services

  • PCP education
  • PCP consultation

Service Site

  • Primary care clinic
  • Remote (phone or electronic)

Service Area

  • Community

Geographic Population

  • Urban
  • Suburban
  • Rural

Service Provider

  • Adult psychiatrist
  • Child & adolescent psychiatrist

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant

Funding

  • Foundation
  • Other

Program or Project State

Utah

Program or Project Description

Gate Utah is a web-based consultation model, based in the Department of Psychiatry at the University of Utah aimed at extending mental health services to children and adults through patient-centered consultations between primary care clinicians and psychiatric specialists. Primary care providers are able to refer families to complete an on-line questionnaire, that then is reviewed by the child psychiatrists, and discussed with the primary care clinician to give case guidance and recommendations.

Program or Project Leadership

Program or Project Evaluation

Ongoing family satisfaction surveys have been collated, to improve our service.

Program or Project Successes

Our format is being incorporated into a high-risk medical clinic to help with curbing costs in their highest care utilizers.

Program or Project Challenges

Funding has continued to be a challenge. We are currently funded out of a physicians' group in a fee-for-service model, by an employee-based clinic in a per member per month model, and with a small foundation grant.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Kristi Kleinschmit

kristi.kleinschmit@hsc.utah.edu

Title of Program or Project

Healthcare Integration

Web Site URL

https://www.cgfs.org/

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Care coordination
  • Telepsychiatry
  • Patient/family education/self-management

Service Site

  • Primary care clinic
  • Community health center

Service Area

  • Community

Geographic Population

  • Urban
  • Inner city
  • Migrant

Service Provider

  • Pediatrician/adolescent medicine
  • Advanced practice nurse
  • Child & adolescent psychiatrist
  • Social worker
  • Mental health counselor
  • Other mental health professional
  • Medical student

Service Recipient

  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Medicaid
  • Other

Program or Project State

Ohio

Program or Project Description

Co-Location of behavioral health services in private and hospital affiliated pediatric practices, family medicine residency program, and FQHC. Providing psychiatry consultation services, tele-psychiatry, counseling, case management, and care coordination. Home-based counseling for medically compromised children, and the refugee population.

Co-Location of an advance practice nurse at our community mental health center providing education to clients, families, and our staff on medical concerns, and linkage to medical providers. Case consultation with PCP and Psychiatrist. RN care coordinator addressing medical issues of clients.

Incorporation of groups that promote exercise and healthy eating: Girls on The Run and Heart and Soul, Hip Hop 2 Health, Gardening Groups.

Program or Project Leadership

Dr. Steve Jewell MD: Vice President and Medical Director
Hattie M. Tracy LISW-S, LCDCIII, MPA: Director, Healthcare Integration
Child Guidance & Family Solutions
18 North Forget Street
Akron, Ohio 44304
330-762-0591

Program or Project Evaluation

PHQ-9
SCARED
GAD-7
Mood and Feeling Questionnaire (long version)
Vanderbilt
Functional Outcomes(hospitalizations, well care visits, er visits, school, work, living situation, BMI, screen time, exercise drug use, etc.)

Program or Project Successes

  • Improved scores on screeners for clients
  • Improved functional outcomes
  • Increased demand for services from physician offices
  • Decreased cancel/fail rates for services
  • Satisfaction of clients and parents for services provided
  • Increased capacity and access for our community

Program or Project Challenges

  • Funding for psychiatric consultation
  • Integration of different EHR systems
  • Funding for warm handoffs and brief interventions before someone is a client
  • Shortage of child psychiatrists
  • PCP's willingness/unwillingness to prescribe psychiatric medications

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Hattie Tracy

trach@cgfs.org

Title of Program or Project

Integrated Pediatric Services, University of Louisville Department of Pediatrics, Divisions of General Pediatrics and Pediatric Psychiatry and Psychology

Web Site URL

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Telepsychiatry
  • Patient/family education/self-management
  • Other

Service Site

  • Primary care clinic

Service Area

  • Other

Geographic Population

  • Urban
  • Suburban
  • Migrant

Service Provider

  • Pediatrician/adolescent medicine
  • Advanced practice nurse
  • Physician assistant
  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker
  • Medical student

Service Recipient

  • Pediatrician/adolescent medicine
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Other

Program or Project State

Kentucky

Program or Project Description

We have a clinical child psychologist integrating into two large department of pediatrics general clinics. We have a child psychiatry fellow and a child psychiatry faculty member present primarily for education and consultation, one day per week to begin. This will expand to doing both co-location services involving social workers, a psychologist, and trainees. Our Division of Pediatric Psychiatry and Psychology is part of the Department of Pediatrics at the University of Louisville School of Medicine (ULSOM). We are using support monies to begin the integration process internally and once established and based on financial support plan to expand this to five days per week, as an integral part of our CAP training program. We've also developed a telephone consultation service for all members of the Department of pediatrics with first line calls directed to a senior child psychiatry fellow with a dedicated faculty member as backup.

I believe we are the only CAP training program in the United States currently a part of a Pediatric Department, not a Psychiatry Department.

Program or Project Leadership

Frederick Stocker MD
Allan Josephson MD
Chris Peters MD
(all Child and Adolescent Psychiatrists with ULSOM)
Christine Brady, PhD

Program or Project Evaluation

In the first two months of the program

Program or Project Successes

To this day it has been a very well received and appreciated service for general pediatricians and her patients. Our fellows especially enjoyed the interface with pediatric trainees and faculty allowing them to educate and support, home consultations skills, and promote the value of integration.

Program or Project Challenges

Lack of long-term dedicated financing at this point.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Frederick Stocker

fjstoc01@louisville.edu

Title of Program or Project

Intermountain Healthcare Mental Health Integration

Web Site URL

https://intermountainhealthcare.org/services/behavioral-health/treatments-and-detection-methods/mental-health-integration/

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Patient/family education/self-management

Service Site

  • Primary care clinic

Service Area

  • State-wide
  • Other

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant
  • Tribal

Service Provider

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Adult psychiatrist
  • Child & adolescent psychiatrist
  • Psychologist
  • Mental health counselor
  • Other mental health professional

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Commercial insurance

Program or Project State

Utah

Program or Project Description

Program or Project Leadership

Program or Project Evaluation

Program or Project Successes

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Title of Program or Project

MGH Chelsea HealthCare Center Embedded Child Psychiatry Consultation Program

Web Site URL

http://www.massgeneral.org/chelsea/

Services

  • PCP education
  • PCP consultation
  • Co-located psychopharmacology
  • Patient/family education/self-management

Service Site

  • Community health center

Service Area

  • Community

Geographic Population

  • Urban

Service Provider

  • Child & adolescent psychiatrist

Service Recipient

  • Pediatrician/adolescent medicine
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Medicaid
  • Commercial insurance

Program or Project State

Massachusetts

Program or Project Description

MGH Chelsea HealthCare Center, a part of Massachusetts General Hospital, provides high quality, community-based, culturally competent health care services to families living in Chelsea, MA and surrounding communities in a "Patient-Centered Medical Home" model. MGH Chelsea Healthcare Center is a leader in the national move toward integrating mental health services into pediatric primary care. The Embedded Child Psychiatry Consultation Program was started in 2013 to provide diagnostic consultation and treatment recommendations by a bilingual child psychiatrist for all pediatric primary care patients at the clinic. The goal of this program was to reduce barriers associated with accessing mental health care including long wait times, high drop-out rates, high cost, stigma, and poor provider communication. This model supplements usual behavioral health care provided at the health center, and differs in several important ways. First, the program strives to engage more families by providing this service within the primary care pediatric setting, as opposed to within the potentially stigmatized behavioral health unit. Indeed, the program has increased arrival rates for psychiatric evaluations by 30%. Second, the program provides a short-term, consultative and collaborative treatment approach, with the ultimate goal of patients being followed mainly by their primary care providers. This allows the child psychiatrist to see more new patients and thus increases access to this scarce resource.

Program or Project Leadership

The program was designed and started by Dr. Andrea Spencer, child and adolescent psychiatrist, with the support of Dr. Mary Lyons-Hunter, Unit Chief of Behavioral Health at MGH Chelsea, and Dr. Rebecca Cronin, who at the time of program initiation was the Unit Chief of the Adolescent and Pediatrics Unit at MGH Chelsea.

Program or Project Evaluation

Program Evaluation is ongoing. Over 200 patients were seen in the first two year of the program, most for 1-3 visits with the child psychiatrist.

Program or Project Successes

  • Decreased no shows compared to usual care
  • Able to seen high number of new patients to provide diagnosis, treatment recommendations, short term stabilization
  • Many young patients seen
  • Success with short term care for most patients
  • Sustainable
  • No grant funding necessary - fee for service care
  • Co-location increases opportunity for curbsides and education without specific funding or time dedicated for this

Program or Project Challenges

  • High rates of "no-shows" (although reduced compared to "usual care")
  • Incredibly high need and high levels of adverse experiences in this underserved population
  • Long term care harder for patients to access and maintain

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Andrea Spencer

andreaespencer@gmail.com

Title of Program or Project

Michigan Child Collaborative Care Program (MC3)

Web Site URL

Services

  • PCP education
  • PCP consultation
  • Co-located psychopharmacology
  • Care coordination
  • Telepsychiatry
  • Patient/family education/self-management

Service Site

  • Primary care clinic
  • Specialty clinic
  • Community health center
  • School/child care
  • Remote (phone or electronic)

Service Area

  • Community
  • State-wide

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant
  • Tribal

Service Provider

  • Adult psychiatrist
  • Child & adolescent psychiatrist
  • Social worker
  • Mental health counselor

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Federal
  • State
  • Medicaid

Program or Project State

Michigan

Program or Project Description

The MC3 program provides psychiatry support to primary care providers in Michigan who are managing patients with behavioral health problems. This includes children, adolescents and young adults through age 26, and women who are contemplating pregnancy, pregnant or postpartum with children up to a year. Psychiatrists are available to offer guidance on diagnoses, medications and psychotherapy interventions so that primary care providers can better manage patients in their practices. Support is available through same day phone consultations to referring providers as well as remote psychiatric evaluation to patients and families through video telepsychiatry.

