1. Project TEACH Matt Perkins, MD, MBA, MPH matthew.perkins@omh.ny.gov

2. 2  The population of children and adolescents under age 20 is projected to grow by about 33 percent in the next 40 years from about 84 million to 112 million by 2050 (U.S. Bureau of the Census, 2010).  The Bureau of Health Professions reported that the demand for the services of child and adolescent psychiatry is projected to increase by 100 percent between 1995 and 2020 (Department of Health and Human Services, 2000).  According to a 2012 Children’s Hospital Association survey, appointments for child and adolescent psychiatric care far exceeds the prevailing benchmark of a two-week wait time in children’s hospitals. The average wait time is 7.5 weeks. Background: Children’s Mental Health

3. 3  21% of children and adolescents in the U.S. meet diagnostic criteria for MH disorder with impaired functioning  16% of children and adolescents in the U.S. have impaired MH functioning and do not meet criteria for a disorder  50% of adults in the U.S. with MH disorders had symptoms by the age of 14 years Epidemiology of Pediatric Mental Health Disorders

4. 4 Child and Adolescent Psychiatrist (CAP) workforce issues and distribution  Approximately 8300 practicing CAPs in the U.S.  83% direct patient care – 6900 CAPS  NYS has among the largest number of CAPs of any state--but there is a significant disparity in distribution  Rural and underserved areas in NYS and elsewhere are particularly hard hit  20% of 58 surveyed counties in NYS have no CAP. Another 15% have only one CAP (Kaye et al, 2009)  60% of psychiatrists over age 55

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6. 6 What percentage of psychiatrists accept private insurance? A.89% B.98% C.75% D.55% E.63%

7. 7 What percentage of psychiatrists accept Medicaid? A.89% B.98% C.75% D.55% E.43%

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9. 9 Waiting List According to a 2012 Children’s Hospital Association survey, appointments for child and adolescent psychiatric care far exceeds the prevailing benchmark of a two-week wait time in children’s hospitals. The average wait time is 7.5 weeks. “Children on the waiting list don’t just quietly wait. Their problems get worse and they deteriorate. They often end up in the emergency room or being admitted to a child psychiatric hospital for problems that had they been treated earlier, would be less costly.” Greg Fritz, M.D. child and adolescent psychiatrist

10. 10 Kids with Mental Ills Often Treated Solely by Primary Care Doctors—10/12/15  More than one-third of U.S. kids receiving care for a mental health problem are treated by their primary care physician alone, without the involvement of a psychiatrist, psychologist or social worker  Primary care providers saw more children with ADHD than did mental health providers, caring for a solid 42 percent of kids diagnosed with the disorder  Nearly three-quarters of ADHD children being treated by a primary care doctor were prescribed medication, compared with 61 percent of those receiving care from a psychiatrist

11. 11 The “Primary Care Advantage”  Longitudinal, trusting relationship  Family centeredness  Unique opportunities for prevention and anticipatory guidance  Understanding of common social-emotional and learning issues in the context of development  Experience in coordinating with specialists in the care of Children with Special Health Care Needs (CSHCN)  Familiarity with chronic care principles and practice improvement  Comfort with diagnostic uncertainty Jane Foy, MD, FAAP

12. 12 Project TEACH Model Project TEACH is comprised of three interrelated services:

13. 13 Cumulative through 8/31/2015 Physicians Enrolled2020 Trainings93 Phone Consults6834 Face to Face evaluations1114 Total Phone + Face-Face Consultations7948 Linkage Calls2494 13 Project TEACH Numbers

