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Buchanan GJR, Berge JM, F Piehler T. Integrated behavioral health implementation and chronic disease management inequities: an exploratory study of statewide data. BMC PRIMARY CARE 2024; 25:302. [PMID: 39143518 PMCID: PMC11323651 DOI: 10.1186/s12875-024-02483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/20/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities. METHODS Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities. RESULTS Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic's location became more White. CONCLUSIONS IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.
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Affiliation(s)
- Gretchen J R Buchanan
- Redleaf Center for Family Healing, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S3, Minneapolis, MN, 55415, USA.
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Jerica M Berge
- Department of Family Medicine and Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Timothy F Piehler
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
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Daskalska L, Broaddus M, Young S. Closing the gap in access to child mental health care: provider feedback from the Wisconsin Child Psychiatry Consultation Program. BMC PRIMARY CARE 2024; 25:300. [PMID: 39143470 PMCID: PMC11323596 DOI: 10.1186/s12875-024-02538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics. OBJECTIVES The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider's ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care. METHODS A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann-Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach. RESULTS Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage. CONCLUSIONS This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.
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Affiliation(s)
- Lora Daskalska
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Michelle Broaddus
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Staci Young
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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3
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Aron E, Londoño Tobón A, Finelli J, Romanowicz M. Serving Families Where They Live: Supporting Multigenerational Health During Infancy and Early Childhood Through Community-centered Approaches. Child Adolesc Psychiatr Clin N Am 2024; 33:331-342. [PMID: 38823807 DOI: 10.1016/j.chc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
This article underscores the critical importance of addressing mental health during infancy and early childhood through a multigenerational, multicultural, community-centered approach. It highlights the unique vulnerability of this period to environmental factors and emphasizes the interconnectedness of caregiver and child mental health. The article advocates for interventions that extend beyond clinical settings, recognizing the value of community involvement and the need to address social determinants of health. It also discusses innovative strategies, such as mental health consultation in early childhood education centers and collaborative care models, to bridge gaps in access to care.
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Affiliation(s)
- Emily Aron
- Department of Psychiatry, Medstar Georgetown University Hospital, 2115 Wisconsin Avenue, NW, Suite 200, Washington, DC 20007, USA.
| | - Amalia Londoño Tobón
- Department of Psychiatry, Medstar Georgetown University Hospital, 2115 Wisconsin Avenue, NW, Suite 200, Washington, DC 20007, USA
| | - Julianna Finelli
- Department of Psychiatry and Sciences, Tulane University School of Medicine 131 S. Robertson Street, New Orleans, LA 70112, USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street, NW Rochester, MN 55906, USA
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Lee CM, Kaplan RM, Nelson SC, Horvitz-Lennon M. Financing the "Village": Establishing a Sustainable Financial System for Child Behavioral Health. Child Adolesc Psychiatr Clin N Am 2024; 33:457-470. [PMID: 38823817 PMCID: PMC11153862 DOI: 10.1016/j.chc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.
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Affiliation(s)
- Chuan Mei Lee
- Department of Psychiatry and Behavioral Sciences, UCSF, 675 18th Street, Box 3132, San Francisco, CA 94143, USA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA.
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Suzie C Nelson
- Department of Psychiatry, Wright State University, 2555 University Boulevard, Dayton, OH 45324, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 910, Boston, MA 02116, USA; Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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Fujiki RB, Fujiki AE, Thibeault SL. Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction. JAMA Otolaryngol Head Neck Surg 2024; 150:368-377. [PMID: 38483372 PMCID: PMC10941021 DOI: 10.1001/jamaoto.2024.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024]
Abstract
Importance Patients with induced laryngeal obstruction (ILO) present with a variety of behavioral health profiles. Identifying these profiles is crucial in that behavioral health conditions may affect treatment duration and outcomes. Objective To characterize the prevalence of anxiety, depression, posttraumatic stress disorder (PTSD), and physical somatic symptoms in adult and pediatric patients with ILO and determine the factors associated with anxiety, depression, PTSD, and physical somatic symptoms in patients with ILO? Design, Setting, and Participants This cross-sectional study included a nonprobability sample of 83 adult and 81 pediatric patients diagnosed with ILO at outpatient adult and pediatric otolaryngology clinics between 2021 and 2023. Exclusion criteria included a comorbid respiratory diagnosis other than asthma, head or neck cancer, or neurological impairments. Recruitment took place between September 2021 and March 2023. The analyses were run in January 2024. Main Outcome Measures Patients were prospectively screened for anxiety, depression, PTSD, and somatic physical symptoms. In addition, any past behavioral health diagnoses were extracted from the medical record. Comorbidities, ILO symptoms triggers, and onset details were gathered from ILO evaluations. Adult patients completed the Screen for Adult Anxiety Related Disorders (SCAARED), depression (Patient Health Questionnaire [PHQ]-9), and somatic physical symptoms portions of the Patient Health Questionnaires (PHQ-15), and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5). Pediatric patients completed the Screen for Child Anxiety Related Disorders (SCARED), depression (PHQ-9A) and somatic physical symptoms portions of the Patient Health Questionnaires for Adolescents (PHQ-15A), and the UCLA PTSD Reaction Index brief screeners. Results Eighty-three adult patients participated in this study (mean [SD] age, 45.8 [14.3] years; 64 female, 19 male). Eighty-one pediatric patients participated (mean [SD] age, 13.83 [2.55] years; 67 female, 14 male). Adult and pediatric patients with ILO screened positive for elevated rates of anxiety (53 adults [63%]; 49 children [60%]), depression (27 adults [32%]; 25 children [30%]), and PTSD (29 adults [34%]; 13 children [16%]). Most of the patients with anxiety and depression symptoms were formally diagnosed prior to ILO evaluation, with rates of previously diagnosed anxiety, depression, and PTSD also above published norms. Adults were twice as likely as children to present with PTSD (odds ratio, 2.1; 95% CI, 0.05-4.48). Elevated rates of physical somatic symptoms were also evident, with 38 adults (45%) and 32 children (39%) scoring in the moderate to severe range. Conclusions and Relevance This study found high rates of adult and pediatric patients with ILO screened positive for anxiety, depression, and PTSD symptoms. Future work should investigate how behavioral health and ILO treatments can best be coordinated to maximize treatment outcomes.
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Affiliation(s)
| | - Amanda Edith Fujiki
- Department of Psychiatry, Child and Adolescent Division, University of Utah School of Medicine, Salt Lake City
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Schaefer AJ, Mackie T, Veerakumar ES, Sheldrick RC, Moore Simas TA, Valentine J, Cowley D, Bhat A, Davis W, Byatt N. Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model. Health Aff (Millwood) 2024; 43:557-566. [PMID: 38560809 DOI: 10.1377/hlthaff.2023.01439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.
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Affiliation(s)
- Ana J Schaefer
- Ana J. Schaefer , Downstate Health Sciences University, Brooklyn, New York
| | | | | | | | | | | | - Deborah Cowley
- Deborah Cowley, University of Washington, Seattle, Washington
| | | | - Wendy Davis
- Wendy Davis, Postpartum Support International, Portland, Oregon
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Reese JB, Ramtekkar U. Telebehavioral Health: Workforce, Access, and Future Implications. Child Adolesc Psychiatr Clin N Am 2024; 33:87-93. [PMID: 37981340 DOI: 10.1016/j.chc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Even before the COVID-19 pandemic, telebehavioral health (TBH) was proving itself to be a valuable, effective tool for service delivery. The widespread adoption of its use over the past 2 years for continuity of care should be considered one of the silver linings of the pandemic. It has the potential to be a particularly powerful tool for providing more equitable access to care for those in rural communities if barriers to broadband access can be addressed. In addition to providing an attractive, flexible method of service delivery for patients and families, TBH holds appeal to the workforce as well.
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Affiliation(s)
- Jennifer B Reese
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ujjwal Ramtekkar
- Department of Psychiatry, University of Missouri School of Medicine, 3 Hospital Drive, Columbia, MO, USA.
