1. Collaboration with Pediatric Primary Care Providers: Bridging the Gap Sandra L. Fritsch, MD, Training Director, Child & Adolescent Psychiatry Residency, Maine Medical Center Renee Leavitt, MS, OTRL, Program Manager, Child & Geriatric Outpatient Psychiatry, Maine Medical Center Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Session #12a October 28, 2011 1:30 PM

2. Faculty Disclosure I/We have not had any relevant financial relationships during the past 12 months.

3. Need/Practice Gap & Supporting Resources What is the scientific basis for this talk? ~ 20 percent of U.S. children and adolescents (15 million), 9 to 17, have diagnosable psychiatric disorders (MECA, 1996, the Surgeon General, 1999) Only about 20% of emotionally disturbed children and adolescents receive some kind of mental health services (the Surgeon General, 1999), and only a small fraction of them receive evaluation and treatment by child and adolescent psychiatrists. 2007 National Survey of Children’s Health (NSCH), 20,562 children (7.2%) in Maine ages 0-17 had an emotional, developmental or behavioral problem for which they needed treatment or counseling. More than 29% of Maine children (40% of U.S. children) with mental health issues did not receive needed mental health services

4. Objectives 1)To provide an understanding of the mental health needs of children and adolescents 2)To describe a collaborative care model: The Child Psychiatry Access Program in Maine (CPAP) 3)To understand how the CPAP model enhances primary care delivery of mental health assessment and treatment

5. Expected Outcomes 1)Learners will understand the needs and challenges for mental health treatment of children and adolescents 2)Learners will be able to describe a collaborative care model between child psychiatry and primary care 3)Learners will be able to identify the key components for success in collaborative care partnerships

6. Learning Assessment A learning assessment is required for CE credit. Attention Presenters: Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.

7. Gap? Why does it exist? Managed care/splitting of benefits Fee for service medicine, time Stigma Training gaps Work force shortage issues Ideological differences “Privacy”

8. Health Care Reform Potential Changes Patient-centered Medical Homes Team-based medical care Accountable care organizations All speak to opportunities/needs/mandates for bringing mental/behavioral health needs into primary care, creating BRIDGES

9. Thoughts on Bridges: Ways/models? How might this work? – Traditional – Collaborative/consultative – Co-located provider Pros & cons of mental health involvement?

10. Radio Play (before CPAP)

11. CPAP Child Psychiatry Access Project Funded by MEHAF, pilot project Ultimate goal is to aid PCP’s with access to child mental health and To promote efficacy and change behaviors of PCP’s to deliver basic mental health screenings and treatment

12. CPAP Model Based on similar model in Massachusetts (www.mcpap.org)www.mcpap.org Attempts to “replicate” MCPAP in other states as well Key personnel – 0.5 fte Clinical care coordinator (CCC) – 0.25 fte Child & Adolescent Psychiatrist (CAP)

13. CPAP (how we “do it”) 1 st : Face to face meeting with all members of practice to describe program and “sign contract” Pre-survey on “access to care” Initial call to CCC to request resource or telephone consultation CAP returns call within 45 minutes Possible face-to-face patient consultation Collaborative learning sessions

14. CPAP Learning Sessions Lunch & Learning Sessions By Year Year OneYear TwoYear Three Formal signing up the practice Fundamentals of Antidepressant Medications Encopresis & Enuresis Mental Health Screening Tools Crisis and Chaos in the PCP Setting ODD, “ Just Say Yes ” Basics for ADHD, Medications and Treatements Treatment of Anxiety in Primary Care Natural Therapies for Mental Health Issues and Sleep What is Therapy? What are the Systems of Care in Maine? Depression and Suicide and the Role of the PCP Substance Abuse

15. Examples of Phone Consults: Review of testing and establishing treatment algorithm School refusal Cutting and IDDM “Messiah” Progressive decline

16. Roles of the Child Psychiatrist Educator Cheerleader Team member Provide a joint partnership “The Expert” “The Bad Guy”

17. Radio Play (After CPAP)

18. CPAP Resource Utilization Jan 2010 – Sept 2010 Total # calls = 117 Calls for resources = 32 Phone consults with CAP = 95 (?) Face to Face Consults = 19 Diagnoses: – Co-morbid = 49% ADHD=18% – Anx/ADHD=17% Dep=13% – Dep/Anx=16% Anx=8% – ADHD/ODD=6%

19. CPAP Statistics, Year 2 Service questionnaire: – Adequate access to child psychiatry? Pre CPAP=100% disagree or strongly disagree 12+ Months after CPAP=100 % agree or strongly agree – Child Psychiatry consultation in timely manner? Pre CPAP = 100% disagree or strongly disagree 12+ months post CPAP = 100% agree or strongly agree – Able to meet the mental health needs of patients with existing resources: Pre CPAP = 12% agree or strongly agree 6 months post CPAP = 100% agree or strongly agree Comments: “I feel now that I can do anything because you are available”, “Thank you that was really helpful”, “I did the PHQ-9 before med and after and it shows she is really better…”

20. Other Statistics, Year 2 Response to survey 11/16= 68.8% Use of CPAP services 9/11= 81.8% How do you screen mental health? – 54.5% tools – 45.5% interview

21. Discussion Ways to “bridge your gaps”

22. You can begin your slides here and REMOVE THIS SLIDE Powerpoint presentations will be reviewed in advance and education sessions audited during the Conference to ensure compliance for accreditation purposes. Commercial support standards require that your presentation be free from commercial bias. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts cannot contain any advertising or product ‐ group message. The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence ‐ based) methods generally accepted by the medical community.

23. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!