Transcript Slides - CT-AAP

Developmental and Behavioral
Health Screening in Pediatric
Primary Care
Kim Brownell, MD
HUB Medical Director, ACCESS-MH CT,
Institute of Living/Hartford Hospital
Barbara Ward-Zimmerman, PhD
Consultant, Child Health and Development Institute, Educating
Practices in the Community Program
Objectives of Webinar
• Underscore the value of screening for
developmental and behavioral health
concerns
• Identify common screening instruments to be
used for early detection
• Review coding and billing procedures for
screening
• Provide mechanisms for securing timely
behavioral health referral resources
Remember, you are not
alone in Connecticut!
Child Health and Development
Institute (CHDI)
• The Educating Practices In The Community
Program (EPIC) provides in-office trainings on
a variety of topics, including screening and
connecting children and families to behavioral
health resources
• To Learn More About EPIC or to SCHEDULE A
Training Session, Contact:
• Maggy Morales, EPIC Coordinator
• [email protected]
• 860-679-1527
Why is Screening Critical in
Pediatric Primary Care?
Primary Care: ideal setting to identify developmental delays;
de facto behavioral health system; PC providers often serve as
gatekeepers to early intervention and behavioral health care 1
Decreases inappropriate referrals, facilitates early identification
and early intervention to improve overall outcomes and cost
savings 2,3
Behavioral health conditions are highly prevalent in PC 4
Majority of behavioral health conditions are undetected and/or
untreated 5
Barriers to Screening in Primary Care
Anticipated Barrier
Proven Experience
Lack of Time
Screening can be completed quickly and
efficiently
Lack of Staff
No additional staff required
Lack of Training
Minimal training is needed for screening
Lack of Patient and/or Vast majority patients and parents accept and
Parent Acceptance
appreciate screening
Remaining Barrier
• Timely, Readily Available, and Collaborative
behavioral health referral resources
• This barrier is being tackled in Connecticut
and the expanding solutions will be addressed
throughout today’s webinar
First-Stage Screening
Brief standardized measures administered on a routine basis
Designed for asymptomatic, apparently “normal” patients
Does not provide a diagnosis but identifies those in need of
further assessment
Results in further discussion, second-stage screening, or
referral for a formal evaluation
Helps to formulate referral questions
Second-Stage Screening
Generally conducted when 1st stage screen identified a risk
Available to all patients but only administered after positive
1st stage screen
Determines if referral for extensive evaluation is
needed/conserves full intensity services for those truly in
need
Effectiveness relies on knowledge of resources to facilitate
timely triage
Uses Single or Multi-Dimensional Scales dependent on
need
Clinical Pearls for the Pediatric Health Care
Provider to Introduce Screening in Primary Care
• Universal (First-Stage) Screening: “We ask all of our
patients these questions because it helps us understand if
you have concerns that we should discuss in our visit.”
• Selective (Second-Stage) Screening: “I see that you have
concerns about your child’s development/your life and
would like you to answer these questions so I can better
understand what is happening and see if I can help.”
• Note: Parents are typically the informants on
standardized screening in pediatric primary care until
the child reaches adolescence
Establishing Screening Practices
WHO will administer
and score the screening
instruments and how will
they be trained?
WHAT are the concerns
of the practice which you
wish to establish
screening for?
WHEN will the
screening occur?
WHERE will the
screening occur and via
what mechanism?
HOW will screens be
scored and results be
made available to
providers, communicated
to patients, and entered in
the record?
HOW much time will
screening require?