Program or Project Leadership

Sheila Marcus, M.D.
Medical Director

Anne Kramer, LMSW
Program Manager

Program or Project Evaluation

We measure project variables including the factors impacting provider engagement; program utilization by primary care providers; changes in prescribing patterns; changes in primary care provider confidence and competence and provider and patient satisfaction. We evaluate levels of integration that Behavioral Health Consultants attain with their assigned practices as well as identifying barriers to integration.

Program or Project Successes

  • Over 1,000 providers from 297 practices enrolled
  • Contracted with local Community Mental Health organizations to hire Behavioral Health Consultants to provide collaborative care services in 40 counties
  • Provided consultation to perinatal providers in addition to pediatric and family practice physicians
  • Provided consultation to Nurse Practitioners, Physician Assistants and Nurse Midwives
  • Assisted providers with diagnostic clarification including the identification of trauma and autism
  • Assisted with increased comfort in evidence based prescribing
  • Provided clarification on medication management and move providers toward evidence based prescribing
  • High satisfaction with services

Program or Project Challenges

  • Estimating demand in order to right size psychiatrist and clinician effort
  • Working with payers to ensure a more sustainable model
  • Continuing to identify strategies for provider engagement
  • Balancing the desires of statewide stakeholders

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Kilbourne, A. M., Spinner, J., Kramer, A., Patel, P. D., & Marcus, S. Sustainable Lifelines: Supporting Integrated Behavioral Health Services for Children and Adolescents in the Accountable Care Era.

Other Publications

Contact Name

Anne Kramer

ack@umich.edu

Title of Program or Project

Montefiore Medical Group Behavioral Health Integration Program

Web Site URL

http://www.montefiore.org/body.cfm?id=1735&action=detail&ref=1010

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Patient/family education/self-management

Service Site

  • Primary care clinic

Service Area

  • Community

Geographic Population

  • Urban
  • Inner city

Service Provider

  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Foundation
  • Medicaid
  • Commercial insurance

Program or Project State

New York

Program or Project Description

Montefiore Medical Group (MMG) Pediatric Behavioral Health Integration Program (BHIP), Bronx, NY

The Pediatric Behavioral Health Integration Program (BHIP) successfully integrates universal mental health screening, assessment, treatment, consultation, and referral as needed within all 20 MMG sites serving pediatric patients (90,000+ patients per year). All have one or more BHIP team member(s) as members of their current patient care teams. Depending on the size and needs of the site, BHIP team members may include Healthy Steps Specialists (LCSWs or early childhood psychologists), child and adolescent psychologists and/or child and adolescent psychiatrists.

All sites conduct universal parent- or patient-completed universal behavioral health screening beginning at newborn visits through adolescence. Screening tools include ACES, PHQ2 (parental depression), MCHAT-R, ASQ-3, ASQ:SE, and PSC-17. Further symptom-specific targeted screening for ADHD, depression, anxiety, trauma, and substance abuse is also completed. All tools are located in our EMR and scoring is done by the computer.

BHIP PROVIDER-HEALTHY STEPS SPECIALIST - HSSs coordinate responses to universal screenings, and any necessary subsequent assessment, treatment, and referral for children from birth to five years of age. HSSs also enroll families of 0-18 month olds found to be particularly at-risk for exposure to toxic stress in a more intensive services program. HSSs are trained to identify and provide early intervention/direct services for children's social-emotional and developmental delays and disabilities, as well as to address the mental health needs of caregivers via our Parental Mental Health component through which caregivers may receive their own individual psychotherapy on site within pediatrics.

BHIP PROVIDER- CHILD AND ADOLESCENT PSYCHOLOGIST (CAP) - The BHIP CAP provider completes brief assessments and conducts short-term, evidence informed interventions for mild to moderate presentations, including anxiety, depression, trauma, ADHD, conduct and behavior problems. BHIP CAPs are trained in evidence based practice in all major areas of child and adolescent psychology. The BHIP provider coordinates care with the primary care provider (PCP) to ensure shared treatment plans and goals, when relevant. Any child with serious and persistent mental illness (SPMI) will be referred out to a more appropriate level of care.

BHIP providers also provide formal and informal education to primary care providers, to improve the ability of the PCP to effectively manage low level concerns presenting in the pediatric office.

BHIP PROVIDER- CHILD AND ADOLESCENT PSYCHIATRIST - The BHIP C/A Psychiatrist provides medication assessment/management of children and adolescents. Another important role is collaboration with primary care providers to improve knowledge and competence regarding medication of children and adolescents, done via formal didactics and case consultation.

Program or Project Leadership

Rahil Briggs, Director

Program or Project Evaluation

Multiple articles, presentations, book

Program or Project Successes

One of the largest fully integrated pediatric behavioral health programs in the country, starting prenatally through adolescence. ACES screening, parental mental health treatment, focus on prevention, evidence informed treatment modules.

Program or Project Challenges

Funding, reimbursement for prevention

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Rahil Briggs

rabriggs@montefiore.org

Title of Program or Project

Partnership Access Line

Web Site URL

http://www.seattlechildrens.org/pal

Services

  • PCP education
  • PCP consultation
  • Telepsychiatry
  • Other

Service Site

  • Remote (phone or electronic)

Service Area

  • State-wide

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant
  • Tribal

Service Provider

  • Child & adolescent psychiatrist
  • Social worker

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional

Funding

  • Federal
  • State
  • Medicaid

Program or Project State

Washington

Program or Project Description

The Partnership Access Line team provides primary care consultation services on behalf of two state Medicaid divisions (both Washington and Wyoming) with which it holds service contracts. The PAL team delivers two types of consultations: elective on-demand consultations requested by care providers, and peer to peer consultations requested by the Medicaid division per a medication review flag. These two general types of community provider and care system consultations are often both referenced jointly as "PAL" as they are provided by the same centralized team to ensure fidelity of care messaging across different points of the system of care. The following provides a few more details of these services:

  1. Partnership Access Line (PAL) is a statewide child psychiatry access program for any primary care provider to immediately consult over the phone with a child psychiatrist. Providers are not required to "enroll" in the program, and can simply call whenever they have a question. When calling they will receive over the phone consultation assistance (usually immediately connected with a child psychiatrist) for any child in their care with any type of insurance during regular business hours. Other components include:
    • Rapid access to in-person or televideo consultations for any child with Medicaid coverage
    • Social work referral assistance for providers to help families connect with appropriate local services
    • Copies of a mental health in primary care treatment guide (specific to each state)
    • Evidence based mental health regional trainings for primary care with free Category 1 CME (4/year in WA, 2/year in WY)
  2. Second Opinion Network Review (SON) program - Medicaid client mandatory doc to doc telephone and record reviews regarding child outpatient psychiatric medications which fall outside of state drug utilization review board set thresholds for "too many, too much, too young" criteria. These reviews deliver both patient specific summarized treatment suggestions/advice and medication authorization recommendations. Reviewed medication classes include stimulants, antipsychotics, alpha2-agonists, duplicate class psychotropic medications, or =5 concurrent psychotropic medications

Program or Project Leadership

Robert Hilt, MD Associate Medical Director for Behavioral Health Consultative and Community Based Programs, Director of Partnership Access Line, Seattle Children's Hospital and University of Washington Division of Child Psychiatry

Rebecca Barclay, MD, Associate Director of Partnership Access Line, Seattle Children's Hospital

Ana Clark, Administrative Director of Partnership Access Line, Seattle Children's Hospital

Program or Project Evaluation

From Hilt et al 2013 in JAMA Pediatrics

  • 87% of PAL calls recommended a new psychosocial intervention
  • 46% of PAL calls recommended to start or increase a medication
  • 24% of PAL calls recommended to stop or decrease a medication
  • 65% of PAL calls recommended ongoing care which did require a child psychiatrist or psychiatric nurse practitioner (primary care +- therapist)
  • Significant increase in psychotherapy claims post PAL consults

From Hilt et al 2015 in Telemedicine and e-Health

  • 42% reduction in state Medicaid psychotropic use in children under 5
  • 52% reduction in state Medicaid psychotropic use in doses >150% the adult FDA maximum
  • 1.82 to 1 fiscal return on investment

Continuous program feedback evaluations from community providers has been highly positive regarding PAL service, including high ratings on items like "have seen patient treatment outcomes improve because of working with the PAL team." Continuous program feedback evaluations from community providers about the medication review service have been positive about receiving high quality and appropriate patient specific care advice, but often there are frustrations expressed about the mandatory nature of these reviews.

