1
|
Thariath J, Salhi RA, Kamdar N, Seiler K, Greenwood-Ericksen M, Nham W, Simpson K, Peterson T, Abir M. Evaluating the pediatric mental health care continuum at an American health system. SAGE Open Med 2023; 11:20503121231181939. [PMID: 37362613 PMCID: PMC10288394 DOI: 10.1177/20503121231181939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To describe trends in the pediatric mental health care continuum and identify potential gaps in care coordination. Methods We used electronic medical record data from October 2016 to September 2019 to characterize the prevalence of mental health issues in the pediatric population at a large American health system. This was a single institution case study. From the electronic medical record data, primary mental health discharge and readmission diagnoses were identified using International Classification of Diseases (ICD-9-CM, ICD-10-CM) codes. The electronic medical record was queried for mental health-specific diagnoses as defined by International Classification of Diseases classification, analysis of which was facilitated by the fact that only 176 mental health codes were billed for. Additionally, prevalence of care navigation encounters was assessed through electronic medical record query, as care navigation encounters are specifically coded. These encounter data was then segmented by care delivery setting. Results Major depressive disorder and other mood disorders comprised 49.6% and 89.4% of diagnoses in the emergency department and inpatient settings respectively compared to 9.0% of ambulatory care diagnoses and were among top reasons for readmission. Additionally, only 1% of all ambulatory care encounters had a care navigation component, whereas 86% of care navigation encounters were for mental health-associated reasons. Conclusions Major depressive disorder and other mood disorders were more common diagnoses in the emergency department and inpatient settings, which could signal gaps in care coordination. Bridging potential gaps in care coordination could reduce emergency department and inpatient utilization through increasing ambulatory care navigation resources, improving training, and restructuring financial incentives to facilitate ambulatory care diagnosis and management of major depressive disorder and mood disorders. Furthermore, health systems can use our descriptive analytic approach to serve as a reasonable measure of the current state of pediatric mental health care in their own patient population.
Collapse
Affiliation(s)
- Joshua Thariath
- University of Michigan Medical School, Ann Arbor, USA
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
| | - Rama A. Salhi
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
| | - Kristian Seiler
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
| | - Margaret Greenwood-Ericksen
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
| | - Wilson Nham
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Kaitlyn Simpson
- University of Michigan Medical School, Ann Arbor, USA
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
| | - Timothy Peterson
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
- Physician Organization of Michigan Accountable Care Organization, Ann Arbor, USA
- Center for Health and Research Transformation, Ann Arbor, USA
- Henry Ford Health, Detroit, USA
| | - Mahshid Abir
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
- RAND Corporation, Santa Monica, CA, USA
| |
Collapse
|
2
|
Mathias S, Tee K, Helfrich W, Gerty K, Chan G, Barbic SP. Foundry: Early learnings from the implementation of an integrated youth service network. Early Interv Psychiatry 2022; 16:410-418. [PMID: 34008340 PMCID: PMC9292689 DOI: 10.1111/eip.13181] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/16/2022]
Abstract
AIMS To provide the first profile of the demographic and service characteristics of young people (aged 12-24 years) who access Foundry, a provincial network of integrated youth health and social service centres in British Columbia, Canada and to share early learnings about implementation and service innovation. METHODS Using a retrospective chart review, we conducted a census of all young people accessing a Foundry centre in a 'proof of concept' phase. Six centres were assessed between October 2015 and March 2018. Data included demographics, mental health service access history, service type the youth was seeking, and information about how they found out about the centre. RESULTS A total of 4783 young people presented during this proof of concept period, for a total number of 35 791 visits. The most frequently accessed category of service was mental health/substance use (57%) followed by physical health (25%). Young people were most likely to be female, aged 15-19, and White. Youth demographic characteristics showed an over-representation of Indigenous and LGBTQ2 youth and under-representation of males and youth aged 20-24. Youth were most likely to learn about Foundry from a friend (44%) or family member (22%). Most youth (58%) reported that they would have gone 'nowhere' if not for Foundry. CONCLUSIONS Foundry is a model of integrated health and social services delivery, focused on early intervention, prevention and accessibility, driven by the needs and priorities of young people and their families. Leveraging international integrated youth health service evidence, the model addresses urgent priorities in Canadian health service delivery.
