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Holy Cow! Mental Health: It’s not all it’s cracked up to be…yet!

Holy Cow! Mental Health: It’s not all it’s cracked up to be…yet!. Kristine Hobbs, LMSW – DHHS July 2011 Learning Collaborative. Remind me why we’re talking about this?. From the grant:

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Holy Cow! Mental Health: It’s not all it’s cracked up to be…yet!

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  1. Holy Cow! Mental Health: It’s not all it’s cracked up to be…yet! Kristine Hobbs, LMSW – DHHS July 2011 Learning Collaborative

  2. Remind me why we’re talking about this? From the grant: “Behavioral health is fully integrated into our demonstration grant as Category C which specifically focuses on the integration of behavioral health care within the medical home…”

  3. Remind me why we’re talking about this? QTIP Doctor - “1/4 to 1/3 of patient visits are mental health related” • 21% of children and adolescents in the US meet diagnostic criteria for MH disorder with impaired functioning • 13% of school-aged, 10% of preschool children with normal functioning have parents with “concerns” • Children with chronic medical conditions have more than 2X the likelihood of having a MH disorder • 8 % of adolescents (2 million youths aged 12 to 17) are estimated to experience a major depressive episode each year, with only two-fifths receiving treatment. Stats: http://www.teenscreen.org/images/stories/PDF/TS_PC_FactSheet_1.18.11.pdf http://gucchdtacenter.georgetown.edu/resources/Call%20Docs/2011Calls/Foy%20Earls%20Georgetown%20-%20Final.pdf

  4. Remind me why we’re talking about this? • 80 % of mentally ill youth are not identified and do not receive mental health services. • The first symptoms of mental illness typically occur two to four years before the onset of a full-blown disorder, leaving an important window of opportunity for prevention. • 90% of adolescent suicide victims have a psychiatric disorder, with 63% exhibiting symptoms identifiable by screening for at least a year before their death. • 50% of all life-time mental health disorders start by age 14. QTIP Doctor - “1/4 to 1/3 of patient visits are mental health related” Stats: http://www.teenscreen.org/images/stories/PDF/TS_PC_FactSheet_1.18.11.pdf http://gucchdtacenter.georgetown.edu/resources/Call%20Docs/2011Calls/Foy%20Earls%20Georgetown%20-%20Final.pdf

  5. Questions from Site Visits… • Ultimate success? • Dismal Failure? • Realistic? • Factors Contributing to Success? • Challenges? • What are you doing already? • How can I best assist you?

  6. Summary of Site Visits No one feels they are meeting the needs completely – they feel the current state of mental health services for kids is the worst case scenario

  7. Summary of Site Visits Needs - • Effective screening, • More service providers, • Easier access to services, and • Billing issues resolved.

  8. Summary of Site Visits Strengths – • Some have systems in place that support having or adding additional services in-house, • Some of you have expanded your capacity to provide limited services, • All of you are dedicated, creative practitioners.

  9. Summary of Site Visits • Challenges – • Limited capacity of caregivers, • Limited resources, • Limited specialist, • Limited knowledge of resources, • Financial issues.

  10. What You Are Doing Now… • 18 practices • 7 of 14 practices interviewed have some form of mental health service provider with the practice (9 total with self-report) • Co-location ranges on-site psychologist 4 hours/week to a full-time mental health counselor • 2 have PT psychiatrist with the practice

  11. How can I best assist you? “Create resources out of dust” “Another form is not the answer” “I want to know what other people do” “Aren’t you a social worker? Come do case management for us.”

  12. Where are we going? In the words of Dr. Rushton… • Prevention • Skill building in the medical home • Better back up and support to front-line medical staff

  13. “Parties who want milk should not seat themselves on a stool in the middle of the field in hopes that the cow will back up to them.”  ~Elbert Hubbard

  14. In General • Provide options for screening and evaluation tools, • Figure out the fiscal issues, • Skill enhancement for pediatricians and pediatric staff around prevention, treatment, referral, • Other training opportunities – enhance prevention and pediatricians skills, • Sharing resources and educational opportunities, • Linkages and support to the medical home.

  15. Resources and referrals • Identify local resources as outlined with NCQA • Build bridges and connections with local resources • Provide ideas for building local networks around resource development and knowledge • Psychometric testing • Benchmarking around referral processes and feedback loops

  16. Co-location & Integration • Ways to identify staff appropriate for co-location • Funding options • Piloting some ideas • Training opportunities for Behavioral Health Staff • Training opportunities for Medical Staff

  17. Psychiatry • Psychiatry Consultation with the Pediatrician • Mini-fellowship in psychiatry • Access to more child psychiatrists

  18. DMH 24/hr ER Telepsychiatry Consultation

  19. You should have…

  20. Ready to take the bull by the horns?Using your handout, indicate your top 3 mental/behavioral health priorities for the next 6 months…

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