Key Steps to Implementing
a Screening Program
• Assess current office protocols
• Identify a clinical champion and an administrative champion
to maintain the initiative as a priority
• Select screening tool(s)
• Map the workflow
• Identify system supports (networking with community
partners is key)
• Conduct staff orientations
• Share process and outcome data at regular intervals with staff
and modify procedures as needed
Establishing a Protocol
for Responding to Positive Screens
Interpretation of a Positive Screen and Follow-Up Activities
•
Interpret score as child is “at risk”
•
May schedule a separate appointment to fully discuss screening results
•
Choose from a pre-established continuum of intervention options 1
•
•
•
Primary care-delivered psychosocial interventions
Behavioral health/developmental specialist or team based in primary care
Linkage with specialty behavioral health/developmental services
•
Referrals for further evaluation/treatment should take into consideration:
settings in which behavioral health difficulty occurs; developmental status;
health status; and family/cultural factors 2
•
Provide assistance to ensure that recommended follow-up services are
secured
Consider Developing a Patient Registry:
It helps to recognize developmental and behavioral
health issues as chronic conditions
•
•
•
•
Maintain ongoing follow-up
PCP office should serve as the patient’s medical home
Use a chronic care model for treatment
This can involve a “Chronic Disease Registry” in your office which could
look like:
• a cardex
• an excel spread sheet
• an electronic data bank
• Some offices will designate one person (medical assistant or nurse) to be
in charge of all matters involving developmental and behavioral health
issues, e.g., ADHD diagnosis and follow-up
• This person can help you with efficiency by making sure parents complete
all relevant paperwork and that you have the results of screening (e.g.,
Vanderbilt) in a timely fashion. They can also obtain copies of any formal
psycho-educational testing done by school or specialists
Patient Registries
• Facilitate clinical decision support
approaches and evidence-based practice
guidelines
• Sophisticated registries extract data
directly from the electronic medical record
and track outcomes overtime
Example Patient Registries
Newly
Identified
Patients with
Depression
Initiated on
Antidepressant
Medication
• FDA recommends follow up weekly times 4 weeks
then every 2 weeks times 2 months and then at
12 weeks
• EHR registry extracts patients who recently
started antidepressant medication
• Care manager schedules 2 phone follow-ups and
an in-person visit within 84 days to monitor
medication compliance and track PHQ9
Follow-Up
FDA Statement: Ideally, such observation would include at least weekly, faceto-face contact with the patients or their family members or caregivers during
the first 4 weeks, then biweekly x4 weeks, then at 12 weeks. Additional
contact by telephone maybe appropriate between face-to-face visits.
*NOTE* There is no empirical evidence to support weekly face-to-face;
evidence suggests telephone contact may be just as effective. AACAP
recommends following FDA guidelines until more research findings available.
Follow Up Schedule
1* 2* 3* 4*
6*
8*
* Face- to- Face
•
•
•
After 12 weeks, visits every 1-2 months x 1year
Continue medications until 9 months after remission is achieved
REMEMBER: Start low, go slow, When stopping, small changes, go slow
12*
Example Patient Registries
Diabetic
Patients
with
Recent
Increase of
A1C >9%
• EHR registry extracts patients with A1C >9%
• Care manager invites patient to a visit or
interdisciplinary group medical appointment;
design individualized plans to address areas of
need (e.g., nutrition, exercise, pharmacological,
behavioral health)
Sample First-Stage Screening for Children
Measure
Age Range
Time
Languages
1-66 Months
10-15 Minutes
English, Spanish
Purchased from:
www.brookespublishing.com (sample
form on website)
5 Minutes
English, Spanish,
Vietnamese
Purchased from:
www.pedstest.com
