Assessment of Primary Care Pediatrician Provision of Mental Health Care

Transcription

1 Assessment of Primary Care Pediatrician Provision of Mental Health Care Kevin Borrup, JD, MPA Connecticut Children's Medical Center University of Connecticut School of Medicine Danielle Chenard Connecticut Children's Medical Center Steven Rogers, MD, MS-CTR University of Connecticut School of Medicine

2 Mission, Vision and Values MISSION Connecticut Children's Medical Center is dedicated to improving the physical and emotional health of children through family-centered care, research, education and advocacy. We embrace discovery, teamwork, integrity and excellence in all that we do. VISION We are making children in Connecticut the healthiest in the country. CORE VALUES Family-Centered Care Discovery Integrity Teamwork Quality Respect

3 Background More than 156,000 children in Connecticut have unmet mental health needs (CT-DCF, 2014) Despite professional mandates, training and outreach, and focused mental health services being available to pediatricians there has been slow progress toward an integrated approach to children s mental healthcare (Hooper, 2012)

4 Research Questions 1. What are the conditions or factors that can promote integration of mental health care for children within the context of pediatric primary care? 2. How do pediatricians perceived roles, relationships, and clinical practice characteristics influence the level of mental health care integration? 3. How do pediatric practice views of the system compare to the existing recommendations in the state plan that seeks to promote children s mental health?

5 Methods 1. Survey (48-items) sent to a representative subset of pediatricians (n=133) 2. Six Mental Health Action Groups (focus groups) engaged in system support mapping (SSM) - 48 participants

6 BRIEF SUMMARY OF RESULTS

7 Variables n Response Categories MODE Practice reports having/using/doing 1=we do not do this 2=we do not do this well 3=we do this to some 4=we do this well Inventory 79 5 (6.3%) 10 (12.7%) 47 (59.5%) 17 (21.5%) Relationships 80 8 (10%) 19 (23.8%) 42 (52.5%) 11 (13.8%) Billing 80 8 (10%) 27 (33.8%) 30 (37.5%) 15 (18.8%) Brochures 80 8 (10%) 22 (27.5%) 32 (40%) 18 (22.5%) Referral supports 80 1 (1.3%) 6 (7.5%) 42 (52.5%) 31 (38.8%) Identification of MH 79 0 (0%) 11 (13.9%) 35 (44.3%) 33 (41.8%) Assessment of care 80 8 (10%) 18 (22.5%) 33 (41.3%) 21 (26.3%) Patient registry for MH (38%) 21 (26.6%) 18 (22.8%) 10 (12.7%) 1=we do not do this Emergency plan (17.7%) 17 (21.5%) 26 (32.9%) 22 (27.8%) Practice collaboration 80 7 (8.8%) 17 (21.3%) 35 (43.8%) 21 (26.3%) Inclusive planning (26.3%) 21 (26.3%) 29 (36.3%) 9 (11.3%) Collection and scoring 78 8 (10.3%) 13 (16.7%) 17 (21.8%) 40 (51.3%) 4=we do this well Validated assessments 79 6 (7.6%) 13 (16.5%) 19 (24.1%) 41 (51.9%) 4=we do this well Tools for treatment (18.8%) 25 (31.3%) 24 (30%) 16 (20%) 2=we do not do this well Access to a psychiatrist 80 9 (11.3%) 16 (20%) 36 (45%) 19 (23.8%)