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Rybak TM, Herbst RB, Stark LJ, Samaan ZM, Zion C, Bryant A, McClure JM, Maki A, Bishop E, Mack A, Ammerman RT. Provider Perspectives on an Integrated Behavioral Health Prevention Approach in Pediatric Primary Care. J Clin Psychol Med Settings 2023; 30:741-752. [PMID: 36828991 PMCID: PMC9957689 DOI: 10.1007/s10880-023-09947-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
The purpose of this study was to use qualitative interviews to ascertain the perspective of pediatric primary care providers on the implementation of Integrated Behavioral Health (IBH) as provided by psychologists within an expanded HealthySteps™ model, and with a particular focus on prevention of behavioral health symptoms in the first five years. A semi-structured interview guide was used to assess medical providers' perceptions of behavioral health integration into their primary care clinics. A conventional qualitative content analysis approach was utilized to identify patterns of meaning across qualitative interviews. Four themes were identified: (1) practice prior to IBH and initial concerns about integration, (2) psychologist's role and perceived added value, (3) what integration looks like in practice, and (4) perceived families' response to and experiences with IBH. Despite initial concerns about potential disruptions to clinic flow, providers indicated that adoption of IBH was seamless. The distinct roles of the psychologist were clear, and both treatment and prevention services provided by IBH were valued. Multidisciplinary collaboration and real-time response to family needs was seen as especially important and primary care providers reported that families were accepting of and highly valued IBH.
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Affiliation(s)
- Tiffany M Rybak
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Rachel B Herbst
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lori J Stark
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zeina M Samaan
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cynthia Zion
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Alyssa Bryant
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Jessica M McClure
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Aileen Maki
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Elizabeth Bishop
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Aimee Mack
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert T Ammerman
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Kim R, Broaddus M, Jandrisevits MD, Taylor T, DiFranceisco W, Chayer R. Expanding Psychiatric Treatment in Primary Care Settings: Improved Care Through the Wisconsin Child Psychiatry Consultation Program. Clin Pediatr (Phila) 2023; 62:1369-1374. [PMID: 37786368 DOI: 10.1177/00099228231158365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
The national shortage of child psychiatrists has resulted in the necessity of primary care providers (PCPs) managing increased mental health concerns of youth. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) is one of several programs throughout the United States which provide PCPs with education, consultation, and resource support related to pediatric mental health. To evaluate initial impact of the program, data from 190 pediatricians and family practitioners from the Wisconsin Health Information Organization (WHIO) were analyzed. Enrollment in the WI CPCP was associated with a significant increase in rates of mental health diagnoses within primary care visits. In addition, the number of providers who made any mental health diagnosis increased from 56% of PCPs pre-enrollment to over 99% post-enrollment. These data provide additional support for pediatric psychiatry consultation programs within primary care.
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Affiliation(s)
- Rosa Kim
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michelle Broaddus
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Matthew D Jandrisevits
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
| | | | - Wayne DiFranceisco
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Robert Chayer
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
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Lee CM, Yonek J, Lin B, Bechelli M, Steinbuchel P, Fortuna L, Mangurian C. Systematic Review: Child Psychiatry Access Program Outcomes. JAACAP OPEN 2023; 1:154-172. [PMID: 38189028 PMCID: PMC10769201 DOI: 10.1016/j.jaacop.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Objective There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs. Method A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health. Results None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost(n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs. Conclusion Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs. Diversity & Inclusion Statement One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. Clinical trial registration information Child Psychiatry Access Programs: A Systematic Review; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410; CRD42020146410.
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Affiliation(s)
- Chuan-Mei Lee
- University of California, San Francisco
- Stanford University School of Medicine
| | | | | | | | | | | | - Christina Mangurian
- University of California, San Francisco
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital
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Overhage L, Hailu R, Busch AB, Mehrotra A, Michelson KA, Huskamp HA. Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic. JAMA Psychiatry 2023; 80:924-932. [PMID: 37436733 PMCID: PMC10339224 DOI: 10.1001/jamapsychiatry.2023.2195] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/21/2023] [Indexed: 07/13/2023]
Abstract
Importance Understanding how children's utilization of acute mental health care changed during the COVID-19 pandemic is critical for directing resources. Objective To examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional analysis of national, deidentified commercial health insurance claims of youth mental health ED and hospital care took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17 614 and 16 815 youth had at least 1 mental health ED visit in the baseline year (March 2019-February 2020) and pandemic year 2 (March 2021-February 2022), respectively. Exposure The COVID-19 pandemic. Main outcomes and measures The relative change from baseline to pandemic year 2 was determined in (1) fraction of youth with 1 or more mental health ED visits; (2) percentage of mental health ED visits resulting in inpatient psychiatry admission; (3) mean length of inpatient psychiatric stay following ED visit; and (4) frequency of prolonged boarding (≥2 midnights) in the ED or a medical unit before admission to an inpatient psychiatric unit. Results Of 4.1 million enrollees, 51% were males and 41% were aged 13 to 17 years (vs 5-12 years) with 88 665 mental health ED visits. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits (95% CI, 4.7%-8.8%). Among adolescent females, there was a larger increase (22.1%; 95% CI, 19.2%-24.9%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4% (95% CI, 5.5%-11.2%). Mean length of inpatient psychiatric stay increased 3.8% (95% CI, 1.8%-5.7%). The fraction of episodes with prolonged boarding increased 76.4% (95% CI, 71.0%-81.0%). Conclusions and relevance Into the second year of the pandemic, mental health ED visits increased notably among adolescent females, and there was an increase in prolonged boarding of youth awaiting inpatient psychiatric care. Interventions are needed to increase inpatient child psychiatry capacity and reduce strain on the acute mental health care system.
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Affiliation(s)
- Lindsay Overhage
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ruth Hailu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Alisa B. Busch
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- McLean Hospital, Belmont, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kenneth A. Michelson
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Shahidullah JD, Roberts H, Parkhurst J, Ballard R, Mautone JA, Carlson JS. State of the Evidence for Use of Psychotropic Medications in School-Age Youth. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1454. [PMID: 37761415 PMCID: PMC10528957 DOI: 10.3390/children10091454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger "whole-child" approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The paper concludes with a discussion about supporting the use of medication treatments in schools, including considerations for ensuring effective family-school-health system collaboration to best meet youth mental health needs.
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Affiliation(s)
- Jeffrey D. Shahidullah
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Holly Roberts
- Department of Psychology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - John Parkhurst
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Rachel Ballard
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Jennifer A. Mautone
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19146, USA;
| | - John S. Carlson
- Department of Counseling, Educational Psychology, & Special Education, Michigan State University, East Lansing, MI 48824, USA
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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de Oliveira C, Iwajomo T, Kurdyak P. Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada. JAMA Netw Open 2023; 6:e2313172. [PMID: 37171817 PMCID: PMC10182426 DOI: 10.1001/jamanetworkopen.2023.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Research on patients with high health care costs has examined mainly adults, with little focus on mental health care use. Objective To examine the characteristics and costs of children and adolescents with high health care costs who use mostly mental health care and whether and why they persist in the high-cost state. Design, Setting, and Participants This population-based, retrospective cohort study used health care records from Ontario, Canada, on all children and adolescents (age 0-17 years) covered under a universal health care system from January 1, 2012, to December 31, 2019. All children and adolescents in and above the 90th percentile of the cost distribution in 2012 for whom costs related to mental health care accounted for 50% or more of their costs were defined as patients with high mental health care costs. Data were analyzed from August 2019 to December 2022. Exposures High health care costs. Main Outcomes and Measures Patients with high mental health care costs were characterized in terms of their sociodemographic characteristics; chronic physical health, mental health, and behavioral conditions; and health care costs (in 2021 Canadian dollars) by health service and type of care (mental health care vs non-mental health care). Patients were followed up until 2019 to assess whether they persisted in the high-cost state and to examine factors associated with persisting in that state. Results In 2012, there were 273 490 children and adolescents with high health care costs (mean [SD] age, 6.43 [5.99] years; 55.8% male; mean cost, $7936.40; 95% CI, $7850.30-$8022.40). Of these, 20 463 (7.5%) were classified as having high mental health care costs (mean cost, $10 040.20; 95% CI, $9822.80-$10 257.50). Asthma (30.3%), attention-deficit/hyperactivity disorder (35.8%), and mood and/or anxiety disorders (94.9%) were the most common chronic physical, behavioral, or mental health conditions. Few patients with high mental health care costs persisted in the high-cost state beyond 3 years (19.0%). Mood and/or anxiety disorders (relative risk ratio [RRR], 6.17; 95% CI, 3.19-11.96) and schizophrenia spectrum disorders (RRR, 2.98; 95% CI, 2.14-4.14) were identified as the main factors associated with persistence in the high-cost state. Conclusions and Relevance In this cohort study of children and adolescents with high health care costs, some patients had high levels of mental health care use and high costs of care, but few of these persisted in the high-cost state for 3 or more years. These findings may help inform the development of care coordination interventions and service delivery models, such as youth integrated services, to reduce costs and improve outcomes for children and adolescents.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mental Health and Addictions Centre of Excellence, Ontario Health, Toronto, Ontario, Canada
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15
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Adiba A, Sidhu SS, Shaligram D, Khan M, Qayyum Z. Advances in Child Psychiatry Education and Training. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2023; 3:S2667-3827(23)00006-6. [PMID: 38620094 PMCID: PMC10132457 DOI: 10.1016/j.ypsc.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The article provides a comprehensive overview of the current state of child and adolescent psychiatry, including historical background and the impact of the COVID-19 pandemic. It discusses recent advances in theoretical frameworks related to physician burnout, prevention, access to care, diversity, equity, and inclusion, and trauma-informed care. The authors conclude by emphasizing the importance of education and training in improving the lives of youth and families and encourage their colleagues to push the boundaries of education and training for a better today and brighter tomorrow, while honoring and doing justice to those they serve.