Program or Project Successes

These programs have been supporting the care of all primary care providers in two different states with a relatively limited child psychiatrist workforce. State Medicaid data shows that along with implementation of these services, there have been very significant reductions in outlier prescribing practices, something which has not been seen in other states.

Program or Project Challenges

Geographic coverage is a major challenge, in that the team cannot simply drop by a practice to discuss the consult programs with care providers. Mandatory medication reviews are less inherently positive for both the reviewer and prescriber, so we have had to learn how to conduct these reviews in a collaborative and patient care enhancing manner. Funding had been a perpetual concern, but over many years enough individuals have come to value the service that service continuation has become more assured. The programs are not currently staffed to provide ongoing collaborative/integrative care, though we are currently investigating ways of supporting local teams to help this occur.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

  1. Hilt R, McDonell MG, Rockhill C, Golombek A, Thompson J. The Partnership Access Line: establishing an empirically based child psychiatry consultation program for Washington State. Report on Emotional and Behavioral Disorders in Youth. 9(1) Winter 2009: 9-12.
  2. Hilt RJ, Romaire MA, McDonnell MG, Sears JM, Krupski A, Thompson JN, Myers J, Trupin EW. The Partnership Access Line: Evaluating a child psychiatry consult program in Washington State. JAMA Pediatrics 2013 Feb; 167(2): 162-8
  3. Hilt RJ, Barclay RP, Bush J, Stout B, Anderson N, Wignall JR. A Statewide Child Telepsychiatry Consult System Yields Desired Health System Changes and Savings. Telemedicine and e-Health Journal. 2015 Jul;21(7):533-7.

Other Publications

Contact Name

Robert Hilt

robert.hilt@seattlechildrens.org

Title of Program or Project

Pediatric Embedded Clinic

Web Site URL

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Patient/family education/self-management

Service Site

  • Primary care clinic
  • Specialty clinic
  • Hospital

Service Area

  • Community

Geographic Population

  • Urban
  • Inner city
  • Migrant

Service Provider

  • Pediatrician/adolescent medicine
  • Child & adolescent psychiatrist
  • Social worker
  • Medical student

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • State

Program or Project State

Illinois

Program or Project Description

Over the last 6 years or so our Program has developed a CAP Psychiatry clinic within the Pediatric Outpatient Clinic. This clinic occurs once per week on a Tuesday afternoon Our first appt.is at 12:30p and the last is 4:30p but we often are in clinic until 6p The aim is to keep two rooms going.There are two co- directors, a wonderful social worker and a CAP psychiatrist (me) who is also boarded in Pediatrics. We have developed an educational rotation for first year CAP fellow for 4 months at a time, and we have one MS3 every 6 weeks. This has been a great opportunity to the first year fellow as a developing teacher We often have Adolescent fellows rotate in our clinic from 6 weeks to 12 months. At the beginning of the clinic, pediatrics had a core CAP rotation, and we loved having them. Reportedly they were told they had too much psychiatry by their RRC.

  1. The referred children, adolescents, and families are patients within the UIC system, primarily PCP or specialty Pediatric physicians are referring.
  2. We attempt to evaluate, treat and stabilize and return to Pediatric care asap although this is often not possible for a considerable period of time. If there is a need for more weekly therapy, we are able to refer to the Colbeth Child Outpatient Psychiatry Clinic with relative ease.
  3. Additionally, and what has been very enjoyable, both Pediatric faculty and residents will come to our clinic area to discuss cases and occasionally we will see a patient right at that time. Generally that is not the case. Pediatric bills the facility fee and I bill pro fees through psychiatry.

Thanks for asking me to share.

Program or Project Leadership

As I wrote above, it has been my pleasure to develop developed the embedded clinic.

I am Kathy Kelley MD, CAP Training Director. I am triple boarded, the long way, as I complete my training before triple boards existed. I see all patients and families who come to the clinic.

There is an LCSW who completed her social work clinical rotation at UIC. She is truly an excellent clinician and teacher. She adds a great deal in regards to teaching trainees and me about community resources.

Program or Project Evaluation

The clinic is evaluated well by our fellows but especially well by medical students.

  1. There is an fellowship end of rotation evaluation for clinics and teachers.
  2. All medical students evaluate their clinical experiences at the end of their clerkship. The medical students are active from the beginning and that is very appreciated. They also develop on one-to-one relationship with the CAP fellow.

Some of my fellows were not happy that they were often seeing a new-to-them patient; however, preparation the evening before helps greatly, especially at the beginning of their four months. When appropriate, fellows have transferred a patient and family into their own caseload in the CAP outpatient clinic.

Program or Project Successes

  1. As integrated care has become more and more important in our work and in the teaching of all our trainees, we were already underway with our embedded clinic. This was very appreciated by my division director and the Head of the Department.
  2. The medical students are active from the beginning and that is very appreciated. They also develop on one-to-one relationship with the CAP fellow.
  3. When appropriate, fellows have transferred a patient and family into their own caseload in the CAP outpatient clinic which provides continuity in level of care.

There were interesting ideas voiced at the recent AADPRT meeting, including matching residents with a CAP fellow for phone consultation.

Program or Project Challenges

It's a keeper rotation; however, it is not the same intensity as sitting in pediatric clinic with residents.

  1. It is our wish to become further integrated into the Pediatric clinic, while maintain our ability to bill. This will hopefully occur when there is a more advanced method of receiving and paying for care.
  2. Some of my fellows were not happy that they were often seeing a new-to-them patient; however, preparation the evening before helps greatly, especially at the beginning of their four months.

I am very happy to hear about the upcoming resources that will be available.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Kathleen Kelley

kkelley@psych.uic.edu

Title of Program or Project

Project COPE, CARE and IMPACTT

Web Site URL

http://my.clevelandclinic.org/services/neurological_institute/epilepsy/patient-education/patient-family-support

Services

  • PCP education
  • PCP consultation
  • Care coordination
  • Telepsychiatry
  • Patient/family education/self-management

Service Site

  • Specialty clinic
  • Hospital

Service Area

  • Community
  • State-wide
  • National

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Developmental behavioral pediatrician
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child & adolescent psychiatrist
  • Psychologist
  • Social worker

Service Recipient

  • Pediatrician/adolescent medicine
  • Other medical professional
  • Psychologist
  • Mental health counselor
  • Other mental health professional

Funding

  • Federal

Program or Project State

Ohio

Program or Project Description

Strategic Approaches to Improving Access to Quality Health Care for Children and Youth with Epilepsy”. Our project, entitled IMPACTT (Integrating Mobile Provider Access for Telemedicine and Transition), addresses the needs of children and youth with epilepsy and their families in three designated Medically Underserved Areas (MUAs). The goals of the project are: (1) to provide care to CYE through a patient/family-centered medical home; (2) to provide transition planning for CYE; (3) to implement telemedicine with CYE and their families at CCF main and 9 clinical sites; (4) to establish a Learning Collaborative involving 9 pediatric primary care sites; and (5) to increase outreach and family engagement, using educational webinars. These goals will be accomplished by 1) implementing evidence-based and innovative models of using health information technologies; 2) implementing the Got Transition Six Core Elements Framework to help youth successfully transition from the pediatric to adult system of health care; and (3) facilitating outreach and education regarding epilepsy among pertinent stakeholders. Five advanced technology programs will be include in the project: (1) telemedicine, including face to face cameras for consultation with patients and between primary care doctor and specialist; (2) use of MyChart, the Cleveland Clinic technology based record keeping and communication system available to all patients and physicians; and (3) mHealth for patients, a phone-based or computer based application, (4) webinars, and (5) the StandUp bully prevention program.

Program or Project Leadership

Cleveland Clinic - Neurologic Institute
Center Director Imad Najm MD
Program Director Tatiana Falcone MD
Pediatric Epilepsy Team
Adult Epilepsy Team
Research Coordinator Diane Zemba RN
Sammy Juhn LSW

Evaluation Team- Jane Timmons- Mitchell PhD (CWRU)

Prochange- Stand Up Program (a bullying prevention Program) - Debbie Levesque PhD

Northwestern University- Department of Preventive Medicine Project Tech (Depression App for Kids with Epilepsy) Joice Ho PhD

Coordinating center American Academy of Pediatrics

Program or Project Evaluation

Project activities and evaluation will follow a Continuous Quality Improvement framework. The 9 sites will participate in a Learning Collaborative that will provide both training and access to expert consultation for primary care providers. Over the three years of the grant, Cleveland Clinic Pediatric Epilepsy and the 9 clinical sites combined will serve at least 1,000 CYE; all of the CYE served by the project will have a seizure action plan in place. Of the nine clinical sites, three are in HRSA designated medically underserved areas (MUAs), constituting about 38% of patients served by the grant. Partnering with families and CYE, Pediatricians, Primary Care providers as well as with Case Western Reserve University, the project will further engagement and outreach in a broader geographic region in Ohio. Resulting in improving services for CYE in Ohio.