8 Variables n Response Categories MODE Practice reports having/using/doing 1=we do not do this 2=we do not do this well 3=we do this to some 4=we do this well Inventory 79 5 (6.3%) 10 (12.7%) 47 (59.5%) 17 (21.5%) Relationships 80 8 (10%) 19 (23.8%) 42 (52.5%) 11 (13.8%) Billing 80 8 (10%) 27 (33.8%) 30 (37.5%) 15 (18.8%) Brochures 80 8 (10%) 22 (27.5%) 32 (40%) 18 (22.5%) Referral supports 80 1 (1.3%) 6 (7.5%) 42 (52.5%) 31 (38.8%) Identification of MH 79 0 (0%) 11 (13.9%) 35 (44.3%) 33 (41.8%) Assessment of care 80 8 (10%) 18 (22.5%) 33 (41.3%) 21 (26.3%) Patient registry for MH (38%) 21 (26.6%) 18 (22.8%) 10 (12.7%) 1=we do not do this Emergency plan (17.7%) 17 (21.5%) 26 (32.9%) 22 (27.8%) Practice collaboration 80 7 (8.8%) 17 (21.3%) 35 (43.8%) 21 (26.3%) Inclusive planning (26.3%) 21 (26.3%) 29 (36.3%) 9 (11.3%) Collection and scoring 78 8 (10.3%) 13 (16.7%) 17 (21.8%) 40 (51.3%) 4=we do this well Validated assessments 79 6 (7.6%) 13 (16.5%) 19 (24.1%) 41 (51.9%) 4=we do this well Tools for treatment (18.8%) 25 (31.3%) 24 (30%) 16 (20%) 2=we do not do this well Access to a psychiatrist 80 9 (11.3%) 16 (20%) 36 (45%) 19 (23.8%)

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10 Feedback we are now sending psychiatric evaluations to pediatricians/pcp s for all child/adolescent clients when those visits occur. We are also sending notes from med [sic] management visits whenever there is a medication change so that the PCP is fully aware of what medications shared patients are on.

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12 FINDINGS/OUTCOMES

13 8 Key Findings/Outcomes 1. Capacity/Access 2. Communication 3. Information 4. Insurance/Cost 5. Training & Education 6. Techniques/Technology 7. Management 8. Parent/Families

14 Capacity/Access Insurance/Billing state level issue MH provider availability impedes access need increased hours, co-location, urgent care/crisis availability, etc Children s Hospitals - should increase capacity

15 Communication Gaps between providers recognized standard protocol/communication tools needed Integrated records (co-location?) Opportunities for dialogue Gaps with families not recognized

16 Information Central information resource needed to facilitate referrals and improve access Complete array of options/services need to be clearly presented to PCPs and families

17 Insurance/Cost Stakeholders need to advocate for adequate reimbursement for mental health services, including home visitation Mental health providers/clinicians should be incentivized to accept all private and public insurance

18 Training & Education Implement webinars and conferences on special issues relevant to pediatric mental health, providing CMEs, MOC, etc Deliver in-service trainings that cover practical in-office protocols, policies, and on-site treatment options/therapies (ex. SBIRT)

19 Techniques/Technology Common or shared screening tools should be widely disseminated Technologies should be utilized in solving the lack of a shared medical record (i.e. Health Information Exchange)

20 Management Further develop the available spectrum of services for children including day treatment programs and other service gaps PCPs should be provided with additional tools to address patient and family needs in-office (such as teaching coping skills to parents)

21 Parent/Families Support to families should be provided around building resiliency in children Ensure that families are consulted during mental health visits and are included in behavioral health planning

22 Logic Model

23 Next Steps

24 Conclusions Pediatricians are an essential part of the system of mental healthcare for children Pediatrician participation in planning efforts to improve the system of care is a fundamental to ensure successful change System Support Mapping can be used as a problem-solving tool

25 Acknowledgments Connecticut Department of Children and Families Kristen Hassmiller Lich Assistant Professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Ann Marie White Assistant Professor, Psychiatry, University of Rochester Medical Center

26 Thank You! About Connecticut Children s Medical Center Connecticut Children s Medical Center is the only hospital in Connecticut dedicated exclusively to the care of children. Connecticut Children s is a nationally recognized not-for-profit with a medical staff of more than 1,000 providing comprehensive, world-class health care in more than 30 pediatric specialties and subspecialties. Connecticut Children s Medical Center is the primary pediatric teaching hospital for the UConn School of Medicine, has a teaching partnership with the Frank H. Netter MD School of Medicine at Quinnipiac University and is a research partner of Jackson Laboratory. Connecticut Children s Office for Community Child Health is a national leader in community-based prevention and wellness programs. To learn more about Connecticut Children s Medical Center, please visit connecticutchildrens.org. 282 Washington Street, Hartford, CT Connecticut Children s Medical Center. All rights reserved.