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Affiliation(s)
- Afifa Adiba
- Sheppard Pratt Health System, Towson, MD, USA
- University of Maryland, 6501 North Charles Street, Baltimore, MD 21204, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Shawn Singh Sidhu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California San Diego Medical Center, UCSD Medical Center, Rady Children's Hospital of San Diego, 2125 Citracado Parkwy, Escondido, CA 92029, USA
| | - Deepika Shaligram
- Boston Children's Hospital, Harvard Medical School, 9 Hope Avenue, Waltham, MA 02453, USA
| | - Manal Khan
- University of California, 300 Medical Plaza Driveway, Los Angeles, CL 90095, USA
| | - Zheala Qayyum
- Harvard Medical School, Yale School of Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
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Warren MD, Kavanagh LD. Over a Century of Leadership for Maternal and Child Health in the United States: An Updated History of the Maternal and Child Health Bureau. Matern Child Health J 2023:10.1007/s10995-023-03629-0. [PMID: 36964842 PMCID: PMC10039340 DOI: 10.1007/s10995-023-03629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 03/26/2023]
Abstract
The Maternal and Child Health Bureau (MCHB) is the only federal agency solely focused on improving the health and well-being of all of America's mothers, children, and families. Founded in 1912 as the Children's Bureau, the Bureau has evolved over 110 years in response to the changing needs of MCH populations and shifting legislative and administrative priorities. The Bureau's role in promoting and protecting maternal and child health has grown, spurred by landmark legislation including the Sheppard-Towner Maternity and Infancy Care Act, Title V of the Social Security Act, and multiple programmatic authorizations. Emerging issues in the field-ranging from deficiencies in access and coverage for health care to the emergence of new infectious diseases-have resulted in additional roles and responsibilities for the Bureau; these include convening state and national partners, providing leadership on priority topics, developing guidelines for care, and implementing new programs. Throughout its history, the Bureau has partnered with other federal government agencies, states, communities, and families to improve outcomes for mothers, children, and families. Previous reports have documented the founding of the Children's Bureau and the growth of federal legislation and programs through 1990. This updated history builds on those works and describes the multiple new programs and legislative authorities assigned to the Bureau since the Title V reforms of the 1980s, the Bureau's response to emerging issues, and the contemporary structure and function of MCHB.
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Affiliation(s)
- Michael D Warren
- Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18W29, Rockville, MD, 20857, USA.
| | - Laura D Kavanagh
- Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18W29, Rockville, MD, 20857, USA
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17
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Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M, Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry 2023; 62:91-119. [PMID: 35779696 DOI: 10.1016/j.jaac.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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18
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Wolpert KH, Kodish I, Kim SJ, Uspal NG. Behavioral Management of Children With Autism in the Emergency Department. Pediatr Emerg Care 2023; 39:45-50. [PMID: 36580892 DOI: 10.1097/pec.0000000000002886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is characterized by impaired social communication in conjunction with patterned behaviors. Often associated with emotional dysregulation, irritability, aggression, depression, and suicidality, ASD youth frequently present to the emergency department for behavioral and mental health evaluation. Psychiatric comorbidities, agitation, and depression are commonly encountered. During these visits, practitioners must thoughtfully consider organic etiologies for presenting symptoms, formulate plans to address risk of agitation, and understand how to effectively formulate disposition options in this patient population.
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Affiliation(s)
- Katherine H Wolpert
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
| | - Ian Kodish
- Associate Professor (Kim and Kodish), Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Neil G Uspal
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
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19
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Godoy L, Hamburger S, Druskin LR, Willing L, Bostic JQ, Pustilnik SD, Beers LS, Biel MG, Long M. DC Mental Health Access in Pediatrics: Evaluating a Child Psychiatry Access Program in Washington, DC. J Pediatr Health Care 2022; 37:302-310. [PMID: 36529554 DOI: 10.1016/j.pedhc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Child psychiatry access programs (CPAPs) provide primary care providers (PCPs) with assistance in mental health diagnosis, management, and resource navigation. METHOD Data collected from DC Mental Health Access in Pediatrics (MAP) included PCPs and patient demographics, clinical encounter information, and provider satisfaction. RESULTS DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP. DISCUSSION DC MAP grew quickly, highlighting program impact and need. Demand for care coordination required flexible staffing and highlighted the need for coordination in pediatrics. Child psychiatry access programs offer an innovative way to enhance PCP management of their patients' mental health needs.
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20
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Bettencourt AF, Coble K, Reinblatt SP, Jadhav S, Khan KN, Riddle MA. Characteristics of Patients Served by a Statewide Child Psychiatry Access Program. Psychiatr Serv 2022:appips20220323. [PMID: 36475823 DOI: 10.1176/appi.ps.20220323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Maryland's Behavioral Health Integration in Pediatric Primary Care (BHIPP) is a child psychiatry access program offering child-adolescent psychiatry consultation, resource and referral networking, and direct-to-patient mental health intervention. This study investigated characteristics of patients for whom primary care providers sought BHIPP services. METHODS Data from 6,939 unique patient contacts between October 2012 and March 2020 were collected on service type, demographic characteristics, presenting concerns, clinical severity, clinicians' diagnostic impressions, current treatments, and BHIPP recommendations. Descriptive statistics and latent class analysis were used. RESULTS Of the 6,939 patient contacts, 38.6% were for direct-to-patient mental health intervention, 27.3% for child-adolescent psychiatry consultation, and 34.2% for resource and referral networking. In total, 50.3% of patients were female, 58.7% were White, and 32.7% were already receiving mental health services. Latent class analysis identified four classes of presenting concerns: anxiety only (44.2%); behavior problems only (30.7%); mood and anxiety (17.1%); and attention, behavior, and learning problems (8.0%). Compared with patients in the anxiety-only class, those in the attention, behavior, and learning problems class were more likely to receive direct-to-patient mental health intervention (OR=3.59), and BHIPP clinicians were more likely to recommend in-office behavioral interventions for those in the mood and anxiety class (OR=1.62) and behavior problems-only class (OR=1.55). CONCLUSIONS Patients supported through BHIPP varied in presenting concerns, condition severity and complexity, current receipt of services, and BHIPP utilization. Latent class analysis yielded more clinically useful information about the nature and complexity of patients' concerns than did consideration of individual presenting concerns.
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Affiliation(s)
- Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Kelly Coble
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Shauna P Reinblatt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Sneha Jadhav
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Kainat N Khan
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Mark A Riddle
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
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21
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Harris K, Aguila Gonzalez A, Vuong N, Brown R, Ciccolari Micaldi S. Understanding Pediatric Mental Health in Primary Care: Needs in a Rural State. Clin Pediatr (Phila) 2022; 62:441-448. [PMID: 36352499 DOI: 10.1177/00099228221136121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The need for mental health care for pediatric patients outstrips the supply, especially in states, like Kansas, that experience shortages of mental health professionals. Pediatric mental health care access programs, like KSKidsMAP (Kansas Kids Mental health Access Program), increase access to care by building competence and confidence in primary care physicians and clinicians (PCPs) through a statewide integrated system that includes a consultation line. This study is a secondary analysis of KSKidsMAP consultation Line inquiries regarding patients aged 0 to 21 years with mental and behavioral health concerns. The study employs a mixed-method approach with descriptive statistics and thematic analysis of inquiries. Five themes were identified: (1) pharmacotherapy, (2) diagnostic evaluation, (3) community resources, (4) psychotherapy, and (5) other. This study sheds light on PCPs needs and illustrates the importance of Pediatric Mental Health Care Access programs offering interprofessional expertise to consulting PCPs, allowing for expansion of pediatric mental illness care into the primary care setting.