Program or Project Successes

The purpose of this project is to improve the quality of life for youth with epilepsy, which will be achieved through:

  1. Improving care coordination
  2. Providing patient and family education
  3. Increasing access to early mental health screening
  4. Increasing family/patient engagement
  5. Improving healthy relationship skills (to decrease bullying in children with epilepsy)

During the 3 years of project CARE to date- we have served 2’200 unique families of CYE. 454 families on the care coordination clinic, 132 families assisted with the transition workbook, 42 families that actively participated in the transition clinic, 1’490 families participated in the webinars, 45 families of CYE participated in the facebook groups, 37 CYE participated in the StandUp bullying prevention intervention. Other number not included in the 2’200 count are : We actively participated in the cross-site evaluation process collecting more than 728 surveys from parents of CYE. 5’184 mental health tool kits were disseminated between professionals in epilepsy care and families. We provided lectures to 500 physicians in 9 national conferences during the 3 year grant (epileptologist, psychiatrist, pediatricians). We provided psychoeducation to 40 teachers about epilepsy. We provided psychoeducation about epilepsy to 12 classrooms from 2 grade to highschool with more than 250 students participation. We provided psychoeducation to families about epilepsy in 4 local meetings from epilepsy association with more than 50 CYE families participating in these events.

Goal 1. To Establish a Care Coordination Clinic for children and youth with epilepsy.

Objective 1. To create a Care Coordination Clinic (according to the AAP definition of medical home).Results: We have provided care coordination services for a total of 454 families; 75 have agreed to complete measures to evaluate the benefits of the care coordination clinic.

Goal 2. To Establish a Transition Clinic for teenagers with epilepsy.

Objective 1. To create a transition clinic for youth with epilepsy that complies with the six core elements of health care transition identified by the National Healthcare Transition Results: We prepared and published a “Journey to Adulthood” workbook for patients and families enrolled in the Transition Clinic. 132 transition workbooks have been disseminated to CYE ages 14-18 and 42 patients have participated in the transition clinic.

Goal 3. To conduct educational webinars for families of youth with epilepsy.

Objective 1. To increase knowledge about epilepsy. Objective 2. To decrease stigma and increase knowledge about mental health problems in CYE and their families. Objective 3. To increase use of advanced technology for families of youth with epilepsy.Results: During project CARE we produced 7 webinars. To date, our 7 webinars have been viewed 10,430 times. If we account for unique families seeing the webinar series (14,430/7) 1,490 families.

Goal 4. To Establish and monitor 2 Facebook groups for youth with epilepsy and their families.

Objective 1. To increase social and emotional support for youth with epilepsy and their families.

Results: We have a total of 45 enrolled into our Facebook groups.

Goal 5. Disseminate the Mental Health and Epilepsy Toolkit to professionals and their families.

Objective 1. The Mental Health and Epilepsy Toolkit to be disseminated to 3000 professionals in epilepsy care and family members of CYE.

Results: The Mental Health and Epilepsy Toolkit developed as part of our previous HRSA funded grant, Project Cope. 5184 tool kits have been disseminated during this grant cycle. From this 4078 tool kits were disseminated to professionals in epilepsy care including, and all the pediatricians in Ohio.

Program or Project Challenges

Challenges in Completing Webinar Surveys. We would like everyone who views a webinar to complete an 11-question survey to describe demographics and to determine whether new knowledge was gained. In the past cycle, the link to the survey was displayed, but it was difficult to open. Only 13 surveys were completed compared with the over 10,000 webinar views.

Challenges with Recruitment of Youth with Epilepsy for the Standup Bullying Prevention Intervention. During our pilot of the StandUp program in a community high school in Ohio, 115 adolescents were recruited, with a limited number of CYE. To overcome this barrier, the program was extended to the 7 other grantee sites from HRSA. Thirty-seven additional patients were recruited during project CARE. During the live session at the school, patients had immediate access to their passwords and hence were able to complete session 1. They however forgot their passwords later on and were unable to complete sessions 2 and 3. During the live session, staff were on site to help with any system difficulties. We will ask for permission to contact the family up to 5 times prior to each session to assure that CYE finish session 2 and 3.

Potential Solutions

Completion of webinar surveys. In order to address this challenge, we will be posting the webinars on a different server. The web design group has received the survey we would like to link. They are testing it for ease of access prior to rolling out the next round of webinars.

Recruitment of youth with epilepsy for the StandUp bullying prevention intervention: The primary barrier identified has been lack of remembering passwords to complete sessions 2 and 3. Using a Continuous Quality Improvement process, we will generate ways to address this barrier. When CYE are given their password, we will work with them to record it and store it in a safe place. We will also work with the program developers to introduce a password linking feature so that CYE who return for sessions 2 and 3 can be linked with their previous program experience.

Program or Project Curricula/Materials

Mental Health Toolkit

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Tatiana Falcone

falcont1@ccf.org

Title of Program or Project

Project TEACH : Child and Adolescent Psychiatry Program for Primary Care

Web Site URL

http://www.cappcny.org

Services

  • PCP education
  • PCP consultation
  • Telepsychiatry
  • Other

Service Site

  • Primary care clinic
  • Specialty clinic
  • Hospital
  • Community health center
  • Health department
  • Remote (phone or electronic)

Service Area

  • Community

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant

Service Provider

  • Child & adolescent psychiatrist
  • Social worker

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • State

Program or Project State

New York

Program or Project Description

CAP PC is uniquely a collaboration between 5 university-based child psychiatry divisions at the University at Buffalo, University of Rochester, Columbia University Medical Center/NY State Psychiatric Institute, SUNY Upstate Medical University in Syracuse, and Hofstra/Northwell Health. CAP PC has partnered with the REACH Institute as well as the NY state chapters of the American Academy of Pediatrics and the American Academy of Family Physicians. The program opened on October 1, 2010 and consists of 2 broad efforts: formal education and consultation support for primary care physicians. The flagship educational component is the REACH Institute's Mini-Fellowship in Child and Adolescent Mental Health. This program consists of an intensive, highly interactive weekend covering broad aspects of assessment and management of mild-moderate mental health problems. The weekend training is followed by 12 biweekly case-based conference calls over 6 months. The REACH Mini-Fellowship offers up to 28 CME credits for participating PCPs at no cost. Additional formal CME evening educational programs were added in 2013 and webinars, and 5-hour on site “core trainings” in 2015. A website has been developed that contains many of these presentations as well as quarterly newsletters and other educational materials for PCPs. The consultation component utilizes a toll free phone line as its entry point. Each of the 5 sites has a team consisting of 2 senior child psychiatrists and 1 Liaison Coordinator (minimally master's level in mental health related field) to assist with administration, the educational programs, and linkage and referral support. In 2016, with additional funding, early career child psychiatrists and care coordinator assistants were added to expand the program and plan for the future. Each team rotates coverage of the phone line which operates Monday-Thursday 8am-7PM, Friday 8AM -5PM. Face to face or telepsychiatric consultation evaluations are also available in selected cases. The program was refunded this year for 5 years through 2020. With this additional funding changes were made to the geographic coverage areas and a statewide coordination center (SCC) was added to standardize the two Project TEACH programs and expand education and outcomes evaluations of the program. The Massachusetts General Hospital Psychiatry Academy was recently named the SCC.

Program or Project Leadership

Project Director
David Kaye MD
dlkaye@buffalo.edu

Project Administrator
Ira Bhatia M.S.
ibhatia@buffalo.edu

Chief Advisor of Outcomes
Alex Cogswell PhD
alexcogs@buffalo.edu

The CAP PC Team:

Upstate Medical University (Syracuse) - Mondays

Terrie Hargrave MD
(315) 464-3266
hargravt@upstate.edu

Wanda Fremont MD
(315) 464-3128
fremontw@upstate.edu

Jennifer Singarayer, MD
(315) 464-3276
singaraj@upstate.edu

Eric MacMaster, MD
(315) 464-3955
macmaste@upstate.edu

Maureen Ryan, PsyD
(315) 291-7022
mryanpsyd@icloud.com

Hofstra Northwell School of Medicine - Tuesdays

Carmel Foley MD
(516) 470-3550
CFoley@northwell.edu

Victor Fornari MD
(718) 470-3501
VFornari@northwell.edu

Scott Falkowitz, DO
(718) 470-3543
Falkowitz@northwell.edu

Leslie Cummins LCSW
(718) 470-4833
LCummins@northwell.edu

Columbia University Medical Center/New York State Psychiatric Institute - Wednesdays

Rachel Zuckerbrot MD
(646) 774-5736
zuckerbr@nyspi.columbia.edu

Jennifer Petras MD
(646) 774-5813
jpetras@nyspi.columbia.edu

Katherine Carnicelli LMSW
(646) 774-5804
carnice@nyspi.columbia.edu

University at Buffalo - Thursdays

David L. Kaye MD
(716) 898-1064
dlkaye@buffalo.edu

Beth Smith MD
(716) 859-5468
balucas@buffalo.edu

Sourav Sengupta, MD, MPH
(716) 320-0362
souravse@buffalo.edu

Kristin McGinley LCSW
(716) 898-1066
knm4@buffalo.edu

University of Rochester - Fridays

Jim Wallace MD
(585) 273-2561
James_Wallace@URMC.Rochester.edu

Michael Scharf MD
(585) 275-3556
michael_sharf@urmc.rochester.edu

Andrew Mietz MD
(585) 279-7901
Andrew_Mietz@URMC.Rochester.edu

Amy Lyons LCAT
(585) 273-4009
amy_lyons@urmc.rochester.edu

Program or Project Evaluation

CAP PC Services: We collect 2 week survey and Annual survey

Education programs : Pre and Post training survey

Program or Project Successes

Project Activity Cumulative (Oct 1, 2010 to 2016)
New Cases - 6285
CAP Consultations (new and follow up) - 8013
Face to Face CAP Evaluations - 577
Referrals - 1966
REACH trained PCPs - 662
PCPs CME - 17523.5
Total registered PCP - 1931

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

David Kaye

dlkaye@buffalo.edu

Title of Program or Project

Psych TLC

Web Site URL

http://psychiatry.uams.edu/clinical-programs/psych-tlc/

Services

  • PCP education
  • PCP consultation
  • Care coordination

Service Site

  • Primary care clinic
  • Specialty clinic
  • Remote (phone or electronic)

Service Area

  • State-wide

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural
  • Migrant

Service Provider

  • Child & adolescent psychiatrist
  • Social worker

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional

Funding

  • State

Program or Project State

Arkansas

Program or Project Description

Through a partnership with the Arkansas Department of Human Services, Arkansas Children’s Hospital and the Psychiatric Research Institute of the University of Arkansas for Medical Sciences (UAMS), the Psych TLC (Psychiatric Telehealth, Liaison, and Consultation) program is now offering Arkansas’ primary care providers (PCPs – pediatricians, family physicians, advanced practice nurses, physicians’ assistants) several new programs, jointly designed to give you the essential support and training you need to be effective “first responders” for the children and adolescents in primary care practices who have mental health needs.