Collapse
Affiliation(s)
- Steve Mathias
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Warren Helfrich
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Krista Gerty
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Godwin Chan
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Costello LH, Suh C, Burnett B, Kelsay K, Bunik M, Talmi A. Addressing Adolescent Depression in Primary Care: Building Capacity Through Psychologist and Pediatrician Partnership. J Clin Psychol Med Settings 2021; 28:53-66. [PMID: 31749100 DOI: 10.1007/s10880-019-09680-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Early identification and treatment of depression during adolescence can contribute to healthier outcomes across the lifespan, yet adolescent depression has been underidentified and undertreated. The American Academy of Pediatrics' (AAP) Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were created to enhance the identification and treatment of adolescent depression. Integrated psychologists in a pediatric primary care setting partnered with providers and clinic staff to implement an adolescent depression screening initiative and transform primary care practice around identification and management. From January 2017 through August 2018, 2107 adolescents between the ages of 11 and 18 were screened using the PHQ-9A. Eleven percent (n = 226) of adolescents had an elevated screen with a score of ≥ 10 and 7% (n = 151) screened positive for suicidal ideation. Identification of depressive symptoms led to increased integrated behavioral health services delivered by psychologists, psychiatrists, and psychology trainees. Psychologists integrated in primary care can support primary care practices to develop service delivery systems aligned with AAP's GLAD-PC and address the diverse implementation barriers associated with incorporating clinical practice guidelines in real-world settings. Universal screening for adolescent depression and response protocols were successfully implemented in a pediatric primary care clinic under the leadership of psychologists and pediatrician partners.
Collapse
Affiliation(s)
- Lisa H Costello
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA.
| | - Christina Suh
- Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Bridget Burnett
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA.,Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Kimberly Kelsay
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA
| | - Maya Bunik
- Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
| | - Ayelet Talmi
- Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children's Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO, 80045, USA.,Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children's Hospital Colorado, Aurora, USA
| |
Collapse
|
4
|
Champine RB, Shaker AH, Tsitaridis KA, Whitson ML, Kaufman JS. Service-Related Barriers and Facilitators in an Early Childhood System of Care: Comparing the Perspectives of Parents and Providers. Community Ment Health J 2019; 55:942-953. [PMID: 31165963 DOI: 10.1007/s10597-019-00418-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2019] [Indexed: 01/13/2023]
Abstract
Systems of care (SOCs) have the potential to enhance underserved families' access to integrated health and support services. Most scholarship on SOCs has involved school-aged children and adolescents. Thus, research is needed to better understand barriers to, and facilitators of, families' access to services during early childhood. The present study included a community-based participatory approach in understanding services for families of children under age six years with severe emotional and behavioral problems. We analyzed data from two focus groups with caregivers (n = 7) and three focus groups with service providers (n = 22). Our thematic analysis of participants' responses revealed five primary barriers to family service access, including challenges associated with transition planning. In comparison, participants described four primary facilitators of family service access, including providers' adoption of "whole-family" service delivery approaches. Findings indicated areas of convergence and divergence in caregivers' and providers' responses. We discuss limitations and potential implications.
Collapse
Affiliation(s)
- Robey B Champine
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, 48503, USA. .,Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, USA. .,Child Health and Development Institute of Connecticut, Farmington, CT, USA.
| | - Andrea H Shaker
- Department of Psychology, University of New Haven, New Haven, CT, USA
| | | | - Melissa L Whitson
- Department of Psychology, University of New Haven, New Haven, CT, USA
| | - Joy S Kaufman
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|