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Affiliation(s)
- Kari Harris
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Amanda Aguila Gonzalez
- Department of Population Health, University of Kansas School of Medicine-Wichita, KS, USA
| | - Ngoc Vuong
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Rachel Brown
- Department of Psychiatry & Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Susanna Ciccolari Micaldi
- Department of Psychiatry & Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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22
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Koet LBM, Bennenbroek JJM, Bruggeman AYS, de Schepper EIT, Bohnen AM, Bindels PJE, Gerger H. GPs’ and practice nurses’ views on their management of paediatric anxiety problems: an interview study. BMC PRIMARY CARE 2022; 23:235. [PMID: 36096736 PMCID: PMC9465156 DOI: 10.1186/s12875-022-01802-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022]
Abstract
Background Anxiety problems are common in both children and adolescents, and many affected children do not receive appropriate treatment. Understaffing of mental healthcare services and long waiting lists form major barriers. In the Netherlands, practice nurses have been introduced into general practice to support general practitioners (GPs) in the management of psychosocial problems. In this study we investigated the views of GPs and practice nurses on their management of paediatric anxiety problems. Methods We performed an exploratory study using semi-structured interviews with 13 GPs and 13 practice nurses in the greater Rotterdam area in 2021. Interviews were transcribed and coded into topics, which were categorized per research question. Results In their management of paediatric anxiety problems, both GPs and practice nurses try to explore the case and the needs of affected children and their parents. GPs rarely follow up affected children themselves. They often refer the child, preferably to their practice nurse. Practice nurses regularly initiate follow-up consultations with affected children themselves. Practice nurses reported using a variety of therapeutic techniques, including elements of cognitive behavioural therapy. In more severe cases, practice nurses refer the child to external mental healthcare services. GPs reported being satisfied with their collaboration with practice nurses. Both GPs and practice nurses experience significant barriers in the management of paediatric anxiety problems. Most importantly, long waiting lists for external mental health care were reported to be a major difficulty. Improving cooperation with external mental healthcare providers was reported to be an important facilitator. Conclusions In their management of paediatric anxiety problems, GPs and practice nurses experience major challenges in the cooperation with external mental healthcare providers and in the long waiting lists for these services. GPs and practice nurses believe that thanks to their shared approach more children with anxiety problems can remain treated in general practice. Future research is needed to evaluate the treatment outcomes of the shared efforts of GPs and practice nurses in their management of paediatric anxiety problems. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01802-y.
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Schuchard J, Blackwell CK, Ganiban JM, Giardino AP, McGrath M, Sherlock P, Dabelea DM, Deoni SCL, Karr C, McEvoy CT, Patterson B, Santarossa S, Sathyanarayana S, Tung I, Forrest CB. Influences of Chronic Physical and Mental Health Conditions on Child and Adolescent Positive Health. Acad Pediatr 2022; 22:1024-1032. [PMID: 35121190 PMCID: PMC9339582 DOI: 10.1016/j.acap.2022.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Pediatric positive health refers to children's assessments of their well-being. The purpose of this study was to contrast positive health for children aged 8 to 17 years with and without chronic physical and mental health conditions. METHODS Data were drawn from the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) research program. Participants included 1764 children ages 8 to 17 years from 13 ECHO cohorts. We measured positive health using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health and Life Satisfaction patient-reported outcome (PRO) measures. We used multiple regression to examine cross-sectional associations between the PROs and parent-reported health conditions and sociodemographic variables. We defined a meaningful difference in average scores as a PROMIS T-score difference of >3. RESULTS The sample included 45% 13 to 17-year-olds, 50% females, 8% Latinx, and 23% Black/African-American. Fifty-four percent had a chronic health condition. Of the 16 chronic conditions included in the study, only chronic pain (β = -3.5; 95% CI: -5.2 to -1.9) and depression (β = -6.6; 95% CI: -8.5 to -4.6) were associated with scoring >3 points lower on global health. Only depression was associated with >3 points lower on life satisfaction (β = -6.2; 95% CI: -8.1 to -4.3). Among those with depression, 95% also had another chronic condition. CONCLUSIONS Many children with chronic conditions have similar levels of positive health as counterparts without chronic conditions. The study results suggest that negative associations between chronic conditions and positive health may be primarily attributable to presence or co-occurrence of depression.
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Affiliation(s)
- Julia Schuchard
- Department of Pediatrics (J Schuchard, CB Forrest), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Courtney K Blackwell
- Department of Medical Social Sciences (CK Blackwell, P Sherlock), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jody M Ganiban
- Department of Psychological & Brain Sciences (JM Ganiban), George Washington University, Washington, DC
| | - Angelo P Giardino
- Department of Pediatrics (AP Giardino), University of Utah School of Medicine, Salt Lake City, Utah
| | - Monica McGrath
- Department of Epidemiology (M McGrath), Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Phillip Sherlock
- Department of Medical Social Sciences (CK Blackwell, P Sherlock), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Dana M Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center (DM Dabelea), University of Colorado Anschutz, Aurora, Colo
| | - Sean C L Deoni
- Department of Radiology and Pediatrics, Bill & Melinda Gates Foundation (SCL Deoni), Brown University, Pawtucket, RI
| | - Catherine Karr
- Department of Pediatrics (C Karr, S Sathyanarayana), University of Washington, Seattle, Wash
| | - Cindy T McEvoy
- Department of Pediatrics (CT McEvoy), Oregon Health & Science University, Portland, Ore
| | - Barron Patterson
- Department of Pediatrics (B Patterson), Vanderbilt University Medical Center, Nashville, Tenn
| | - Sara Santarossa
- Department of Public Health Sciences (S Santarossa), Henry Ford Health System, Detroit, Mich
| | - Sheela Sathyanarayana
- Department of Pediatrics (C Karr, S Sathyanarayana), University of Washington, Seattle, Wash
| | - Irene Tung
- Department of Psychiatry (I Tung), University of Pittsburgh, Pittsburgh, Pa
| | - Christopher B Forrest
- Department of Pediatrics (J Schuchard, CB Forrest), Children's Hospital of Philadelphia, Philadelphia, Pa
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Martsenkovskyi D, Martsenkovsky I, Martsenkovska I, Lorberg B. The Ukrainian paediatric mental health system: challenges and opportunities from the Russo-Ukrainian war. Lancet Psychiatry 2022; 9:533-535. [PMID: 35613625 DOI: 10.1016/s2215-0366(22)00148-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Dmytro Martsenkovskyi
- Department of Psychiatry and Narcology, Bogomolets National Medical University, Kyiv 01601, Ukraine; Department of Child Psychiatry, SI Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of Ministry of Health of Ukraine, Kyiv, Ukraine.
| | - Igor Martsenkovsky
- Department of Child Psychiatry, SI Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of Ministry of Health of Ukraine, Kyiv, Ukraine; Child Section of Ukrainian Psychiatric Association, Kyiv, Ukraine
| | - Inna Martsenkovska
- Department of Child Psychiatry, SI Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Boris Lorberg
- Department of Psychiatry, University of Massachusetts TH Chan School of Medicine, Worcester, MA, USA
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Garbutt J, Dodd S, Rook S, Ericson L, Sterkel R, Plax K. Primary care experiences of providing mental healthcare for children in the USA during the COVID-19 pandemic: a qualitative study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001497. [PMID: 36053621 PMCID: PMC9272128 DOI: 10.1136/bmjpo-2022-001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The increased demand for mental healthcare associated with the COVID-19 pandemic adds to the already high unmet mental health needs among paediatric patients, resulting in a declared 'mental health emergency'. The study objective was to describe paediatric primary care providers (PCPs') experience of meeting their patients' needs for mental healthcare during the pandemic and to identify opportunities to optimise care. METHODS 19 paediatricians and 2 nurse practitioners completed a 30 min video interview in May 2021. Interviews were recorded and transcribed, and transcripts were analysed using consensual qualitative research methods. RESULTS Participants reported marked increases in patient mental health needs during the COVID-19 pandemic. These included new diagnoses of anxiety and depression and increased treatment needs for patients with a prior mental health diagnosis. They identified that the mental health needs of their patients were greater, more severe and more challenging to manage with the resources currently available. While they were frustrated with the lack of communication and support from their mental health colleagues, and felt isolated and overwhelmed, they approached the increased demand for mental healthcare with a growth mindset. This outlook included providing care, seeking help to improve their skills and engaging with local resources such as the Child Psychiatry Access Project (CPAP). CONCLUSIONS Our findings suggest that urgent action is needed to better support paediatric PCPs to provide mental healthcare in our community. Providers identified an ongoing need for timely access to and effective communication with mental health providers to guide care in the medical home. This need could be addressed immediately by providing training for new and experienced clinicians, expanding the scope of CPAP programmes to include patient assessment and supporting implementation of integrated behavioural health programmes into the medical home.