Psych TLC has two major assistance functions:

Same-day case consultation and support: A licensed mental health professional (MHP) and a child and adolescent psychiatrist (CAP) are available via telephone to provide consultation and support to primary care practitioners from 8 a.m. to 5 p.m., Monday through Friday, except for official holidays. If you have a child or teen in your practice who is experiencing behavioral or emotional difficulties, and you uncertain how to help them, please call us! That is why we are here.

To arrange a time to talk, simply call (844) 547-5688 or (501) 320-7270 to contact the Psych TLC Call Center. One of our expert MHPs will obtain basic information from your about the child and/or your referral needs. Or, if you need diagnostic or treatment advice about a specific child, the MHP will schedule a convenient time for a child and adolescent psychiatrist to call you back, usually within 15 minutes to one hour.

Hands-on coaching and training: Psych TLC also offers a high quality training experience to PCPs, helping you to assess and manage common pediatric mental health problems. PCPs are essential in this role, as there are so few child psychiatric resources across Arkansas. This training program, originally developed by the non-profit REACH Institute, has been provided to over 2200 PCPs across the US and Canada, and is described by most as “the best CME I have ever attended.” The first Arkansas training was conducted in January 2016 at Arkansas Children’s Hospital.

With support from the three partners, this program, AR-REACH, will be delivered by Arkansas’ own expert pediatricians and child psychiatrists. It is available at no cost to all Arkansas PCPs, and offers 26 hours of AMA Category I CME credit. Training slots are limited, and it is “first come, first served.” The training begins with an intensive hands-on, skills-focused 3 day practicum, followed by 12 weekly 1-hour small group conference calls where practitioners take turns presenting their own challenging cases. These 12 calls are scheduled at convenient times for busy practitioners — in the early morning, at lunch time, or at the end of the day.

To sign up for a training, PCPs should contact the Program Director, Peter S. Jensen, MD, at psjensen@uams.edu.

Program or Project Leadership

Program Director: Peter S. Jensen, MD, psjensen@uams.edu

Program Manager: Darren L. Reeves, MSW, DLReeves@uams.edu

Program or Project Evaluation

Program or Project Successes

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Peter Jensen

psjensen@uams.edu

Title of Program or Project

Psychiatric Consultation to Mosaic Pediatrics and Central Oregon Pediatric Associates (Bend, OR)

Web Site URL

Services

  • PCP education
  • PCP consultation
  • Co-located psychopharmacology
  • Other

Service Site

  • Primary care clinic

Service Area

  • Community

Geographic Population

  • Urban

Service Provider

  • Child & adolescent psychiatrist

Service Recipient

  • Pediatrician/adolescent medicine
  • Other medical professional
  • Child
  • Parents

Funding

  • County

Program or Project State

Oregon

Program or Project Description

Child psychiatry consultation to two large pediatric primary care clinics in Bend, OR. Using a model that is aspiring to Collaborative Care model though have had many challenges since initiating in January 2016. This includes struggling to develop and maintain directory, consistently obtain treat-to-target measures, follow-up with previously consulted cases in a timely manner and have enough interaction with PCPs to generate enough support and buy-in. Primary consultation is to BHCs (psychologists and LCSWs) using a "deep dive" of EMR and consultation to BHCs and PCPs if available. No face to face time with children or families. On-site one morning a month at each clinic. Consultation note documented in EMR with brief impression and specific recommendations across bio-psycho-social domains for PC team to consider.

Program or Project Leadership

Mike Franz, MD
OCCAP Distinguished Fellow

Funded by Deschutes County Behavioral Health

Program or Project Evaluation

Reviewing provider satisfaction survey's at 0 time and 1 year. Trying to gather data on PSC-17 and PSS to see if scores improve over time.

Program or Project Successes

Variable success subjectively informed -- one site is further along likely due to regular face to face interaction with PCPs.

Program or Project Challenges

See project description above.

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Mike Franz

mike.franz@stanfordalumni.org

Title of Program or Project

Rush University Medical Center, Section of Population Behavioral Health | Department of Psychiatry

Web Site URL

Services

  • PCP education
  • PCP consultation
  • Co-located therapy
  • Co-located psychopharmacology
  • Care coordination
  • Patient/family education/self-management

Service Site

  • Primary care clinic
  • Specialty clinic
  • Hospital
  • Community health center
  • Remote (phone or electronic)

Service Area

  • Community
  • Other

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Migrant

Service Provider

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Developmental behavioral pediatrician
  • Physician assistant
  • Other medical professional
  • Adult psychiatrist
  • Social worker
  • Mental health counselor
  • Other mental health professional
  • Medical student
  • Other

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional
  • Child
  • Adolescent
  • Parents
  • Family

Funding

  • Federal
  • State
  • County
  • Corporate
  • Medicaid
  • Commercial insurance
  • Other

Program or Project State

Illinois

Program or Project Description

The purpose of this program is to preventatively identify patients with behavioral health concerns and work together with primary care teams across multiple specialties (including pediatrics, family medicine, internal medicine, and geriatric medicine) in a major urban center. The program is currently emphasizing identification of depressive symptoms using a screening protocol (PHQ-2/9) and appropriately treat depressive symptoms using a collaborative care team approach. We have a dedicated child and adolescent psychiatrist and a general psychiatrist providing clinical consultation via our multidisciplinary team and directly with primary care providers when needed. The ultimate goal is to improve patient quality of life and to improve health outcomes and reduce costs. Depression screenings for adolescents and adults are being incorporated into primary care outpatient appointments. Depression symptomology will be addressed through a menu of possible treatments, including medication, brief Cognitive Behavioral Therapy (CBT), care coordination with a social worker therapist, consultation with psychiatry, and/or online depression resources, as appropriate.

Program or Project Leadership

Niranjan S. Karnik, MD, PhD
Director, Section of Population Behavioral Health | Department of Psychiatry
The Cynthia Oudejans Harris, MD, Professor of Psychiatry
Rush University Medical Center, Chicago Illinois

James G. MacKenzie, DO
Director, Pediatric Collaborative Care
Assistant Professor, Departments of Psychiatry and Pediatrics
Rush University Medical Center, Chicago Illinois

Neha V. Gupta, MD
Director, Adult Collaborative Care
Assistant Professor, Departments of Psychiatry and Internal Medicine
Rush University Medical Center, Chicago Illinois

Rebecca Lahey, MSW, LCSW
Supervisor of Mental Health Services
Rush University Medical Center

Program or Project Evaluation

Evaluation Logistics: Data for initial program evaluation includes available electronic medical record (EMR) tracking of PHQ 2/9 initial administration and comparison results after patient identification and participation.

Program or Project Successes

Program or Project Challenges

Program or Project Curricula/Materials

Peer-Reviewed Journal Articles

Other Publications

Contact Name

James MacKenzie

james_mackenzie@rush.edu

Title of Program or Project

Stark County Pediatric Medical Home Project/Medical Services Redesign

Web Site URL

https://candapediatricmedicalhomes.wordpress.com

Services

  • PCP education
  • PCP consultation
  • Care coordination
  • Other

Service Site

  • Primary care clinic
  • Specialty clinic
  • Community health center
  • School/child care
  • Remote (phone or electronic)

Service Area

  • Community

Geographic Population

  • Urban
  • Inner city
  • Suburban
  • Rural

Service Provider

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Other medical professional
  • Child & adolescent psychiatrist

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional

Funding

  • County
  • Foundation

Program or Project State

Ohio

Program or Project Description

Our plan for medical services redesign has three overarching goals:

1. Enhancing the capacity of patient-centered pediatric medical homes to identify kids at risk of significant mental illness and to support local pediatricians in broadening their ability to provide evidence-based medical intervention for children and teens with common mental health conditions.

2. Building upon the agency’s established training program in psychology to develop a Center of Excellence for Interdisciplinary Training of medical and mental health professionals.