14. 14 C.A.P.E.S. The Child and Adolescent Psychiatry Education and Support (C.A.P.E.S.) Program for Primary Care Physicians is a training and consultation support initiative that was designed to help Primary Care Physicians (PCP's) better meet the mental health needs of child and adolescent patients. The C.A.P.E.S. Program has been active since 2005. It was created, and continues to be led, by Jeffrey M. Daly, M.D. The C.A.P.E.S. Program offers PCPs the opportunity to participate in an evidence-based training curriculum and to access consultation services with a child and adolescent psychiatrist. The Program also works to link PCPs with behavioral health clinicians in their community by providing referrals and maintaining a detailed mental health provider directory. By participating in the C.A.P.E.S. Program, primary care physicians receive access to: o Continuing Medical Education events that focus on the assessment, diagnosis and treatment of child and adolescent psychiatric issues within a primary care practice. o Telephone consultation time with Dr. Daly for assistance with difficult psychiatric cases. o Direct evaluation services with Dr. Daly for patients with complex psychiatric presentations. o Assistance with referrals to outpatient mental health providers in your community. www.capesprogram.org/

15. 15 CAP PC Child and Adolescent Psychiatry for Primary Care (CAP PC) is a collaboration between the Departments of Psychiatry at the University at Buffalo, University of Rochester, Columbia University, SUNY Upstate, and Long Island Jewish/North Shore University. The child psychiatry divisions at these 5 university based sites have partnered with the REACH Institute to provide primary care physicians with the education and support to better meet the mental health needs of children in the state by offering:  Education CAP PC is offering the REACH (Resource for Advancing Children’s Health) Institute's Mini- Fellowship in Child and Adolescent Mental Health in 2013. It consists of CME training in recognizing, assessing, and managing mild-moderate mental health problems in children and adolescents. The program is at no cost to participating PCPs and consists of a three-day dynamic workshop, involving interactive learning methods. The program also includes twice- monthly case-based phone conferences for 6 months.  Consultation support o One toll free phone line (1-855-227-2727) for access to CAP PC child and adolescent psychiatrists o Phone and face-to-face consultation support 5 days a week from 9:00 AM to 5:00 PM. o Access to CAP PC Liaison Coordinators to assist with linkage and referral to specialty child mental health services. www.cappcny.org

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18. 18 Planning In 2014, OMH sought input from key stakeholders on how best to extend and expand Project TEACH services  Project TEACH Advisory Committee  American Academy of Pediatrics/American Academy of Family Physicians  Conference of Local Mental Hygiene Directors  Department of Health  OMH Leadership

19. 19 Recommendations Expand services and utilization of services Standardize both the delivery of services and the marketing of Project TEACH across the state Foster collaborative work with other prevention and early identification initiatives Build in evaluation throughout the initiative

20. 20 Recommendations Increase the Child Adolescent Psychiatry staffing available for consultation Expand services to provide consultation to ALL prescribers who are treating children Focus on increasing participation in areas of unmet need that have the lowest number of physicians participating Add specialty consultation for identified areas of need such as intellectual disabilities, substance abuse, and maternal depression. Provide a broader menu of training opportunities and increase the number of targeted local trainings

21. 21 Two RFPs Regional Providers Continue to provide and expand usage of component services– consultation, training and linkage/referral Statewide Coordination Center Coordinate and manage the work of the Regional Providers to ensure that utilization of Project TEACH services is at full capacity Oversee the successful expansion of Project TEACH services Serve as a leader in NYS to advance prevention science, promote children’s social emotional health Support the continued integration of pediatric primary care and behavioral health.

22. 22 Regional Providers

23. 23 Regional Providers RFP Provides for expansion of services and of outreach on the regional level: Continue to provide the three services within three delineated regions with a minimum number of sites per region Increase of total funding for the Regional Providers Increase of minimum Child Adolescent Psychiatry time available Focus of training is on-site training to PCPs both to provide education and as a strategy for outreach to PCPs within the region

24. 24 Project TEACH Statewide Coordination Center

25. 25 Statewide Coordination Center Project TEACH Statewide Coordination Center will be responsible for four functions: Coordination of the services provided by the Project TEACH Regional Providers and the expansion of those services Expansion of Training and Consultation Services on a state-wide basis Be a resource for Evidence-based and Best Practice Strategies for Advancing Children’s Health Evaluation of the services provided by Project TEACH and ongoing evaluation of the statewide impact of the program