Presentation on theme: "Behavioral Health Screening & Referral in Pediatric Clinics"— Presentation transcript:
1 Behavioral Health Screening & Referral in Pediatric Clinics Brigette Vaughan MSN, APRN, PMHNP-BCUniversity of Nebraska Medical Center
2 Setting the stage…Nebraska has 27 “rural” psychiatrists (only 9 see children), 20 psychiatric nurse practitioners, 61 psychologists, and 0 developmental pediatricians.Outside of Omaha and Lincoln, only 4 counties have a child psychiatristRural mental health providers are spread over 70,000 square miles and 900,000 livesThere are few resources for children and families, as well as schools and primary care providers for managing behavioral health concerns
3 NAMI Report Card (“Grading the States”, 2006) Infrastructure D-Information Access FServices DRecovery Supports C-Overall grade: D
4 Updating the SystemThe family physician or pediatrician is often the FIRST person consulted regarding behavioral health issues. They have become “defacto” behavioral health providers.>60% of psychotropic medications are prescribed by primary care providersMany providers surveyed indicate they are not comfortable prescribing these medications
5 Research has demonstrated that behavioral health issues are “missed” greater than 53% of the time in primary care.The use of behavioral screening tools in primary care can increase recognition and diagnosis of behavioral disorders up to 70%.
6 LB556Provides that a trained staff person must be available if a child is receiving telehealth servicesThe trained staff will create a safety plan if a safety threat results during therapyBehavioral health screenings should be offered by physicians during physicals
7 The Behavioral Health Center of Nebraska will provide training on children’s behavioral health care for educators serving clinics that provide behavioral health screenings (with parental consent) during physicals and offer integrated child psychologist services on site.Right now this includes the Valentine, Omaha Children’s Physicians Dundee, and Columbus areas. These areas are engaged in a pilot integrated clinic program (as set up by LB556) to measure effectiveness of routing screenings
8 Establishes consultation services for primary care clinicians caring for children with behavioral health issues in integrated pilot site clinicsThe bill establishes regulations on how the integrated clinics will run, and what data will be collectedThe bill addresses various reimbursement issues under Title XIX, to include medicaid reimbursements for services provided via telehealth
9 The Vanderbilt ScaleA 55-question assessment tool. It reviews symptoms of ADHD according to the DSM-IV criteria. It also screens for co-existing conditions such as conduct disorder, oppositional-defiant disorder, anxiety and depression, and more.
10 Current Screening Data Total Screens All Ages (3-18) 1029Positive259 (25.2%)All AgesInattention 10.4%Hyperactivity 8.2%Combined 6.5%Older Children 6-18Inattention 11%Hyperactivity 7.3%Combined 5.7%ODD 10.6%Conduct 3.5%Anxiety/Depression 6.9%Younger Children 3-5Inattention 9.0%Hyperactivity 10.0%Combined ADHD 8.3%143 f/u Calls51 successful phone contact34 psychology service referrals/consults17 declined services25 NP referrals/consultsNegative770 (74.8%)+ screen-met threshold on scale or requested helpPsych referral includes recommendations given over phone, already a current patient in psychology or scheduled new apptNP consult includes referrals (primarily Columbus) and phone med consults
11 Number of Areas Scored Above Cut-off (children 6-18 years)
12 ADHD Comorbidity Often Complicates the Diagnosis and Treatment of ADHD ADHD alone31%31%OppositionalDefiantDisorder40%Tic Disorder11%ADHDn=579ConductDisorder14%38%Anxiety/MoodDisordersJensen P, et al. Arch Gen Psychiatry 1999;56:
13 LB556 & School NursesIntegrated care is the goal for behavioral health care in the future. This will reduce stigma, increase access, and reserve more severe cases for psychiatric nurse practitioner and child psychiatrist care.If a school nurse notices a child is exhibiting symptoms of a behavioral health disorder, this condition should be brought to the teacher and parent’s attention using school policy. The parents should then be referred to a primary care clinic for care, preferably one that offers integrated care (psychologist in-house).
14 Encourage physician colleagues to encourage the use of valid and reliable screening tools in their clinic as a routine part of child physicals.Encourage parents and physicians to refer to child psychologists/behavioral therapists for combined treatment.Reach out to MMI and BHECN for needed educational programs to meet knowledge gaps.
15 BHECN http://www.unmc.edu/bhecn/ Howard Y. Liu, M.D.Medical Director Behavioral Health Education Center of Nebraska (BHECN)Office Phone: Direct Line: Pager: Heidi J. Keeler, PhD, RNAsst. Professor, Community Based Health Dept.Nurse Planner, Continuing Nursing EducationDirector of Educational Design, BHECNPhone: (w)Fax:For more information regarding CNE opportunities please visit:
16 Munroe Meyer Institute Munroe Meyer InstituteJoseph H Evans, Ph.D.Professor, MMI and PediatricsAssociate Clinical Director, Behavioral Health Education Center of NebraskaMunroe-Meyer InstituteUniversity of Nebraska Medical Center
17 Brigette Vaughan MSN, APRN-BC, NP Nurse Practitioner, Munroe Meyer InstituteUNMC Developmental and Behavioral PediatricsNurse Coordinator, Department of PsychiatryChild & Adolescent Psychopharmacology Research