Online test found at: www.Forepath.org
Initial screen:
5 minutes
English, Spanish,
French, Japanese,
Vietnamese +
Freely available: www.mchatscreen.com
2-60
Months
<15
minutes
English, Spanish
4-16 Years
5 Minutes
English, Spanish,
Brazilian, Chinese +
Freely available:
http://www.massgeneral.org/psychiatry
/services/psc_home.aspx
11-18
Years
5-10
Minutes
English, Spanish
Freely available:
http://www.massgeneral.org/psychiatry
/services/psc_home.aspx
Patient Health Questionnaire (PHQ-9):
Modified for Teens (Depression)
12-18 Years
<5 Minutes
English, Spanish,
Chinese, Italian +
www.phqscreeners.com
CRAFFT Test (Substance Abuse)
11-21 Years
<5 Minutes
English, Spanish +
www.ceasarboston.org/clinicians/crafft.php
Ages and Stages Questionnaires, 3rd
Edition (ASQ3)
Parent Evaluation of Developmental
Status (PEDS)
**Recommend:
9, 18 and 24/30
months
0-8 Years
**Recommend:
9, 18 and 24/ 30
months
Modified Checklist for Autism in
Toddlers, Revised with Follow-Up (MCHAT-R/F)
Coming Soon:
The Survey of Wellbeing of Young
Children (SWYC)
Pediatric Symptom Checklist (PSC-17;
parent completed)
Pediatric Symptom Checklist-Youth
Report
16-30 months
**Recommend:
18 and 24
months
Coming Soon:
Brief Pediatric Symptom ChecklistYouth Report
Source
Freely available:
www.THESWYC.org
ASQ3
PEDS
22
M-CHAT-R
23
PSC-17
LISTA DE SÍNTOMAS DE PEDIATRÍA (PSC-17)
PEDIATRIC SYMPTOM CHECKLIST (PSC-17)
Child’s Name: ______________________________________ Completed by: _____________________________________
Child’s Birthdate: __________________________________ Today’s Date: ______________________________________
Please mark under the heading
that best fits your child
Never Sometimes Often
For Office
Use Only
I A E
1. Fidgety, unable to sit still
2. Feels sad, unhappy
3. Daydreams too much
4. Refuses to share
5. Does not understand other people’s feelings
6. Feels hopeless
7. Has trouble concentrating
8. Fights with other children
9. Is down on him or herself
10. Blames others for his or her troubles
11. Seems to be having less fun
12. Does not listen to rules
13. Acts as if driven by a motor
14. Teases others
15. Worries a lot
16. Takes things that do not belong to him or her
17. Distracted easily
Totals:
Total Score:
Additional questions:
Do you feel that your child has any emotional or behavioral problems for which he or
she needs help?
Yes
No
Do you or your child receive support or other help for any of the above difficulties?
Yes
No
If yes, what services? __________________________________________________________________________
------------------------------------- – FOR OFFICE USE ONLY – ---------------------------------------Suggested Screen Cutoff:
· Fill in unshaded box on the right with:
I≥5
o Never = 0
A≥7
o Sometimes = 1
E≥7
o Often = 2
Total Score ≥ 15
· Sum the columns:
o Internalizing is the sum of column I
o Attention is the sum of column A
Created by W Gardner and K Kelleher (1999), and
o Externalizing is the sum of column E
based on PSC by M Jellinek et al. (1988).
Format adapted for ease of scoring.
o Total score is the sum of columns I, A, & E
PEDIATRIC SYMPTOM CHECKLIST (PSC-17)
Nombre de hijo(a): ________________________________ Completado por: ______________________________
Fecha de nacimiento: _________________________
Fecha de hoy: ________________________
Marque bajo del título que
mejor se describe su hijo(a)
A veces Seguido
Nunca
Para uso de la
oficina
E
A
I
1. No puede estar quieto(a)
2. Se siente triste, infeliz
3. Sueña despierto demasiado
4. Se rehúsa a compartir
5. No comprende los sentimientos de otros
6. Siente desesperanza
7. Tiene problemas para concentrarse
8. Pelea con otros niños(as)
9. Se siente mal de si mismo
10. Culpa a otros por sus problemas
11. Parece que se divierte menos
12. No obedece las reglas
13. Actúa como si impulsado por un motor
14. Molesta o se burla de otros
15. Se preocupa mucho
16. Toma cosas que no le pertenecen
17. Se distrae fácilmente
Totales:
Total de Puntuación:
– PARA USO DE LA OFICINA –
· Rellene el cuadro sin sombra a la derecha con:
o “Nunca” = 0
