behavioral-health integration in pediatric primary care and race to the top project 7
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Behavioral-Health Integration in Pediatric Primary Care and
Race to the Top Project 7
Maryland B-HIPP Made possible through:
• Funding support from DHMH/MHA and MSDE• No cost to providers or patients
no insurance requirements
Collaboration among University of Maryland, Johns Hopkins Bloomberg School of Public Health, Salisbury University, and community/ advocacy groups
Rationale PCP are frontline. Reduce common barriers Include social emotional development
in screening process Develop trauma and family informed
approach to care and consultation
B-HIPP Aims & Goals To support the capacity of primary care
providers to participate in the mental health care of children and youth, thus increasing access to child mental health services
Components• Phone Consultation Service–Clinical questions–Referral information– Links to family navigators
• Continuing Education– Training and QI/MOC opportunities
• Referral & Resource Networking–Building connections among PCPs and mental
health professionals–Connecting providers with referral resources
Phone Consultation Service
Enrolled providers call (or fax) 855-MD-BHIPP
Call is answered by a master’s level clinician• Will address questions as appropriate
Dependent on what is needed to address question, passes call to consultant who calls PCP back • Child psychiatrist• Psychologist• Social worker specializing in trauma or young
children
Prevelance Early maladaptive behaviors can be indicators of
acute stress or early signs of persistent maladaptive trajectories (Egger & Angold, 2009; Angold & Egger, 2007).
Incidence of psychiatric disorders in children ages 2-5 is 16% (Egger, et al., 2006), compared to 13% in older children (Costello, Mustillo, Erkanli, Keeler, & Arnold, 2003).
Early aggression and post-traumatic stress, are persistent over time with long lasting effects (Zeanah, 2009) that can lead to serious psychological disorders in later childhood (Keenan, Shaw, & Delliquardi, 1998; Shaw, Gilliom, & Ingoldsby, 2003).
Impact on School Readiness
Early aggression has been linked to increased expulsion rates from pre-K programs (Gilliam, 2005), later aggression at age 9 (National Institute of Child Health and Human Development Early Child Care Research Network, 2004).
Identification of and connection with mental health services can ameliorate the long term impact of early childhood mental health difficulties (Knitzer & Lefkowitz, 2006; National Council on the Developing Child, 2008; National Scientific Council on the Developing Child, 2004)..
The National Early Intervention Longitudinal Study (NEILS, 2007) found that 32% of parents receiving Part C services reported having difficulty managing their child’s behavior, but only 4% of children were referred for social/emotional or behavior challenges.
Maryland’s Story Vision: “Start early and the benefits can
last a lifetime: Integrative services in the earliest years of life are smart (high yield on investment) and essential to building healthy brains and productive and safe communities.”
Foundation: Partnerships Building Blocks: Grant Opportunities-
(RTT, PL); Research Projects; Policy Efforts, Workforce Development
Race to the Top: Project #7
Addressing the health and behavioral needs of children through a coherent set of early intervention and prevention programs.
Partnerships Early Childhood Mental Health (Race to
the Top): • Consultation and training focused on the
youngest children (ages 0-5)• Comprehensive integration with B-HIPP
overlap in staff, resources, phone consultation service, evaluation, and training
Project Launch: • Pediatric consultation and training focused on
children ages 0-8 in Prince George’s County
Progress: Pediatric Consultation
7.1 Early Childhood Mental Health Phone Consultation for Pediatricians: Develop and implement phone consultation services for primary care providers in concert with the B-HIPP Project. The goal was to enroll a minimum of 20 pediatric PCPS,
and that goal has been surpassed. There are 110 providers enrolled, and 60% are pediatricians and the remaining 40% are family physicians, nurse practitioners, or another type of primary care provider.
The phone consultation line is operational and has conducted 47 consultations and 26% of the case consultations are for children under the age of 6
Progress: ECMH Training for Pediatricians
7.2 Early Childhood Mental Health Consultation Training for Pediatricians: Recruit and train primary care providers (PCP) and Early Childhood Mental Health (ECMH) consultants Clinical team is completely clinical manual Innovative ways to reach out to physicians Research strategies and stakeholder input
to develop a training manual and booster for primary care and ECMH certificate graduates
Data Collection REDCap Qualitative interviews Referral database and GIS Coming Soon-training evaluation
ECMH Training Stakeholder input Recruit a corpe of PCP in PG Develop curriculum Pilot it and evaluate Disseminate more broadly
ECMH Resource Networking
• Encourage connections/partnerships among PCPs and mental health professionals, ECMH consultants and other Project Launch partners and services.
What kinds of very young patients are providers calling about?
Case Example
Information Look at what other
states are doing• www.nncpap.org
Email contact• [email protected]• [email protected]
aryland.edu• [email protected]• [email protected]
yland.edu