BHIP: Behavioral Health Integration Program at Montefiore- Across the Pediatric Lifespan

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1 BHIP: Behavioral Health Integration Program at Montefiore- Across the Pediatric Lifespan Rahil D. Briggs, PsyD. Associate Professor of Pediatrics, Albert Einstein College of Medicine Director, Pediatric Behavioral Health Services, Montefiore Medical Group

2 Healthy Steps at Montefiore 2006-present Co-location and integration of mental health specialists in pediatric primary care Universal screening, assessment, treatment, and referral of infant mental health/development and caregiver mental health Adverse Childhood Experiences (ACES) Ages and Stages Questionnaires: Social Emotional (ASQ:SE) Patient Health Questionnaire ( PHQ-9) Provider education

3 Healthy Steps at Montefiore First time mothers and their children and partners enrolled either prenatally or before the child is 2 months old Co-management of well child visits Baby and Me group Home visits Adult mental health services

4 Healthy Steps Program Evaluation montekids.org

5 Design Quasi-experimental longitudinal follow up of children enrolled in a Healthy Steps (HS) program at their primary care pediatric setting and a comparison group (CG) from a matched clinic who met enrollment criteria, but did not receive the intervention

6 Objective and Method Determine the relationship between maternal ACES and maternal report on the ASQ:SE at 36 months General linear model and logistic regression (LR) analyses Adjusted for baseline differences between HS and CG and between study completers and drop-outs

7 Results Impact of Intervention on 36 month ASQ:SE scores CG Children of mothers with 1 or more ACES CG children of mothers with no ACES HS Children of mothers with 1 or more ACES HS Children of mothers with no ACES 0 ASQ:SE mean score p<.001 Briggs, et al. (2014). Healthy Steps as a Moderator: The Impact of Maternal Trauma on Child Social- Emotional Development. Clinical Practice in Pediatric Psychology (2, 2),

8 Behavioral Health Integration Program Behavioral Health Pediatric Primary Care

9 Our model (present future) 300,000 patients (90,000 pediatric) 21 sites Healthy Steps 0-5, innovative Child and Adolescent programming (CAP), Collaborative Care Initiative model for adults Universal life span behavioral health screening Family assessments Integrated care at each site (hubs and satellites) Challenges

11 CAP Study Objectives Understand the feasibility of implementing integrated behavioral health services on a large scale in pediatric clinics with a particularly vulnerable population Understand the effectiveness of CAP in improving the mental and physical health Montefiore s pediatric patients Understand the effectiveness of CAP in reducing health care utilization and costs

12 Outcome measures Primary outcomes: Mental health symptoms measured using PSC-17 4-month follow-up administered by research assistants Only among primary sample: patients at BOPS clinics with positive PSC-17 Better Health Medical service utilization sick visits and ED utilization Lower Costs Steroid prescriptions for asthma as a proxy for asthma control Better Health

13 Outcome measures Secondary outcomes: Patient satisfaction two questions modified from the Strengths and Difficulties Questionnaire Provider satisfaction Online survey (comfort with behavioral health issues and satisfaction with the mental health care provided) Process measures measuring success of implementation % of patients referred to mental health providers % of patients referred who came to the first mental health visit number of days between referral and the first mental health visit number of mental health visits patients attended number of patients who successfully completed treatment

14 BHIP Conclusions It is feasible and efficacious to integrate pediatric behavioral health into primary care pediatrics/family medicine settings HS as a moderator between ACES in parents and SE development in children Early data from CAP: Sept-Nov 2014: 19.6% of children presenting for HCM were referred to BHIP (N=833 referrals) at least 55% of those children came in for separate visits with the BHIP provider.

15 Acknowledgements Andrew Racine Judy Aschner Peter Belamarich BHIP and Healthy Steps providers MMG provider and practice teams, MMC leadership Supporters (Altman Foundation, Center for Medicaid and Medicare Innovation, Child Welfare Fund, Edith Glick Shoolman Children s Foundation, Grinberg Family Foundation, Marks Family Foundation, NYC Children s Mental Health under 5 Initiative, Price Family Foundation, Stavros Niarchos Foundation, Tiger Foundation)

Rahil Briggs, PsyD Director, Pediatric Behavioral Health Services Clinical Team, Healthy Steps (Birth-5 years) Rebecca Schrag Hershberg, PhD Director of Training, Healthy Steps Clinical Team, Child &

16 Rahil Briggs, PsyD Director, Pediatric Behavioral Health Services Clinical Team, Healthy Steps (Birth-5 years) Rebecca Schrag Hershberg, PhD Director of Training, Healthy Steps Clinical Team, Child & Adolescent Psychology Miguelina German, PhD Director of Training, Child and Adolescent Laura Krug, LCSW Senior Healthy Steps Specialist Polina Umylny, PhD Senior Healthy Steps Specialist Elizabeth Altschuler, PhD Healthy Steps Specialist Loring Bartlett, PsyD Healthy Steps Specialist Kate Cuno, PsyD Healthy Steps Specialist Elizabeth Ward, PhD Healthy Steps Specialist Carina Wind, LMSW Healthy Steps Specialist Miguelina German, PhD Clinical Director, Parental Mental Health Desiree Castillo, PhD Parental Mental Health Specialist Micheal Dowling, PhD Parental Mental Health Specialist Clinical Team, Child & Adolescent Psychiatry Audrey Walker, MD Division Chief, Child and Adolescent Psychiatry Jason Herrick, MD Pediatric Psychiatrist Uchenwa Okoli, MD Pediatric Psychiatrist Darryl Smith, MD Pediatric Psychiatrist Susan Weinstein, MD Pediatric Psychiatrist Research Evaluation Team Miguelina German, PhD Director of Quality Elizabeth Altschuler, PhD Pediatric Psychologist Diane Bloomfield, MD, FAAP Medical Director, FCC Nicole Brown, MD, MPH, MHS Attending Physician, FCC Silvie Colman, PhD Health Economist Lauren Haliczer, MA Lab Manager Teresa Hsu-Walklet, PhD Senior Psychologist Michael Rinke, MD, PhD Assistant Medical Director of Pediatric Quality Carla Cirilli, PsyD Senior Psychologist Dana Crawford, PhD Senior Psychologist Teresa Hsu-Walklet, PhD Senior Psychologist Elizabeth Merrill, PsyD Senior Psychologist Elizabeth Altschuler, PhD Pediatric Psychologist Martha Bennett, PsyD Pediatric Psychologist Desiree Castillo, PhD Pediatric Psychologist Kate Cuno, PsyD Pediatric Psychologist

Mental Health Screening in Pediatric Primary Care: Results from a Quality Improvement Learning Collaborative

Leandra Godoy, PhD, Melissa Long, MD, Tamara John Li, MPH, Mark Weissman, MD, Lee Savio Beers, MD April 1, 2016 Society for Behavioral Medicine Mental Health Screening in Pediatric Primary Care: Results