o “A Veces” = 1
o “Seguido” = 2
· Encuentra el total de las columnas:
o Interiorizando es el total de la columna I
o Atención es el total de la columna A
o Externalizando es el total de la columna E
o Total de Puntuación es el total de columnas I,
A, & E
Corte sugerido del PSC-17:
I≥5
A≥7
E≥7
Total de puntuación ≥ 15
PHQ-9: Modified for Teens
25
CRAFFT
26
New Recommendation in Connecticut:
Screening for Postpartum Mood and Anxiety Disorders
Measure
Edinburgh Postnatal
Depression Scale
(EPDS)
Age Range
Time
Languages
Source
Mothers 1, 2, 4
and 6 months
postpartum
<5 minutes
23,
Including
English &
Spanish
Freely Available:
www.brightfutures.org; and
http://www.fresno.ucsf.edu/pedi
atrics/downloads/edinburghscale
.pdf
• 10% to 20% of women giving birth each year experience mental
health challenges that affect their ability to nurture their children 1
• Consequences of maternal postpartum mental health disorders are
far-reaching and family-wide 2, 3 contributing to:
• Developmental delays; Learning difficulties; Lifelong behavioral
health difficulties; Partner stress and depression
• Pediatric primary care, where infants receive services frequently in
the first year of life, is an opportune site to identify mothers with
Postpartum Mood and Anxiety Disorders and connect them to
treatment 4
Second-Stage Screening for Children
Measure
Domain
Age Range
Time
Screen for Child Anxiety
Related Disorders- Brief
(SCARED-Brief)
Anxiety
8-18
Parents complete: 811
Child completes:
12-18
<5 minutes
Freely Available:
Birmaher, B., et al., (1999)
J Am Acad Child Adolesc Psychiatry,
38(10), 1230-1236
Vanderbilt ADHD
Screening Tool
ADHD and
Comorbid
Disorders
6-12 (parent and
teacher forms)
10 minutes
Freely Available:
www.nichq.org
SNAP-IV Rating Scale Revised (SNAP-IV-R)
ADHD and
Comorbid
Disorders
6-18 (parent and
teacher forms)
10 minutes
Freely Available:
http://www.adhd.net
**Recommended: 13-17
Depression
6-17
5 minutes
Freely Available:
http://www.brightfutures.org/ment
alhealth/pdf/tools.html
Center for Epidemiological
Studies – Depression Scale
for Children & Adolescents
**Recommended:
Children Under 12
(CES-DC)
Post-Traumatic Stress
Disorder Reaction Index
– Abbreviated (UCLA
PTSD RI)
Trauma
Coming Soon:
Connecticut Trauma
Screen
Trauma
5 – 10
minutes
© 2001 R.S. Pynoos, MD and A.M.
Steinberg, PhD (Youth Version)
© 2008 R.S. Pynoos, MD, A.M. Steinberg,
PhD, and M.S. Scheeringa, MD.
5 – 10
minutes
Lang, Cloud, Stover, & Connell. 2014.
Permission is granted to use for noncommercial purposes
Caregiver Report: 4+
Child Report: 8+
Caregiver Report: 6+
Child Report: 7+
Source
Targeted Screens To Consider:
Measure
Domain
Age Range
Time
Cardiac Health and
Family History
Prior to
Selecting
Psychotropi
c
Medication
Any Age
<5 minutes
Child and Family
Mental Health History
(CHDI)
Prior to
Selecting
Psychotropi
c
Medication
Any Age
Adult ADHD SelfReport Scale (ASRSv1.1) Symptom
Checklist
Adult ADHD
18+
Ask Suicide Screening
Questions
Follow-up to
Positive
Suicidal
Ideation
Source
Freely Available:
CTAAP Developmental & Behavioral
Screening Tool Kit, October 2014
<5 minutes
Freely Available:
CTAAP Developmental & Behavioral
Screening Tool Kit, October 2014
5 minutes
Freely Available:
www.help4adhd.org
(under Rating Scales and Checklists)
10-21
<5 minutes
Freely Available:
http://www.nimh.nih.gov/news/sciencenews/2013/file_143902.pdf
Helpful Mnemonic for
Evaluating Self Harm:
STOPFIRES
Measure
Domain
Age
Range
Time
STOPFIRE
S
Self Harming
Adolescents
Adolescenc
e
5
minutes
Source
Freely Available:
Non-suicidal Self-Injury; Kerr, P., et al. (2010). A
review of current research for family medicine and
primary care physicians. J Am Board Family
Medicine, 23, 240-259.
Tool Selection
Useful Resources for Selecting Measures Include:
• American Academy of Pediatrics’ Mental Health Toolkit (2010)
http://www.aap.org/commpeds/dochs/mentalhealth/docs/MH-ScreeningChart.pdf
• Weitzman, C., & Wegner, L. (2015). Promoting optimal development:
Screening for Behavioral and Emotional Problems. Pediatrics, 135(2),
384-395.