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Affiliation(s)
- Jane Garbutt
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sherry Dodd
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Shannon Rook
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lauren Ericson
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randall Sterkel
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Katie Plax
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
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Reese JB, Ramtekkar U. Telebehavioral Health: Workforce, Access, and Future Implications. Psychiatr Clin North Am 2022; 45:313-319. [PMID: 35680247 PMCID: PMC9399902 DOI: 10.1016/j.psc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Even before the COVID-19 pandemic, telebehavioral health (TBH) was proving itself to be a valuable, effective tool for service delivery. The widespread adoption of its use over the past 2 years for continuity of care should be considered one of the silver linings of the pandemic. It has the potential to be a particularly powerful tool for providing more equitable access to care for those in rural communities if barriers to broadband access can be addressed. In addition to providing an attractive, flexible method of service delivery for patients and families, TBH holds appeal to the workforce as well.
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Affiliation(s)
- Jennifer B Reese
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ujjwal Ramtekkar
- Department of Psychiatry, University of Missouri School of Medicine, Teladoc Health Inc., 3 Hospital Drive, Columbia, MO, USA.
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Ramtekkar U, Maras M, Ell W, Nicol G, Young-Walker L. Academic-Community Partnership to Improve Pediatric Mental Health Access: Missouri Child Psychiatry Access Project. Psychiatr Serv 2022; 73:588-591. [PMID: 34470505 DOI: 10.1176/appi.ps.202100074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Because of significant shortages in the behavioral health workforce, primary care providers (PCPs) have become the de facto mental health providers to address poor access to mental health care. Child psychiatry access programs (CPAPs) could support PCPs through case consultations. This column describes the innovative Missouri Child Psychiatry Access Project, highlighting the unique enhancements to existing CPAPs and the partnership between community and academic settings to support behavioral health access in primary care. Using an implementation science approach, the authors applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework to disseminate replicable steps for other systems; they also discuss future directions for expanding utility and scope.
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Affiliation(s)
- Ujjwal Ramtekkar
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio (Ramtekkar); Department of Psychology (Maras) and Department of Psychiatry (Ell, Young-Walker), University of Missouri, Columbia; Department of Psychiatry, Washington University in St. Louis, St. Louis (Nicol). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Melissa Maras
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio (Ramtekkar); Department of Psychology (Maras) and Department of Psychiatry (Ell, Young-Walker), University of Missouri, Columbia; Department of Psychiatry, Washington University in St. Louis, St. Louis (Nicol). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Wendy Ell
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio (Ramtekkar); Department of Psychology (Maras) and Department of Psychiatry (Ell, Young-Walker), University of Missouri, Columbia; Department of Psychiatry, Washington University in St. Louis, St. Louis (Nicol). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Ginger Nicol
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio (Ramtekkar); Department of Psychology (Maras) and Department of Psychiatry (Ell, Young-Walker), University of Missouri, Columbia; Department of Psychiatry, Washington University in St. Louis, St. Louis (Nicol). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Laine Young-Walker
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio (Ramtekkar); Department of Psychology (Maras) and Department of Psychiatry (Ell, Young-Walker), University of Missouri, Columbia; Department of Psychiatry, Washington University in St. Louis, St. Louis (Nicol). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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Xu L, Zimmermann M, Forkey H, Griffin J, Wilds C, Morgan WS, Byatt N, McNeal CJ. How to Mitigate Risk of Premature Cardiovascular Disease Among Children and Adolescents with Mental Health Conditions. Curr Atheroscler Rep 2022; 24:253-264. [PMID: 35320835 PMCID: PMC8940585 DOI: 10.1007/s11883-022-00998-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this article is to characterize the myriad of ways that children with mental health conditions can be at risk for premature cardiovascular disease (CVD) and various modalities to ameliorate this risk in childhood in order to improve the life course of these children. REVIEW FINDINGS Child and adolescent mental health conditions are a common yet underrecognized risk factor for premature CVD. The American Heart Association has recently included psychiatric conditions as a CVD risk factor (CVDRF) and the evidence linking childhood adversity to cardiometabolic disease. There are bidirectional and additive effects from the intrinsic emotional dysregulation and inflammatory changes from the mental health condition, the associations with risky health behaviors, and in some cases, metabolic side effects from pharmacotherapy. These pathways can be potentiated by toxic stress, a physiologic response to stressors from childhood adversity. Toxic stress is also associated with development of mental health conditions with epigenetic effects that can result in transgenerational inheritance of cardiometabolic risk. Exposure to toxic stress and mental health conditions in isolation sometimes compounded by pharmacotherapies used in treatment increase the risk of cardiometabolic diseases in childhood. The multiple pathways, which adversely influence cardiometabolic outcomes, encourage clinicians to consider strategies to mitigate these factors and justify the importance of early screening and treatment for CVDRFs. Mental health, health behaviors, and environmental factors co-occur and intersect in complex pathways that can increase CVD risk over the lifespan. Early detection and response can mitigate the risks associated with premature development of CVD.
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Affiliation(s)
- Lulu Xu
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Martha Zimmermann
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Heather Forkey
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Jessica Griffin
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Caitlin Wilds
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
- Boston Child Study Center, Boston, MA, 02116, USA
| | - Wynne S Morgan
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Nancy Byatt
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Catherine J McNeal
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, 76508, USA.
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Edgcomb J, Coverdale J, Aggarwal R, Guerrero APS, Brenner AM. Applications of Clinical Informatics to Child Mental Health Care: a Call to Action to Bridge Practice and Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:11-17. [PMID: 35175570 PMCID: PMC8852995 DOI: 10.1007/s40596-022-01595-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Juliet Edgcomb
- University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Shook B, Palusak C, Davies SC, Lundine JP. A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021. [DOI: 10.1177/20534345211070653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction & importance Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child's complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. Methods A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. Results 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. Discussion Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI.
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Affiliation(s)
- Brandy Shook
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH, USA
| | - Cara Palusak
- Heritage College of Osteopathic Medicine, Ohio University Dublin Campus, Columbus, OH, USA
| | - Susan C Davies
- Department of Counselor Education and Human Services, University of Dayton, Dayton, OH, USA
| | - Jennifer P Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH, USA
- Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children’s Hospital, Columbus, OH, USA
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Mazur SL, Edelsohn GA, DePergola PA, Sarvet BD. Ethical Imperatives for Participation in Integrated/Collaborative Care Models for Pediatric Mental Health Care. Child Adolesc Psychiatr Clin N Am 2021; 30:697-712. [PMID: 34538442 DOI: 10.1016/j.chc.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The significant and ongoing shortage of child and adolescent psychiatrists has limited access to mental health care in the pediatric population. In response to this problem, integrated/collaborative care models have been established. These models, as all imperfect things in medicine, have their own set of challenges. A careful ethical analysis of integrated/collaborative care models is essential to protect the social and emotional health and safety of children with mental illness. To this end, ethical assessment supports the use of integrated/collaborative care models, and recent studies have demonstrated the benefits of their implementation.