3. Establishment of a new medical services team and rightsizing the department’s current caseload.

Program or Project Leadership

Child and Adolescent Behavioral Health (C&A) is the largest provider of mental health services to children, teens and families in Stark County. The agency offers an array of school-based and outpatient mental health and case management services, a school-based day treatment program and outpatient psychiatric services. C&A is serving as the lead agency for the project.

Stephen Grcevich, MD is currently serving as the agency's Transitional Medical Director and is responsible for overseeing the project. The project is an outgrowth of recommendations Dr. Grcevich made in 2016 to the Stark County Mental Health and Addiction Recovery Board and C&A's Board in response to a lack of access to psychiatric services for children, teens and families in the county and systemic changes resulting from the Ohio Department of Mental Health's planned behavioral health redesign.

Dr. Elizabeth Hayford was hired in August, 2017 as C&A’s first full-time Medical Director since 1997 and began work on August 1st. Dr. Hayford is Board Certified in Family Medicine and General Psychiatry, and is scheduled to take her certification exam in Child and Adolescent Psychiatry in September. Dr. Hayford worked in Alliance for two years as a family practitioner before pursuing training in general and child psychiatry at Akron General Hospital and Akron Children’s Hospital. She and her family reside in North Canton. She will be working 32 hours/week. Dr. Hayford’s principal responsibility during her first six months of employment will be provision of clinical care. She will gradually assume responsibility for providing support to pediatric medical homes and supervision/collaboration with APNs. We plan for her to fully assume the Medical Director’s role by the third quarter of 2018.

Program or Project Evaluation

Supporting Patient-Centered Pediatric Medical Homes:

• Provide direct access for pediatricians and pediatric nurse practitioners to “curbside consultation” offered by a child and adolescent psychiatrist during normal working hours.

To date, we’ve introduced the project to five pediatric groups in Stark County - Akron Children’s Pediatrics (Alliance), Akron Children‘s Pediatrics (North Canton), Community Health Care Pediatrics (Jackson), Primary Care Physician Associates (Jackson) and Shipley Clinic (Canton). These practices represent approximately half of the practicing pediatricians and pediatric nurse practitioners in Stark County.

The “Curbside Consultation” service launched on March 1, 2017. To date, the service has processed four consultation requests through the established process. Three of the four requests were for children or teens with primary diagnoses of anxiety disorders, one with depression. One family was seen through Dr. Grcevich’s private office for consultation and stabilization and subsequently returned to their local pediatrician for follow-up. All other patients continued to be served through their local pediatric practice.

• Assist pediatric practices in setting up screening tools for kids at risk of common mental health conditions.

We launched a website in March to serve as a resource hub for the project: https://candapediatricmedicalhomes.wordpress.com

Primary care physicians in Stark County have been provided access to a comprehensive library of free children’s mental health screening tools and rating scales in the public domain through the project website. Instruments are available for screening and monitoring response to treatment for children and teens with ADHD, anxiety disorders, Bipolar Disorder, depression, disruptive behavior disorders, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Schizophrenia, substance use disorders and tic disorders. Screening tools are also available for suicide risk and monitoring movement disorders associated with antipsychotic medication. The screening tool library is available here: https://candapediatricmedicalhomes.wordpress.com/child-psychiatry-rating-scales-for-primary-care-physicians/

The website also houses links to access the “curbside consultation” service and a complete set of practice parameters for specific conditions published by the American Academy of Child and Adolescent Psychiatry.

• Establish quarterly “lunch and learn” meetings with each participating pediatric practice in the county tailored to the unique practice needs of their group.

We will have completed quarterly lunch and learns for two quarters with CHC Pediatrics and one quarter with Primary Care Physician Associates by the end of this quarter. We are still in the process of introducing other groups to the pediatric medical home project. Community Healthcare Pediatrics requested and received training on the following topics:

Understanding DMDD (Disruptive Mood Dysregulation Disorder) Risks and Benefits of Serotonin Reuptake Inhibitors in Children and Teens

• Monthly videoconferences to discuss common topics of interest among pediatricians from participating practices.

• Explore availability of offering Continuing Medical Education credits and events.

• Assist with development of Quality Improvement projects related to child and adolescent mental health necessary for pediatricians to meet Maintenance of Certification (MOC) requirements.

• Partner with Northeast Ohio Medical University’s TACT (Integrated Care Technical Assistance and Consultation) Team to provide training and support in implementing the Collaborative Care model in primary care practices and assistance in developing multidisciplinary training opportunities for professionals.

We’ve been partnering with Northeast Ohio Medical University’s (NEOMED) Department of Psychiatry in implementing education-related goals associated with supporting pediatric medical homes and interdisciplinary training of students in mental health-related fields. NEOMED has grant funding through the Ohio Department of Mental Health to implement Project Echo in the region. Here’s a summary of what we’re working on from Nichole Ammon at NEOMED:

Northeast Ohio Medical University has partnered with the University of New Mexico’s ECHO Institute to become a Project ECHO® replication partner. Project ECHO® is a hub and spoke knowledge-sharing networks create a learning loop where community providers learn from specialists, community providers learn from each other, and specialists learn from community providers as best practices emerge. Through technology-enabled collaborative learning, ECHO creates access to high-quality specialty care in local communities.

As an ECHO hub (Project ECHO: NEOMED Ohio Alliance), NEOMED’s the Department of Psychiatry, Best Practices in Schizophrenia Treatment (BeST) Center has been working on the development of an Integrated Primary and Mental Healthcare Tele-ECHO Clinic, with an initial focus on youth patient populations. The BeST Center team has developed a draft curriculum to be covered during the ECHO Clinic Sessions and they are in the process of working with the Continuing Education Office at NEOMED, so that participants in the community will be able to earn CE credit (Ohio MD, Nursing, Counseling, Social Work, Psychology and Pharmacy). The BeST Center team has been working with Dr. Grcevich, consultant to C&A, on the development of a survey and an initial list of providers to target for participation. NEOMED’s Department of Public Relations and Marketing is assisting the BeST Center Team in creation of promotional materials. More information will be available for distribution online and printed materials, as soon as possible.

NEOMED’s goal is to disseminate the survey and promotional materials to an initial target audience in September, with a tentative ECHO Clinic launch date in late October 2017. In the meantime, a shared email has been established so that the BeST Center team is able to start fielding questions and interest in Project ECHO® - IntegratedCareECHO@neomed.edu

Individuals and organizations with interest and/or questions about the Integrated Care ECHO Clinic can contact the team at this email, or they can contact the project lead: Nichole Ammon, M.S.Ed., LPCC-S, Manager for Integrated Healthcare Initiatives/IPE Faculty Educator at nammon@neomed.edu or at 330.325.6613.

• Access to a “Care Coordinator” or “Care Concierge” from C&A‘s Medical Services team to help facilitate appropriate (and timely) referrals of pediatric within the agency and clinical communication between C&A and participating pediatric groups.

Delays in the implementation of behavioral health redesign in Ohio caused us to postpone Meredith Skotschir’s planned transition into the Care Coordinator role until January 1st. Staffing transitions within the Medical Services department necessitated that Meredith continue to serve primarily as a clinician until that time. Recent staff additions will free Meredith to assume these responsibilities after the first of the year. In the interim, Georgene Voros (the agency’s Clinical Director) is assuming responsibility for ensuring that kids and families from primary care practices with acute mental health needs can access specialized services in a timely fashion.

Other potential components of a pediatric medical home project:

• Exploration of a partnership with Shipley Clinic to develop a “Quadrant IV” pediatric medical home for children in Stark County with high acuity behavioral and physical health needs and/or a partnership with Aultman Family Practice to provide ongoing pharmacotherapy for “Quadrant I” kids currently treated at C&A who are stabilized on medication without acute physical health needs who lack a primary care medical home.

We’ve had one preliminary meeting to date with the Executive Director and medical team at Shipley as well as a meeting with Dr. John Sutton of Aultman Hospital, who is leading the hospital’s efforts to launch a federally qualified health center (FQHC) in Stark County.

Program or Project Successes

See above

Program or Project Challenges

The greatest challenges we’ve faced in implementing the project have been getting access to and engagement from the pediatric practices in Stark County, a lack of accurate baseline data regarding the psychiatric diagnoses of kids seen by the Medical Services department and the identity of their primary care physicians, and our inability to quickly and easily gather data regarding existing patients through the agency’s electronic medical record.

Access/Engagement with Primary Care Practices:

We’ve only accessed a little less than half of the pediatric practices to date in the county to introduce the project. We’ve received some very harsh, but helpful feedback during meetings with two practices.

Why are they reluctant to engage?

Taking care of more kids with mental health concerns represents an additional burden to their practices. Kids with mental health concerns are messy and complicated. Their needs don’t easily fit within the brief follow-up appointments necessary to sustain the business model of their practices. In retrospect, we shouldn’t have been surprised to have experienced significant resistance and pushback when we asked them to take kids back into their practices who had been stabilized when we haven’t been willing or able to accept their most complicated patients.

C&A developed a negative reputation among pediatricians in the county. The agency has historically communicated very poorly with pediatricians. For many years, C&A’s capacity to provide psychiatric care offered has been very limited. They can’t directly refer families to a psychiatrist, psychologist or counselor within the agency as they would for families with private insurance.

What are we doing to overcome the obstacles?

