Transcript Title of Presentation - Collaborative Family Healthcare Association

Session #12a
October 28, 2011
1:30 PM
Collaboration with Pediatric Primary
Care Providers: Bridging the Gap
Sandra L. Fritsch, MD, Training Director, Child &
Adolescent Psychiatry Residency, Maine Medical Center
Renee Leavitt, MS, OTRL, Program Manager, Child &
Geriatric Outpatient Psychiatry, Maine Medical Center
Collaborative Family Healthcare Association 13th Annual Conference
October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Faculty Disclosure
I/We have not had any relevant financial
relationships
during the past 12 months.
Need/Practice Gap & Supporting Resources
What is the scientific basis for this talk?
• ~ 20 percent of U.S. children and adolescents (15 million), 9 to 17,
have diagnosable psychiatric disorders (MECA, 1996, the Surgeon
General, 1999)
• Only about 20% of emotionally disturbed children and adolescents
receive some kind of mental health services (the Surgeon General,
1999), and only a small fraction of them receive evaluation and
treatment by child and adolescent psychiatrists.
• 2007 National Survey of Children’s Health (NSCH), 20,562 children
(7.2%) in Maine ages 0-17 had an emotional, developmental or
behavioral problem for which they needed treatment or
counseling. More than 29% of Maine children (40% of U.S. children)
with mental health issues did not receive needed mental health
services
Objectives
1)
2)
3)
To provide an understanding of the mental health needs of
children and adolescents
To describe a collaborative care model: The Child Psychiatry
Access Program in Maine (CPAP)
To understand how the CPAP model enhances primary care
delivery of mental health assessment and treatment
Expected Outcomes
1)
Learners will understand the needs and challenges for
mental health treatment of children and adolescents
2)
Learners will be able to describe a collaborative care model
between child psychiatry and primary care
3)
Learners will be able to identify the key components for
success in collaborative care partnerships
Learning Assessment
A learning assessment is required for CE credit.
Attention Presenters:
Please incorporate audience interaction through a
brief Question & Answer period during or at the
conclusion of your presentation.
This component MUST be done in lieu of a written
pre- or post-test based on your learning objectives to satisfy
accreditation requirements.
Gap? Why does it exist?
• Managed care/splitting of
benefits
• Fee for service medicine,
time
• Stigma
• Training gaps
• Work force shortage issues
• Ideological differences
• “Privacy”
Health Care Reform
Potential Changes
• Patient-centered Medical Homes
• Team-based medical care
• Accountable care organizations
• All speak to opportunities/needs/mandates
for bringing mental/behavioral health needs
into primary care, creating BRIDGES
Thoughts on Bridges:
• Ways/models? How might
this work?
– Traditional
– Collaborative/consultative
– Co-located provider
• Pros & cons of mental health
involvement?
Radio Play
(before CPAP)
CPAP
• Child Psychiatry Access Project
• Funded by MEHAF, pilot project
• Ultimate goal is to aid PCP’s with access to
child mental health and
• To promote efficacy and change behaviors of
PCP’s to deliver basic mental health screenings
and treatment
CPAP Model
• Based on similar model in Massachusetts
(www.mcpap.org)
• Attempts to “replicate” MCPAP in other states
as well
• Key personnel
– 0.5 fte Clinical care coordinator (CCC)
– 0.25 fte Child & Adolescent Psychiatrist (CAP)
CPAP (how we “do it”)
• 1st: Face to face meeting with all members of practice
to describe program and “sign contract”
• Pre-survey on “access to care”
• Initial call to CCC to request resource or telephone
consultation
• CAP returns call within 45 minutes
• Possible face-to-face patient consultation
• Collaborative learning sessions
CPAP Learning Sessions
Lunch & Learning Sessions By Year
Year One
Year Two
Year Three
Formal signing up the
practice
Fundamentals of
Antidepressant
Medications
Encopresis & Enuresis
Mental Health Screening
Tools
Crisis and Chaos in the PCP
Setting
ODD, “Just Say Yes”
Basics for ADHD,
Medications and
Treatements
Treatment of Anxiety in
Primary Care
What is Therapy? What are
the Systems of Care in
Maine?
Depression and Suicide and
the Role of the PCP
Natural Therapies for
Mental Health Issues
and Sleep
Substance Abuse
Examples of Phone Consults:
• Review of testing and establishing treatment
algorithm
• School refusal
• Cutting and IDDM
• “Messiah”
• Progressive decline
Roles of the Child Psychiatrist
•
•
•
•
•
•
Educator
Cheerleader
Team member
Provide a joint partnership
“The Expert”
“The Bad Guy”
Radio Play
(After CPAP)
CPAP Resource Utilization
Jan 2010 – Sept 2010
•
•
•
•
•
Total # calls = 117
Calls for resources = 32
Phone consults with CAP = 95 (?)
Face to Face Consults = 19
Diagnoses:
–
–
–
–
Co-morbid = 49%
Anx/ADHD=17%
Dep/Anx=16%
ADHD/ODD=6%
ADHD=18%
Dep=13%
Anx=8%
CPAP Statistics, Year 2
• Service questionnaire:
– Adequate access to child psychiatry?
• Pre CPAP=100% disagree or strongly disagree
• 12+ Months after CPAP=100 % agree or strongly agree
– Child Psychiatry consultation in timely manner?
• Pre CPAP = 100% disagree or strongly disagree
• 12+ months post CPAP = 100% agree or strongly agree
– Able to meet the mental health needs of patients with
existing resources:
• Pre CPAP = 12% agree or strongly agree
• 6 months post CPAP = 100% agree or strongly agree
Comments: “I feel now that I can do anything because you are available”,
“Thank you that was really helpful”, “I did the PHQ-9 before med and after
and it shows she is really better…”
Other Statistics, Year 2
• Response to survey 11/16= 68.8%
• Use of CPAP services 9/11= 81.8%
• How do you screen mental health?
– 54.5% tools
– 45.5% interview
Discussion
Ways to “bridge your gaps”
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