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Affiliation(s)
- Shannon L Mazur
- Department of Psychological Medicine, Yale New Haven Hospital, 20 York Street, Fitkin 607, New Haven, CT 06510, USA.
| | - Gail A Edelsohn
- Community Care Behavioral Health Organization, UPMC Insurance Services Division, 1 East Uwchlan Avenue, Suite 311, Exton, PA 19341, USA
| | - Peter A DePergola
- Department of Medicine, University of Massachusetts Medical School - Baystate, 759 Chestnut Street, Daly 6100B, Springfield, MA 01199, USA; Department of Bioethics and Medical Humanities, College of Our Lady of the Elms, 291 Springfield Street, Chicopee, MA 01013, USA; St. Augustine Center for Ethics, Religion, and Culture, College of Our Lady of the Elms, 291 Springfield Street, Chicopee, MA 01013, USA
| | - Barry D Sarvet
- Department of Psychiatry, University of Massachusetts Medical School - Baystate, 759 Chestnut Street, WG703, Springfield, MA 01199, USA
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Sengupta S. Engaging Pediatric Primary Care Clinicians in Collaborative and Integrated Care. Child Adolesc Psychiatr Clin N Am 2021; 30:767-776. [PMID: 34538447 DOI: 10.1016/j.chc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pediatric primary care clinicians (PPCCs) are managing increasing mental health challenges in the children and adolescents they treat. Child and adolescent psychiatrists (CAPs) are increasingly involved in collaborative and integrated care (CIC) work that builds the knowledge and skills of PPCCs to manage mild to moderate mental health challenges for children and adolescents in primary care. CAPs who can establish good working relationships, communicate clearly and efficiently, and facilitate the care of this population will be successful in engaging our PPCC partners in CIC.
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Affiliation(s)
- Sourav Sengupta
- Departments of Psychiatry & Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA; Children's Psychiatry Clinic of Oishei Children's Hospital, 1028 Main Street, Buffalo, NY 14202, USA.
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33
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Walton QL, Bromley E, Porras-Javier L, Coker TR. Building Bridges: Primary Care and Mental Health Providers’ Perspectives on a Behavioral Health Collaborative Intervention Among Underserved Populations. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fallucco EM, Landy RE, Leung K, Robertson Blackmore E. Child Psychiatry Consultation Clinic for Pediatricians: Long-Term Outcomes. Clin Pediatr (Phila) 2021; 60:350-362. [PMID: 34008439 DOI: 10.1177/00099228211015844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an urgent need for new clinical models to improve access to child mental health care. Pediatricians are tasked to care for youth with mild to moderate mental health problems, but require additional training. This article describes an outpatient child psychiatry consultation clinic (CPC) designed to empower pediatricians to care for youth with depression, anxiety, and attention deficit/hyperactivity disorder. Over a 2-year period, 40 primary care physicians (PCPs) referred 159 patients to the CPC. The most common primary diagnoses of patients seen for consultation were generalized anxiety disorder (35%), major depressive disorder (24%), and attention deficit/hyperactivity disorder (20%). Most patients (89%) had at least 2 psychiatric diagnoses. Nearly four fifths (79%) of these patients successfully returned to their PCP for ongoing care. PCPs reported that the CPC enhanced their skills and improved access to mental health care. Similar models are needed to facilitate early intervention for the millions of youth with mental health problems.
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Affiliation(s)
- Elise M Fallucco
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Kitty Leung
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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35
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Need for Integrated Behavior Health Model in Primary Care. Pediatr Clin North Am 2021; 68:533-540. [PMID: 34044982 DOI: 10.1016/j.pcl.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Children and adolescents with clinically concerning behavioral health conditions face several barriers to accessing specialized mental health care. One proposed solution is to improve and expand integrated care provided in the primary health care provider's office. Several strategies can increase pediatrician comfort and willingness to collaborate in diagnosing and treating behavioral health conditions, and increased utilization of new technologies (such as telehealth) are likely to play an increasingly important role in the process.
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Paton K, Gillam L, Warren H, Mulraney M, Coghill D, Efron D, Sawyer M, Hiscock H. Clinicians' perceptions of the Australian Paediatric Mental Health Service System: Problems and solutions. Aust N Z J Psychiatry 2021; 55:494-505. [PMID: 33461341 DOI: 10.1177/0004867420984242] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Despite substantial investment by governments, the prevalence of mental health disorders in developed countries remains unchanged over the past 20 years. As 50% of mental health conditions present before 14 years of age, access to high-quality mental health care for children is crucial. Barriers to access identified by parents include high costs and long wait times, difficulty navigating the health system, and a lack of recognition of the existence and/or severity of the child's mental health disorder. Often neglected, but equally important, are clinician views about the barriers to and enablers of access to high-quality mental health care. We aimed to determine perspectives of Australian clinicians including child and adolescent psychiatrists, paediatricians, psychologists and general practitioners, on barriers and enablers within the current system and components of an optimal system. METHODS A total of 143 clinicians (approximately 35 each of child and adolescent psychiatrists, paediatricians, child psychologists and general practitioners) from Victoria and South Australia participated in semi-structured phone interviews between March 2018 and February 2019. Inductive content analysis was applied to address the broad study aims. FINDINGS Clinician-identified barriers included multi-dimensional family factors, service fragmentation, long wait times and inadequate training for paediatricians and general practitioners. Rural and regional locations provided additional challenges but a greater sense of collaboration resulting from the proximity of clinicians in rural areas, creating an opportunity to develop support networks. Suggestions for an optimal system included novel ways to improve access to child psychiatry expertise, training for paediatricians and general practitioners, and co-located multidisciplinary services. CONCLUSION Within the current mental health system for children, structural, training and workforce barriers prevent optimal access to care. Clinicians identified many practical and systemic ideas to improve the system. Implementation and evaluation of effectiveness and cost effectiveness of these ideas is the next challenge for Australia's children's mental health.
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Affiliation(s)
- Kate Paton
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Lynn Gillam
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Hayley Warren
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Melissa Mulraney
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - David Coghill
- Mental Health, The Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Daryl Efron
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Sawyer
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Children's Research Institute and The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
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Tian PGJ, Harris JR, Seikaly H, Chambers T, Alvarado S, Eurich D. Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan. JMIR Form Res 2021; 5:e17672. [PMID: 33620325 PMCID: PMC7943336 DOI: 10.2196/17672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. OBJECTIVE As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. METHODS We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. RESULTS The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. CONCLUSIONS Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use. .
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Affiliation(s)
| | - Jeffrey Richard Harris
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Thane Chambers
- University of Alberta Libraries, University of Alberta, Edmonton, AB, Canada
| | - Sara Alvarado
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Bettencourt AF, Plesko CM. A Systematic Review of the Methods Used to Evaluate Child Psychiatry Access Programs. Acad Pediatr 2020; 20:1071-1082. [PMID: 32673763 DOI: 10.1016/j.acap.2020.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/12/2020] [Accepted: 07/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a well-documented gap between the need for and availability of mental health services for children nationwide. To address this gap, over 30 regional Child Psychiatry Access Programs (CPAPs) provide psychiatric consultation and other services to primary care providers. OBJECTIVE Summarize the methods used to evaluate CPAPs in the United States. DATA SOURCES PubMed, PsychInfo, CINAHL, and reference checking. STUDY APPRAISAL METHODS A systematic literature review was conducted searching 3 databases. The search produced 307 unique articles, 278 were excluded for irrelevance, leaving 29 for data extraction. Data extracted included author(s), publication year, provider types, CPAP formats, study sample, design, outcomes examined, results, and limitations. Articles were also appraised for quality using the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide. RESULTS The 29 articles evaluated 13 unique CPAPs. Most evaluations used nonexperimental observational designs (68.9%), 6.9% used quasi-experimental designs, and none used true experimental designs. Evaluations examined the following outcomes: usage of program services (82.8%), provider satisfaction (48.3%), provider comfort/confidence with managing mental health concerns (31.0%), provider practice change (24.1%), patient outcomes (13.7%), and family satisfaction (6.9%). Outcomes were measured using surveys, qualitative interviews, or insurance claims data. LIMITATIONS Review was limited to articles published in English in 3 databases or identified by reference checking. CONCLUSIONS Evaluations of CPAPs have largely been descriptive in nature, focusing primarily on program usage and provider satisfaction. Few studies have examined the impact of CPAPs on patients, families, or health systems. Future studies should evaluate the broader impacts of CPAPs.