• Massachusetts General Hospital School Psychiatry Program & Madi
Resource Center
http://www2.massgeneral.org/schoolpsychiatry/screeningtools_table.asp
• Massachusetts Primary Care Behavioral Health Screening Toolkit
http://www.mcpap.com/pdf/PCCScreeningToolkitUpdate04292010.pdf
Tool Selection:
Consider the Role of Electronic Screening
Electronic Systems Administer, Score, and Analyze Online Measures
with Potential Advantages:
• Conducted in either the patient’s home or in the office
• Pre-visit data collection from the patient’s home allows increased time for parent to
consider responses and formulate questions
• The increasing use of handheld tablets allows for flexibility and growing possibilities in
the office
• Saves time for provider as tools are scored and interpreted immediately
• Information can be collected from multiple adults (parents and teachers) with
online consent to share data
• Primary care clinician aware of problems and strengths prior to a visit and
can prepare
• For adolescents: electronic screening is more likely to elicit concerns and
may be viewed as more confidential than interviews or paper-and-pencil
measures 1
• Assists with overcoming language and literacy challenges
•
Measures are becoming available with audio tracks in a variety of languages,
customization is possible
• Facilitates quality improvement activities
•
•
Creates patient registries; tracking progress over time for individual children, subgroups, and entire population
Assists with program performance measurement
Sample Resources for
Electronic Screening
•
Multiple tools in one system
•
Child Health and Development Interactive System (CHADIS)
• Web-based diagnostic, management, and tracking tool www.childhealthcare.org/chadis
• Over 50 tools with linked decision support and resources (E-Textbook, handouts,
imported local referral sources)
•
Patient Tools System – pediatrics.patienttools.com
• Integrates with office systems to automate screening in the practice and at home
• Assessment Library includes the most commonly used tools
• Can be tailored to a particular practice’s needs
•
Customized Tablet Systems (e.g., Phreesia – www.phreesia.com)
• Electronically administers validated screening tools
• Responses are automatically scored
• Results immediately communicated to the clinician via a Patient Report
•
•
Single tools available online (PEDS, ASQ3)
Individualization of Electronic Medical Records Systems (e.g., Free access
measures incorporated by a health system into their EMR, such as EPIC)
Reimbursement for Screening
CPT Codes: Overview
•
96110 (developmental screening, (e.g., developmental milestone survey, speech and
language delay screen) with scoring and documentation, per standardized
instrument), covers office overhead, i.e., the practice and malpractice expenses
in the use of a screening instrument (nonphysician may give the instrument to the
patient, score, and record but physician reviews)
• CT Medicaid requires specification of results: Positive or Negative (effective
August 1, 2014)
•
96127 (brief emotional or behavioral assessment, with scoring and
documentation, per standardized instrument)
• Code became effective nationally: January 1, 2015
• CT Medicaid requires specification of results: Positive or Negative
•
99420 covers administration and interpretation of health risk assessment
instruments, e.g., postpartum depression screening
Coding Resource
•
AAP Coding Hotline: [email protected]
AAP Newsflash
Medicaid Uses New CPT Code 96127 for Billing Behavioral Health Assessments (BH screens)
•
•
•
•
•
Connecticut's Department of Social Services loaded CPT code 96127 to the physician office and outpatient fee schedule to
be used for behavioral health assessments. Providers will be required to bill with the appropriate modifier (U3 or U4)
similar to when billing for developmental screens.
Effective for dates of service January 1, 2015 and forward there will be a new CPT code for billing behavioral health
screens (BH screens).
96127 is a new code for "Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale) with scoring and
documentation, per standardized instrument. " CT DSS also requires the use of modifiers U3 (positive screen) and U4
(negative screen) when billing for screens for patients under age 18 with HUSKY.
96110 has been modified and now is defined as "Developmental screening (e.g., developmental milestone survey, speech
and language delay screen) with scoring and documentation, per standardized instrument. CT DSS also requires the use of
modifiers U3 (positive screen) and U4 (negative screen) when billing for screens for patients under age 18 with HUSKY.
As communicated in PB 2014-43, the Department requires physicians (excluding psychiatrists), APRNs (excluding
psychiatric APRNs), and physician assistants to use modifiers U3 (positive developmental / BH screen) and U4 (negative
developmental / BH screen) when billing for developmental and behavioral health screens for HUSKY Health clients under
the age of eighteen. This policy will continue to be required for developmental screens billed as CPT code 96110, and
effective for dates of service January 1, 2015 and forward, will be required for BH screens billed as CPT code 96127. Please
refer to PB 2014-43 and PB 2014-58 for more information regarding developmental and behavioral health screens,
including how to locate validated tools.
