Illinois Children’s Healthcare Foundation CHILDREN’S MENTAL HEALTH INITIATIVE Building Systems of Care: Community by Community Fostering Creativity Through Shared Ideas Anita Berry MSN, CNP, APN Director, Healthy Steps for Young Children Program Advocate Health Care Project Director, Enhancing Developmentally Oriented Primary Care

Objectives Participants will be able to Identify the importance of Integrating primary care and mental health Understand Enhancing Developmentally Oriented Primary Care (EDOPC) and how they work in Illinois Clarify the concept of a Medical Home

Primary Care and Mental Health What Do Community Resources Tell Us about Communicating With Primary Care Providers? difficult to access needed records and forms lack of response to requests for medical records or prescriptions for service spend too much time on seemingly simple tasks – reaching the appropriate practice staff member, securing signed forms conflicting information regarding level of detail desired in reports

Primary Care and Mental Health What is it All about?

AAP Mental Health Task Force Plan* Facilitate needed system change Build skills Incremental practice change AAP Task Force on Mental Health, June 2010, Pediatrics

EDOPC Key Partners 6 Illinois Chapter American Academy of Pediatric Advocate Health Care Healthy Steps for Young Children Program

EDOPC Goals Improve delivery and financing of preventive health and developmental services for children birth to three Build on existing programs to develop a range of strategies for primary care settings 7

EDOPC Topics for Training Developmental Screening and Referral Social and Emotional Development: Screening Strategies for Primary Care Physicians Identifying Postpartum Depression During Well-Child Visit: Resources for Screening, Referral, and Treatment Early Autism Detection and Referral Domestic Violence Effects on Children: Detection, Screening and Referral in Primary Care Obesity Prevention in the Early Years 8

Additional EDOPC Topics for Training Effective Discipline in the Early Years Coordinating Care Between EI and the Primary Care Medical Home Project Psychosocial Developmental Screening and Referral for Children Aged Five to Eight Years Coordinating Care Between Early Intervention and the Primary Care Medical Home Bright Futures Guidelines for Health Supervision (beginning July 2011)

EDOPC Methods On site presentations to entire practice staff and topic specific community resources Educational Teleconferences Hospital Grand Rounds or Department Meetings Web based training Technical Assistance – , phone, on site Local and National Conferences

EDOPC Training in Illinois 1250 primary care providers 3200 allied healthcare staff 80% of Federally Qualified Health Centers 153 private practices 30 Residency, Nurse Practitioner, and Physician Assistant programs

EDOPC Provider Survey Providers who received intense EDOPC training, which includes technical assistance, were more likely to have a higher screening rate than providers with little or no EDOPC training. Trained Little or no training PPD-59% PPD-25% Dev-89% Dev-69% SE-37% SE-17%

Medicaid Data Analysis Rise in percent of well child visits with developmental screen 2002 = 15% 2009 = 32% percent of providers conducting at least one developmental screen in a year increased 2002 = 13% 2009 = 46% The percent of EI recipients screened for development by primary care provider before beginning EI services = 18% 2009 = 54%

So Where Are We Going?

Task Force on Vision in Pediatrics By the year 2020 Mental health care will constitute a significant part of pediatric practice

Why do this? Research findings Unique Access of Pediatric PCP High prevalence of mental health problems Mental health service shortage

AAP Task Force on Mental Health* Transformation of practice New knowledge and skills Payment structures Collaborative relationships Office systems and resource Greater role for pediatric PCP in mental health care Prevention Early recognition Referral Treatment Medical home enhancement AAP Task Force on Mental Health, June 2010, Pediatrics

Proposed Mental Health Screening of Children and Adolescents * Use of validated screening tool for those with abnormal developmental or autism screening results For any child with poor growth, behavioral, psychosocial concerns Age 0-5 Use validated screening instruments for all children in this age group at health maintenance visits Use also at time of family disruption, school problems, behavioral problem, recurrent somatic complaints etc 5- Adolescence Screen all adolescents for substance abuse at health maintenance visits Other appropriate times Adolescence AAP Task Force on Mental Health, June 2010, Pediatrics

Proposed Screening and Surveillance of Family and Social Environment for Risk Factors* *AAP Task Force on Mental Health, June 2010, Pediatrics Update child and family psychosocial history at each health maintenance visit Screen for maternal depression in the first year of life of the child or when indicated

Pediatric Primary Care Providers as a Mental Health Provider? ???

Developing collaborative relationships

Definition of HEALTH/MEDICAL HOME Accessible Family-Centered Comprehensive Continuous Coordinated Compassionate Culturally-effective Care that is: A partnership between primary care physicians/ nurse practitioners and families

Care Coordination is Key Through a Medical Home partnership, PCPs can help the family access and coordinate – specialty care – educational services – in and out-of-home care – family support – other community services PCPs and Community Resources must work together to coordinate care 24

Summary Primary care needs to be included in planning for a system of mental health care EDOPC training and technical assistance improves providers ability to screen, treat, and follow up with children and make appropriate referrals to community resources A medical home is a partnership to help families access and coordinate care

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