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Abstract
Challenges associated with the integration of pediatric mental health care in the primary care setting include limitations of training and time, high volume of patients, need for coordination with external specialists, limited infrastructure, and limited funding. All of these issues can negatively influence the quality of mental health service delivery. Measurement-based care (MBC) processes have the potential to mitigate many of these challenges and generate data, allowing practices to evaluate and improve the performance of integrated mental health processes. Implementing MBC requires initial investment of staff resources for planning and training and information technology resources.
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Affiliation(s)
- Barry Sarvet
- Department of Psychiatry, University of Massachusetts Medical School-Baystate, Baystate Medical Center, WG703, 759 Chestnut Street, Springfield, MA 01199, USA.
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40
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Waid J, Kelly M. Supporting family engagement with child and adolescent mental health services: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1333-1342. [PMID: 31951087 DOI: 10.1111/hsc.12947] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 05/10/2023]
Abstract
A key challenge facing the mental health field is connecting children and families to services when symptoms first appear. Multiple barriers inhibit timely access to treatment, and interventions to resolve barriers to care are not common among health and social care organisations. To address this research-to-practice gap this study undertook a scoping review of the empirical literature aimed at identifying key factors in the social ecology of families which influence family engagement with child and adolescent mental health services, then identifying and describing models of intervention designed to help facilitate access to care. Forty studies published between 1 January 2000 and 28 February 2019 were reviewed. Key factors associated with child and adolescent mental health service engagement included family attitudes towards mental illness and help seeking, the flexibility and availability of needed services, community attitudes and stigma surrounding mental illness and mental health treatment, and the degree of coordination and integration across systems of health and social care. Models of intervention to facilitate engagement with mental health services included family outreach, telephone and digital health strategies, and integrated care approaches. Empirical support is strongest for family outreach and integrated care, although telephone and digital health strategies are underexplored with children and families and a potentially promising avenue for future research. To support family engagement with child and adolescent mental health services health and social care organisations should be prepared to identify barriers in their local practice settings and integrate efficacious engagement approaches into their continuum of available services.
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Affiliation(s)
- Jeffrey Waid
- School of Social Work, University of Minnesota - Twin Cities, Paul, MN, USA
| | - Meredith Kelly
- School of Social Work, University of Minnesota - Twin Cities, Paul, MN, USA
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41
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Sweeney S, Coble K, Connors E, Rebbert-Franklin K, Welsh C, Weintraub E. Program development and implementation outcomes of a statewide addiction consultation service: Maryland Addiction Consultation Service (MACS). Subst Abus 2020; 42:595-602. [PMID: 32814004 PMCID: PMC7892630 DOI: 10.1080/08897077.2020.1803179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: As the opioid epidemic continues, there is a mounting sense of urgency to improve access to high-quality early identification and treatment services. However, the need is outpacing capacity in many states and effective solutions to support primary care and specialty prescribers to identify and treat more patients with opioid use disorders are still emerging. This paper describes one state's approach to increase access to medication for opioid use disorders (MOUD) through development and implementation of a statewide addiction consultation service: Maryland Addiction Consultation Service (MACS). Methods: Program components include a warmline, outreach and training, and resource and referral linkages for prescribers based on related consultation service models and documented barriers to prescribing MOUDs. Results: Initial implementation outcomes indicate service components are being adopted as intended and by the target audience; many prescribers who engaged with the service have their buprenorphine waiver (44%) but do not have any additional formal addiction training (57%). Also, statewide penetration is promising with prescriber engagement in 100% of counites, however only 33% of counties in engaged in all four types of MACS services. Most calls (61%) originated from urban counties. Conclusions: The MACS program increases access to specialty addiction medicine consultation and training through use of technology. MACS can serve as a model for other states looking to bridge the gap in access to addiction treatment.
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Affiliation(s)
- Sarah Sweeney
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kelly Coble
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Elizabeth Connors
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Christopher Welsh
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Eric Weintraub
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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42
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McLaurin-Jiang S, Cohen GM, Brown CL, Edwards P, Albertini LW. Integrated Mental Health Training Relates to Pediatric Residents' Confidence with Child Mental Health Disorders. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:299-304. [PMID: 31965516 DOI: 10.1007/s40596-020-01182-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The primary aim of this study was to determine the association of an integrated mental health training model on pediatric residents' use of (1) secondary screens, (2) mental health referrals, (3) psychotropic medications, and (4) follow-up appointments for mental health concerns. The secondary aim was to determine resident confidence managing mental health conditions. METHODS Visits of children ages 6-18 years old with either a positive primary mental health screen or a mental health diagnosis in pre- and post-intervention years (N = 113 and N = 251, respectively) at a single-site continuity clinic were included. Authors also surveyed alumni from pre- and post- intervention years (N = 46) about their confidence with managing mental health disorders. The authors used chi-squared and t-tests to compare visit characteristics between years and multivariable logistic regression to determine correlates of mental health management. RESULTS Post-intervention residents more often used secondary screening tools (adjusted odds ratio 5.61, 95% confidence interval 2.08-15.17). There were no differences in referrals, prescribing psychotropic medications, or follow-up visits. Post-intervention graduates reported higher confidence with diagnosis, screening, medication management, and follow-up for mental health disorders. CONCLUSIONS After transitioning to an integrated mental health model, residents were more likely to use secondary screens and post-intervention graduates reported higher confidence with managing mental health disorders.
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Affiliation(s)
- Skyler McLaurin-Jiang
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Gail M Cohen
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Spencer AE, Platt RE, Bettencourt AF, Serhal E, Burkey MD, Sikov J, Vidal C, Stratton J, Polk S, Jain S, Wissow L. Implementation of Off-Site Integrated Care for Children: A Scoping Review. Harv Rev Psychiatry 2020; 27:342-353. [PMID: 31714465 PMCID: PMC7374937 DOI: 10.1097/hrp.0000000000000239] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care. METHODS We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability). RESULTS We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models. CONCLUSIONS Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.
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44
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Yang Y, Dillon EC, Li M, Li J, Erlich KJ, Heneghan AM, Becker DF. Primary care provider utilization and satisfaction with a health system navigation program for adolescents with behavioral health needs. Transl Behav Med 2020; 9:549-559. [PMID: 31094446 DOI: 10.1093/tbm/ibz049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Approximately 49.5% of the adolescents report a mental health disorder; only about half of the children and adolescents with mental health disorders seek treatment from a mental health professional. Stigma and poor access to behavioral health providers are leading barriers to care. A large ambulatory health system implemented a BH navigation program to facilitate referrals from primary care physicians (PCPs), including pediatricians and family physicians, to BH providers. We studied PCP adoption of BH navigation services over a 4-year period, from July 2014 to June 2018. We retrieved operational data regarding service utilization, patient information from electronic health records and PCP information from administrative data, and surveyed PCPs for their appraisals of navigation services. Four thousand five hundred and fifty-five referrals were made for 3,912 patients from 290 PCPs (71% of PCPs in the health system). Depression (39%), anxiety (25%), and attention-deficit hyperactivity disorder (7%) were the most frequent reasons for referral. Referrals increased dramatically in the first half of the study period and decreased afterwards. Ninety-one percent of the PCPs agreed or strongly agreed that navigation enhanced their clinical care at 12-month survey. More than 90% of the PCPs rated the referral process, communication with navigation staff, and the overall experience as above average or excellent at 12 months. There was a decrease in these evaluation indicators after 2.5 years. The initial high referral volume reflects a need for BH navigation services. However, challenges remain to maintain positive PCP assessment in the face of such demand.
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Affiliation(s)
- Yan Yang
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Ellis C Dillon
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Martina Li
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Jinnan Li
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
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45
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Lenton-Brym T, Rodrigues A, Johnson N, Couturier J, Toulany A. A scoping review of the role of primary care providers and primary care-based interventions in the treatment of pediatric eating disorders. Eat Disord 2020; 28:47-66. [PMID: 30664402 DOI: 10.1080/10640266.2018.1560853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Youth with eating disorders are often cared for by specialized interdisciplinary teams in pediatric tertiary care centers. Enhanced involvement of primary care providers may provide added benefits to patients because it offers improved access, better continuity of care, and possibly less financial burden. This paper aims to synthesize and assess the literature on the role of the primary care provider in treating pediatric eating disorders in order to identify an optimal model of shared care. Sources were identified by entering search terms in 10 databases. Eligible sources were English publications focusing on primary care-based interventions for eating disorders in youth (=<24 years). The search yielded 5,516 unique citations. Of these, 61 were ultimately included. Sources fell into two categories: (1) primary research (n = 3) and (2) reviews with recommendations for primary care providers (n = 58). The primary studies considered the primary care provider conducting behavioral therapy and guided self-help. Review articles suggested providing education, assessing for hospitalization, aiding in weight restoration, managing complications, referring, and coordinating care. Limited evidence exists that can guide effective primary care-based interventions for the treatment of pediatric eating disorders. Further research is needed to develop and evaluate interventions for the treatment of pediatric eating disorders in primary care settings so that best practices can be identified.