Download the Provider Bulletin: PB 2014-91 2015 HIPPA Update.pdf
Nina Holmes, MPH
[email protected]
Department of Social Services
Division of Health Services
Steps to Bill for Universal Developmental
and Behavioral Health Screening
1.
Code well child exam (99391 – 99395) with Z00.129 (Encounter for routine child
health examination without abnormal findings) or Z00.121 (Encounter for routine
child health exam with abnormal findings, e.g., ear infection, ADHD)
2.
Designate Screening Type
Developmental Screening:
•
Add 96110 with a modifier 25 appended to the preventative service code
Behavioral Health Screening (As of January 1, 2015):
•
•
Add 96127 with a modifier 25 appended to the preventative service code
OPTIONAL: add modifier 33 appended to the 96127 code
Notes:
•
•
CPT Codes 96110 and 96127 CAN be billed on the same date of service
Typically a maximum of 2 units will be reimbursed for a given visit, however, some companies will
pay for as many as 2 screens of each type conducted at the same visit (i.e., 2 developmental and 2
behavioral health screens with a maximum of 4 screens)
Steps to Bill for Developmental and
Behavioral Health Screening continued
3. Additional Instructions
•
•
PRIVATE INSURANCE
• When billing for more than one screen of a given type at a given visit, specify number of units
performed, e.g., 96110 x 2 units and/or 96127, modifier 33 x 2 units
MEDICAID (As of August 1, 2014)
• When one formal tool of a given type is used:
•
•
•
If two screens of the same type have the same result, the units must be rolled into one detail
line:
•
•
Add Modifier U3 for a positive screen (i.e., 96110-U3 OR 96127-U3)
Add Modifier U4 for a negative screen (i.e., 96110-U4 OR 96127-U4)
For example, if two instruments billed using the 96110 code and two instruments billed using the 96127
code all result in either positive or negative scores, each type of screening will have its own single line:
1. 96110 U3 x 2; 96110 U4 x 2
2. 96127 U3 x 2; 96127 U4 x 2
If screens of the same type have different results, they must be split between multiple detail
lines:
•
For example, if one instrument billed using the 96110 code results in a positive score and another
scores negative, and one instrument billed using the 96127 code results in a positive score and another
scores negative, there will be 4 detail lines:
1. 96110 U3 x 1
2. 96110 U4 x 1
3. 96127 U3 x 1
4. 96127 U4 x 1
Completing the Steps
Document screening in medical record: TSA
• Tool(s) used
• Score(s) Achieved
• Action(s) taken- e.g., guidance
provided to parents/child, referral
made
Reimbursement Challenges:
• Contact CT-AAP/AACAP Executive Director Jillian Wood with
specific coding/payment problems: [email protected]
• If interested in participating in a work group on
reimbursement advocacy for behavioral health screening in
CT, contact CT-AAP Marketing/Communications Manager:
Yvette Moretti
[email protected]
(860) 525-9738
Advantages Afforded by Screening
Outweigh Any Drawbacks 1,2
• Encourages parents to discuss developmental and
behavioral health concerns
• Underscores importance of behavioral health
• Greatly improves detection rates
• Increases parental awareness of appropriate
expectations
• Improves parental observation skills
• Focuses visit
• Provides a template for anticipatory guidance
• May shorten visits and facilitate patient flow
• Reduces “hand-on-the-door” comments
• Increases parental satisfaction
40
Dismantling the
Behavioral Health Resource Barrier
• ACCESS-Mental Health CT
• Child Health and Development Institute’s
EDUCATING PRACTICES IN THE COMMUNITY
PROGRAM (EPIC)
• CT Child Development Infoline-2-1-1 to
connect to Birth-To-Three, HELP ME GROW,
autism specific programs
• Stay Tuned: Office of the Healthcare
Advocate: Behavioral Health Clearinghouse
Child Health and Development Institute (CHDI) of CT:
Educating Practices in the Community Program (EPIC)
• What is EPIC?