• We’ve implemented a system to improve communication with primary care practices. First, we’ve begun systemically collecting and recording information regarding each client’s primary care physician. At the outset of the project, the Medical Services Department had information regarding the child’s primary care physician (PCP) on only 7.0% of patients served. By the end of July, we obtained PCP information on 56.2% of our patients.

• Notifications are sent to primary care physicians whenever a child presents to C&A for mental health services. In addition, a notification is faxed to the primary care physician is when a child is initially seen by the Medical Services department including the child’s diagnosis and medication regimen, whenever the child’s medication regimen is changed or discontinued, and when a child discontinues treatment through Medical Services.

• We’ve trained our non-medical clinicians on appropriate methods of communication for coordinating care with primary care physicians. Clinicians serving children and teens with mental health conditions with pharmacotherapy needs appropriate for primary care are to speak with primary care physicians by phone before referring parents to those practices for medical services.

• NEOMED has agreed to assist with promotion of Project ECHO among primary care physicians in Stark County. Mailings and announcements will be sent out under the medical school’s letterhead.

• Most importantly, we’re going to be able to provide pediatric practices to access to psychiatric services when their kids have need. We haven’t been positioned to develop a truly reciprocal relationship with these practices when it comes to referrals for a long time. When they recognize that we can provide services to children and teens in from their practices in a timely fashion, we believe they’ll be far more likely to engage.

Peer-Reviewed Journal Articles

Other Publications

Contact Name

Stephen Grcevich

sgrcevich@neomed.edu

Title of Program or Project

The Collaborative Care Initiative: A Partnership between Pediatrics and Psychiatry

Web Site URL

http://partnershipforchildhealth.org/collaborative-care/

Services

  • PCP education
  • PCP consultation

Service Site

  • Primary care clinic
  • Specialty clinic

Service Area

  • Community

Geographic Population

  • Urban
  • Suburban

Service Provider

  • Child & adolescent psychiatrist
  • Psychologist

Service Recipient

  • Pediatrician/adolescent medicine
  • Family Practitioner
  • Advanced practice nurse
  • Physician assistant
  • Other medical professional

Funding

  • Federal
  • Foundation

Program or Project State

Florida

Program or Project Description

The Collaborative Care Initiative (CCI) aims to advance a collaborative model of mental health care between pediatric primary care and psychiatry; and to improve early identification and treatment of emotional and behavioral disorders in children and adolescents in primary care. Three components of CCI are clinical training, clinical consultation, and research.

Clinical training. The CCI provides specialized clinical training and resources for pediatric primary care providers to identify and manage common emotional and behavioral problems. These include emotional and behavioral problems in early childhood (18 months - 60 months), anxiety disorders in school-age children (6 years – 12 years) and adolescents (13 years and older), depression and suicide risk assessment in adolescents (12 years and older), and caregiver stress and depression.

Clinical Consultation. A CCI psychiatrist is available for face-to-face outpatient child and adolescent psychiatric consultation to pediatric primary care providers who have participated in CCI clinical training. The goal of this consultation is to provide an initial assessment and limited follow-up with transition back to the pediatric provider who now has the resources and skills to manage mild to moderate emotional and behavioral problems.

Research. The CCI team studies the impact of our programs on screening and treating emotional and behavioral problems through our pediatric primary care research network.

Program or Project Leadership

The Collaborative Care Initiative: A Partnership between Pediatrics and Psychiatry is under the leadership of Dr. Elise Fallucco. She is a child and adolescent psychiatrist, Associate Professor of Psychiatry at the University of Florida, and Director of the Collaborative Care Initiative (CCI). In addition, Dr. Peggy Greco, a clinical pediatric psychologist at Nemours Children’s Healthcare System and Assistant Professor of Psychology at Mayo College of Medicine, serves as a CCI consultant.

Program or Project Evaluation

  • a. Fallucco EM, Wysocki T, James L, Kozikowski C, Williams A, & Gleason MM. (2017). The brief early childhood screening assessment: preliminary validity in pediatric primary care. Journal of Developmental and Behavioral Pediatrics, 38(2):89-98.
  • b. Fallucco EM, Blackmore E, Bejarano CM, Wysocki T, Kozikowski CB, & Gleason MM. (2016). Feasibility of screening for preschool behavioral and emotional problems in primary acre using the early childhood screening assessment. Clinical Pediatrics, 56(1): 37– 45.
  • c. Fallucco EM, Blackmore ER, Bejarano CM, Kozikowksi CB, Cuffe S, Landy R, & Glowinski A. (2016). Collaborative care: a pilot study of a child psychiatry outpatient consultation model for primary care providers. Journal of Behavioral Health Services and Research, 1 -12.
  • d. Fallucco EM, Seago RD, Cuffe SP, Kraemer DF, & Wysocki T. (2015). Primary care provider training in screening, assessment, and treatment of adolescent depression. Academic Pediatrics, 15(3): 326-332.
  • e. Fallucco EM, Conlon MK, Gale G, Constantino JN, & Glowinski A. (2012). Use of a standardized patient paradigm to enhance proficiency in risk assessment for adolescent depression and suicide. Journal of Adolescent Health, 51(1): 66-72.
  • Program or Project Successes

    • Number of providers trained in Screening, Assessment, and Treatment for Adolescent Depression (SATD): 138
    • Number of providers trained in Advanced Depression: 32
    • Number of providers trained in Early Childhood Screening Assessment (ECSA): 32
    • Number of providers trained in anxiety: 83

    Program or Project Challenges

    1. Engaging child and adolescent psychiatrists to practice a consultation model.
    2. Scheduling trainings and meetings with primary care providers to provide mental health training.

    Program or Project Curricula/Materials

    CCI Anxiety Dosing Pocket Card

    Peer-Reviewed Journal Articles

    Other Publications

    Contact Name

    Valentina Bolanos

    valentina.bolanos@jax.ufl.edu

    Title of Program or Project

    The Pediatric Approach to Trauma, Treatment and Resilience (PATTeR)

    Web Site URL

    Services

    • PCP education

    Service Site

    • Remote (phone or electronic)
    • Other

    Service Area

    • National

    Geographic Population

    • Urban
    • Inner city
    • Suburban
    • Rural
    • Migrant
    • Tribal
    • Other

    Service Provider

    • Pediatrician/adolescent medicine

    Service Recipient

    • Pediatrician/adolescent medicine
    • Advanced practice nurse
    • Other medical professional

    Funding

    • Federal

    Program or Project State

    California

    Program or Project Description

    The Pediatric Approach to Trauma, Treatment and Resilience (PATTeR) is designed to educate pediatricians about childhood trauma to improve the identification, care, management and outcomes of millions of traumatized children who currently have limited access to mental health resources. PATTeR is proposed and led by the Department of Pediatrics at UCLA, in collaboration with the American Academy of Pediatrics and UMMS Department of Pediatrics. In 2013, only 4% of pediatricians who responded to the AAP's national Periodic Survey were familiar with childhood trauma. Yet, pediatricians are likely to be the first, and often only, professionals who encounter the 68% of American children who have experienced trauma. Because pediatricians currently lack the knowledge and skills to undertake trauma care and there is a dearth of mental health trauma resources, the University of California at Los Angeles (UCLA) Department of Pediatrics' Development al Studies Program, the American Academy of Pediatrics (AAP), and the University of Massachusetts Medical School (UMMS) Department of Pediatrics are partnering to achieve PATTeR's 3 primary goals: 1) To develop/adapt curricula to train pediatricians about the trauma-informed approach to pediatric care in every interaction with children and families; 2) To educate pediatricians recruited nationally about the PATTeR curriculum via multiple AAP venues to create a Trauma-Aware pediatric workforce; and, 3) To educate a subset of nationally representative pediatricians using an advanced PATTeR curriculum to create a Trauma-Responsive leadership able to promote the transformation of pediatrics to a Trauma-Responsive system of care. Specifically, Trauma-Responsive leadership will receive training about quality improvement to promote the implementation of trauma screening and evidence-informed trauma-specific anticipatory guidance, known as Child Health Advice for Trauma (PATTeR CHAT) in their offices. Trauma-Responsive leaders will also acquire the knowledge and skills to train their colleagues, thus expanding the population of trauma-informed pediatricians. In a Trauma-Responsive system of care, pediatricians will be prepared to identify and manage traumatized patients and families and connect them to evidence-based interventions and/or provide support for families. PATTeR will utilize NCTSN (and SAMHSA, where applicable) products and prepare pediatricians to identify and care for high-risk underserved populations. We anticipate directly training at least 180 pediatricians over the project timeline through the Extension for Community Healthcare Outcomes (ECHO) to create a nucleus of Trauma-Aware and Trauma-Responsive pediatricians who will directly impact the care of up to 270,000 children. By adapting the PATTeR ECHO curriculum to multiple AAP educational venues and harnessing the AAP's strong member engagement, we anticipate reaching many of its 64,000 pediatric members. This will support replication, dissemination, and sustainability, promote the transformation of pediatrics to a Trauma-Responsive system of care, and improve outcomes for millions of traumatized children across the USA.