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Affiliation(s)
- T Lenton-Brym
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - A Rodrigues
- Division of Adolescent Medicine, McMaster University, Hamilton, ON, Canada
| | - N Johnson
- Division of Adolescent Medicine, McMaster University, Hamilton, ON, Canada
| | - J Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - A Toulany
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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46
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Cama S, Knee A, Sarvet B. Impact of Child Psychiatry Access Programs on Mental Health Care in Pediatric Primary Care: Measuring the Parent Experience. Psychiatr Serv 2020; 71:43-48. [PMID: 31551042 DOI: 10.1176/appi.ps.201800324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to assess parents' satisfaction with the primary care provider (PCP) in the treatment of their child's mental health problems after the PCP consulted with the Massachusetts Child Psychiatry Access Program (MCPAP). It studied how parental satisfaction may vary across factors, including service utilization, parental perception of the child's illness, and parental perception of certain PCP attributes. METHODS The study analyzed 374 telephone consultations made from PCPs to MCPAP between March 2010 and June 2012. Questions in a structured telephone survey administered to parents identified the types of services participants were referred to and assessed satisfaction rates on the basis of measures reflective of the patient-doctor relationship and of illness factors. RESULTS Eighty-six percent of participants expressed satisfaction with their PCP's handling of their child's mental health problems after MCPAP consultation. Participants who agreed with statements reflective of a positive patient-doctor relationship (in terms of the PCP's empathy and knowledge) exhibited higher rates of satisfaction with the PCP's role in the treatment of their child's mental health problems than those who did not agree. The most common recommendations made to families after consultation were to follow up with the child's PCP (94%) and to obtain further MCPAP consultation (78%). CONCLUSIONS The survey results indicated high rates of parents' satisfaction with the PCP's handling of their child's mental health issues. Recommendations made to PCPs by MCPAP consultants aimed to strengthen the PCP's role as a mental health provider.
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Affiliation(s)
- Shireen Cama
- Department of Psychiatry, Harvard Medical School and Cambridge Health Alliance, Cambridge, Massachusetts (Cama); Department of Medicine (Knee) and Department of Psychiatry (Sarvet), University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Alexander Knee
- Department of Psychiatry, Harvard Medical School and Cambridge Health Alliance, Cambridge, Massachusetts (Cama); Department of Medicine (Knee) and Department of Psychiatry (Sarvet), University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Barry Sarvet
- Department of Psychiatry, Harvard Medical School and Cambridge Health Alliance, Cambridge, Massachusetts (Cama); Department of Medicine (Knee) and Department of Psychiatry (Sarvet), University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
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47
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Lu J, Ketterer E, McGuire P. Implementation of psychiatric e-consultation in family medicine community health centers. Int J Psychiatry Med 2019; 54:296-306. [PMID: 31438754 DOI: 10.1177/0091217419869081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychiatric E-consult is an innovative model of psychiatric consultation via the electronic health record. The project was completed as a quality improvement effort within a residency program in order to increase timely access to psychiatric consultation. Over 100 electronic consultations were requested in the initial 20 months of this project. Questions ranged from assistance with medication management, diagnostic clarification, to referral to outside resources. Findings from this quality improvement project include that the e-consultation model enhanced primary care physicians’ and associated primary care health professionals’ management of behavioral issues, increased behavioral health knowledge, and subjectively improved patient care.
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Affiliation(s)
- Jiayun Lu
- 1 Combined Family Medicine Psychiatry Residency Program, Pittsburgh, PA, USA
| | - Emily Ketterer
- 2 Renaissance Family Practice-Aspinwall, Pittsburgh, PA, USA
| | - Patricia McGuire
- 3 St. Margaret Family Medicine Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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48
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Correction to Marcus et al. Psychiatr Serv 2019; 70:852. [PMID: 31474215 DOI: 10.1176/appi.ps.709correction3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marcus S, Malas N, Dopp R, Quigley J, Kramer AC, Tengelitsch E, Patel PD. The Michigan Child Collaborative Care Program: Building a Telepsychiatry Consultation Service. Psychiatr Serv 2019; 70:849-852. [PMID: 31272335 DOI: 10.1176/appi.ps.201800151] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column describes the establishment of the Michigan Child Collaborative Care (MC3), a statewide telepsychiatry consultation program that provides support to primary care providers (PCPs) in meeting the mental health needs of youths and perinatal women. The MC3 program provides cost-effective, timely, remote consultation to primary care providers in an effort to address the lack of access and scarcity of resources in child, adolescent, and perinatal psychiatry. Data from 10,445 service requests are summarized. Common diagnoses included attention-deficit hyperactivity disorder, mood disorders, anxiety disorders, and autistic spectrum disorders, with many cases (58%) deemed moderate to severe. Co-occurring psychological trauma was suspected in 9% of service requests. Partnerships, stakeholder roles, PCP engagement, and workflow integration are highlighted as keys to the program's success.
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Affiliation(s)
- Sheila Marcus
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Nasuh Malas
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Richard Dopp
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Joanna Quigley
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Anne C Kramer
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Elizabeth Tengelitsch
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
| | - Paresh D Patel
- Department of Psychiatry (Marcus, Malas, Dopp, Quigley, Kramer, Tengelitsch, Patel) and Department of Pediatrics and Communicable Diseases (Malas, Quigley), University of Michigan, Ann Arbor. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., are editors of this column
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50
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Walter HJ, Vernacchio L, Trudell EK, Bromberg J, Goodman E, Barton J, Young GJ, DeMaso DR, Focht G. Five-Year Outcomes of Behavioral Health Integration in Pediatric Primary Care. Pediatrics 2019; 144:peds.2018-3243. [PMID: 31186366 DOI: 10.1542/peds.2018-3243] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In the context of protracted shortages of pediatric behavioral health (BH) specialists, BH integration in pediatric primary care can increase access to BH services. The objectives of this study were to assess the structure and process of pediatric BH integration and outcomes in patient experience (access and quality), cost, and provider satisfaction. METHODS In 2013, we launched a multicomponent, transdiagnostic integrated BH model (Behavioral Health Integration Program [BHIP]) in a large pediatric primary care network in Massachusetts. Study participants comprised the first 13 practices to enroll in BHIP (Phase-1). Phase-1 practices are distributed across Greater Boston, with ∼105 primary care practitioners serving ∼114 000 patients. Intervention components comprised in-depth BH education, on-demand psychiatric consultation, operational support for integrated practice transformation, and on-site clinical BH service. RESULTS Over 5 years, BHIP was associated with increased practice-level BH integration (P < .001), psychotherapy (P < .001), and medical (P = .04) BH visits and guideline-congruent medication prescriptions for anxiety and depression (P = .05) and attention-deficit/hyperactivity disorder (P = .05). Total ambulatory BH spending increased by 8% in constant dollars over 5 years, mainly attributable to task-shifting from specialty to primary care. Although an initial decline in emergency BH visits from BHIP practices was not sustained, total emergency BH spending decreased by 19%. BHIP providers reported high BH self-efficacy and professional satisfaction from BHIP participation. CONCLUSIONS Findings from this study suggest that integrating BH in the pediatric setting can increase access to quality BH services while engendering provider confidence and satisfaction and averting substantial increases in cost.
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Affiliation(s)
- Heather J Walter
- Departments of Psychiatry, .,Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and
| | - Louis Vernacchio
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and.,Pediatrics, and
| | - Emily K Trudell
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts
| | - Jonas Bromberg
- Departments of Psychiatry.,Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and
| | - Ellen Goodman
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Jessica Barton
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Gregory J Young
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and.,Pediatrics, and
| | - David R DeMaso
- Departments of Psychiatry.,Harvard Medical School, Boston, Massachusetts; and
| | - Glenn Focht
- Connecticut Children's Medical Center, Hartford, Connecticut
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