• EPIC offers in-office, evidence-based trainings to pediatric and family
medicine providers on a wide range of topics vital to the healthy
development of CT’s children
• EPIC trainings are brief, timely, free, and offered in the comfort of the
provider’s office over breakfast or lunch (supplied for the practice) or
at another convenient time
• In addition to resource material and linkages to services in the
practice’s community, participating providers now receive CME/CEU
credits
• A Maintenance of Certification is available for some modules
• CHDI created EPIC in collaboration with the CT chapters of the
American Academy of Pediatrics and Family Physicians
• CT Children’s Medical Center’s Office for Community Child Health works
closely with CHDI in the development and delivery of several of the EPIC
training modules
EPIC Trainings Most Relevant to
Establishing Developmental and Behavioral
Health Screening Programs
1.
Behavioral Health Screening: Integration into Pediatric Primary Care.
This training:
• Offers practical guidelines about behavioral health (and developmental)
screening in primary care
• Provides a brief orientation to the most commonly used tools (sample
measures along with scoring directions disseminated)
• Reviews billing procedures
2.
Addressing Postpartum Depression: Opportunities in the Pediatric
Setting. This training:
• Reviews the prevalence, symptoms, and broad ranging effects of postpartum
depression and anxiety on the mother, baby, and family
• Imparts information on screening tools (sample measures disseminated)
• Provides resource materials for educating parents
• Introduces practices to local behavioral health programs and clinicians
specializing in maternal/infant care
EPIC Trainings
3. Connecting Children to Behavioral Health Resources. This
training:
• Introduces the practice to a continuum of behavioral health providing
agencies, programs, and individual clinicians from their local
community
• A broad range of behavioral health providers typically participate;
covering infants to older adolescents, addressing mild to severe disorders,
describing outpatient, in-home, day treatment, substance abuse
interventions and emergency mobile services
• Medicaid and private insurance referral resources represented, along with
the local Regional Network Manager from the CT Behavioral Health
Partnership
• Discussions are facilitated promoting streamlined referral practices and bidirectional communication on shared patients
• The development of a one-page Behavioral Health Referral Resource
Decision Tree listing programs and contact information is constructed
upon request by participating behavioral health providers
EPIC TRAININGS
• Additional Trainings Relevant to Developmental and
Behavioral Health Screening Include:
•
•
•
•
•
Autism Spectrum Disorders (children younger than three)
Autism Spectrum Disorders (children older than three)
Developmental Surveillance Screening & Help Me Grow
Social and Emotional Health and Development in Infants
Trauma Screening, Identification and Referral in Pediatric Practice
• To Learn More About EPIC or to SCHEDULE Your Next Training
Session, Contact:
Maggy Morales, EPIC Coordinator
[email protected]
860-679-1527
A New Screening Project from CT-AAP
CQN PIAASU Project
Substance use is a major issue among children and adolescents, with alcohol, tobacco, and marijuana used most often. The
rise in marijuana use, non-medical use of prescription drugs, and electronic nicotine delivery systems warrants concern for
adolescents.
Most young people do not seek substance abuse treatment on their own. By any definition, they are in the early stages of
change so it can be difficult to determine whether an adolescent is having normal mood swings or if they are suffering from
substance abuse
Pediatricians have an important role in preventing, identifying, and treating substance use and mental health concerns.
PIAASU PROJECT
•
Improve Substance Abuse and Mental Health Care for Adolescence in your Practice
BENEFITS TO YOUR PRACTICE
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Improve care of youth with substance use and mental health concerns
Meet the American Board of Pediatrics of certification requirements for quality improvement (25
credits)
Receive expert coaching
Receive free access to the AAP Quality Improvement Data Aggregator for 12 months
Improve the efficacy and efficiency of your office system
Access practical tools and effective strategies for how to integrate changes into your practice
Interested in participating in the
CQN PIAASU Project?
For more information contact:
• Physician Project Leader
Robert Dudley, MD
(860) 490-4639
[email protected]
• Chapter Project Manager
Yvette Moretti
(860) 525-9738
[email protected]
Conclusion
Screening for Developmental and Behavioral Health
Disorders in Pediatric Primary Care Constitutes
Sound Medical Practice
• Developmental and Behavioral health problems are worthy of
screening on a universal and routine basis in pediatric primary care 1
• Common
• Important
• Severity and impact decreased through early detection and
subsequent intervention
• Inexpensive, valid, and reliable measures available
• Screening is a good use of resources (“pay me now or pay me
(more) later”)
THE OPENING OF “PANDORA’S BOX”
IS LONG OVERDUE
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Questions?
Discussion…