    Program or Project Leadership

    PI: Moira Szilagyi, MD, PhD, Professor of Pediatrics at UCLA, Section Chief of Developmental Studies

    Collaborators:

    Heather Forkey, MD, Associate Professor of Pediatrics, UMass Medical School, Devision Director for Child Protection Program

    Mary A Crane, PhD, LSW, .American Academy of Pediatrics (AAP), Division of Developmental and Behavioral Pediatrics and manager of the AAP Council on Foster Care, Adoption and Kinship Care

    Tammy Piazza Hurley, American Academy of Pediatrics, manager for the AAP Committee and Section on Child Abuse and Neglect

    Program or Project Evaluation

    To begin 10/1/2016

    Program or Project Successes

    Pending

    Program or Project Challenges

    Pending

    Program or Project Curricula/Materials

    Peer-Reviewed Journal Articles

    Other Publications

    Contact Name

    Heather Forkey

    heather.forkey@umassmemorial.org

    Title of Program or Project

    Tulane Early Childhood Collaborative

    Web Site URL

    http://tulane.edu/som/tecc

    Services

    • PCP education
    • PCP consultation
    • Care coordination

    Service Site

    • Primary care clinic

    Service Area

    • Community

    Geographic Population

    • Urban

    Service Provider

    • Pediatrician/adolescent medicine

    Service Recipient

    • Pediatrician/adolescent medicine

    Funding

    • Foundation

    Program or Project State

    Louisiana

    Program or Project Description

    The Tulane Early Childhood Collaborative program provides consultation to pediatric primary care providers to promote mental health in children under 6.

    Our goal: Promoting early childhood and family well-being by Supporting pediatric primary care providers to identify risk factors early, promote family well-being, and address early mental health problems. Read more about TECC under program information tab.

    TECC is here to support primary care providers to promote mental health in children under 6 and their families through

    • Mental Health Consultation
    • Curbside consultations at your office
    • Phone, e-mail, or secure video consultations
    • We can also see children for a consultation evaluation to help clarify the diagnosis or make treatment recommendations
    • In-service trainings/“lunch and learns” for PCPs about early childhood mental health
    • Web-based resources to hand out to families or to learn more about the foundations of early childhood mental health

    We can answer questions about general topics or about specific children

    • Promoting emotional health in typically-developing children
    • Behavioral concerns
    • Emotional problems or trauma reactions
    • Parent-child relationships
    • Medication questions
    • Parenting resources for families
    • And any others you want!

    Program or Project Leadership

    Who we are: We are pediatric mental health providers: child psychiatrists, pediatrician-child psychiatrists, and child psychologists. We've worked in primary care clinics and specialty early childhood mental health clinics and are part of the Tulane Institute of Infant and Early Childhood Mental Health. Our program includes rotating pediatric residents and general psychiatry residents as well as child psychiatry fellows and senior triple board residents.

    Program or Project Evaluation

    Program evaluation is underway. Our program will be measuring use of consultation and changes in provider's attitudes, beliefs, and knowledge about early childhood mental health.

    Program or Project Successes

    Early successes are anecdotal to date. Pediatric primary care providers have given written narrative comments including some of these below:

    "TECC consultants were extremely helpful in meeting with my patients/parents, put the parent and patient at ease with their approach, and the parent left with a clear plan for initial management of their child's behavioral concerns. Follow-up plans were also given at the initial appointment. Would not change a thing."

    "Very educational. For me as a provider and for parents."

    "I am pleased and grateful for the consultations."

    "Being present in the clinic and visible makes use of the consultation very accessible and readily available"

    "TECC has made a big difference in my practice. It's wonderful to be able to offer help to families of young children that is convenient for them and through having TECC available in our clinic I am learning to better manage common mental health and behavioral problems in young children myself"

    Subjectively, providers who have utilized consultation have shown increasing sophistication of consultation questions, formulating the case in ways they did not when they started in the beginning of the consultation project.

    Program or Project Challenges

    Some challenges or areas of growth have included

    • Professional cultural factors that influence how consultants interact with the pediatric providers. We have become more intentional in training non-pediatrically trained consultants in understanding pediatric practice, culture and expectations.
    • Interest in "owning" mental health issues is variable among consultees, especially around the role of maternal depression.
    • Interest in universal screening has been limited to date.

    Program or Project Curricula/Materials

    Peer-Reviewed Journal Articles

    Other Publications

    Contact Name

    Mary-Margaret Gleason

    mgleason@tulane.edu

    Title of Program or Project

    Wisconsin Child Psychiatry Consultation Program (CPCP)

    Web Site URL

    http://www.chw.org/cpcp

    Services

    • PCP education
    • PCP consultation
    • Care coordination
    • Patient/family education/self-management

    Service Site

    • Specialty clinic
    • Hospital
    • Remote (phone or electronic)

    Service Area

    • Community
    • Other

    Geographic Population

    • Urban
    • Inner city
    • Suburban
    • Rural
    • Migrant
    • Tribal

    Service Provider

    • Child & adolescent psychiatrist
    • Psychologist
    • Social worker
    • Other mental health professional
    • Other

    Service Recipient

    • Pediatrician/adolescent medicine
    • Family Practitioner
    • Advanced practice nurse
    • Physician assistant
    • Other medical professional
    • Child
    • Adolescent
    • Parents
    • Family

    Funding

    • State
    • Foundation

    Program or Project State

    Wisconsin

    Program or Project Description

    The CPCP provides service to enrolled Primary Care Providers (PCPs) in the Northern and Southeastern regions of Wisconsin and Milwaukee County.

    The CPCP exists to increase primary care clinicians’ capacity to support behavioral health needs of children, adolescents, and their families in their care. The CPCP accomplishes this goal by:

    • Providing consultation to primary care providers regarding diagnosis and management options for children and adolescents with mental health problems
    • Providing and ensuring a referral support system for these pediatric patients to other mental health professionals and community resources as identified and needed
    • Providing education and training in mental health issues for primary care providers

    Program or Project Leadership

    Jon Lehrmann, MD is the chairperson of the Medical College of Wisconsin Department of Psychiatry and Behavioral Medicine. He is also the Charles E. Kubly professor in Psychiatry and Behavioral Medicine as well as the associate chief of staff for mental health at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin.

    Robert Chayer, MD is the Chucker Aring chair in Child and Adolescent Psychiatry, the vice-chair of child and adolescent services, and an associate professor in the Medical College of Wisconsin Department of Psychiatry and Behavioral Medicine.

    Program or Project Evaluation

    CPCP outcomes involve both infrastructure and service-related outcomes. Data come from consultation encounter records, baseline surveys from enrolled providers, and satisfaction surveys.

    Program or Project Successes

    Infrastructure success:

    • One of the main successes of the CPCP in the first year was the rapidity with which the team was able to develop the infrastructure necessary to enroll clinics in the Milwaukee County and Southeaster and Northern Regions. This was accomplished by hiring requisite program leadership and staff in both regions along with the creation of a phone line, email process, website, stakeholder meetings, and standardized communication tools. The creation and implementation of in person and online training also reflect the agility of the CPCP team to work together to fill a gap in education among PCPs in child and adolescent psychiatry in a method that is responsive to their learning needs. This work required multi-sector collaboration and flexibility over the granting period among all vested partners, a theme that resounded from many CPCP team members during discussions. These qualities have provided the current CPCP team a solid framework on which to build the structure to execute successf ully the goals of the CPCP in the two regions of Wisconsin.

    Service outcome success:

    • The use of CPCP steadily increased over Year 1. PCP survey results indicate high satisfaction with the program.

    Education success:

    • In 2015, CPCP provided 61 face-to-face educational sessions that were also converted into online modules available to all enrolled providers.
    • The number of PCPs who received the primary educational sessions included:
      • 118 for "Treatment of ADHD in children and adolescents."
      • 98 for "Assessment and treatment of depression in children and adolescents."
      • 98 for "Use of atypical antipsychotics in children and adolescents."

    Consultation successes:

    • In 2015, the CPCP provided 328 PCP consultations via telephone or secure email (i.e., encounters). More than half of these calls originated from Milwaukee and Marathon counties (38% and 19%, respectively). Thus far, 121 different providers (41% of those enrolled) have utilized the consultation service, calling about approximately 275 children and adolescents with behavioral and mental health needs in their practice.

    PCP satisfaction success:

    • During 2015, CPCP implemented satisfaction surveys with PCPs enrolled to understand satisfaction with the education and consultation services provided by the program. Overall, the results indicate a high satisfaction with CPCP services. Nearly all were satisfied with the various lectures they attended. In addition, among PCPs who had an encounter with the consultation line and completed the satisfaction survey, over 90% were satisfied with the length of time in which the CPCP responded to their call or email, the amount of time a CPCP member spent with them, and the encounters regarding medications.

    Program or Project Challenges

    Barriers were identified during the pilot phase through stakeholder meetings, individual interviews conducted with members of the CPCP team, anecdotes shared by PCPs, and general observations by CPCP team members. The most significant of these are:

    • Busy schedules of PCPs and clinic managers.
    • PCPs outside of the Northern and Southeastern Regions of Wisconsin and Milwaukee County have requested access to the CPCP.
    • Northern Region providers appeared to be less interested in face-to-face educational sessions.
    • Clinics in the Northern Region have difficulty reporting number of children and adolescents served possibly due to reduced access to electronic medical record systems.
    • Many PCPs work at more than one clinic.
    • Evaluation system does not include outcomes from children, adolescents, or families.

    Program or Project Curricula/Materials

    Peer-Reviewed Journal Articles

    Other Publications

    Contact Name

    Sara Herr

    sherr@mcw.edu

    There are currently no programs & projects that match this criteria.


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