Behavioral-Health Integration in Pediatric Primary Care and Race to the Top Project 7

1. Behavioral-Health Integration in Pediatric Primary Care and Race to the Top Project 7

2. 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

3. Rationale PCP are frontline. Reduce common barriers Include social emotional development in screening process Develop trauma and family informed approach to care and consultation

4. 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

5. 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

6. 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

7. 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).

8. 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.

9. 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

10. Race to the Top: Project #7 Addressingthehealth and behavioralneeds of childrenthrough a coherent set of earlyintervention and preventionprograms.

11. 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

12. 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

13. 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

14. Data Collection REDCap Qualitative interviews Referral database and GIS Coming Soon-training evaluation

15. ECMH Training Stakeholder input Recruit a corpe of PCP in PG Develop curriculum Pilot it and evaluate Disseminate more broadly

16. ECMH Resource Networking • Encourage connections/partnerships among PCPs and mental health professionals, ECMH consultants and other Project Launch partners and services.

17. What kinds of very young patients are providers calling about?

18. Case Example

19. Information • Look at what other states are doing • www.nncpap.org • Email contact • Lwissow@jhsph.edu • Kconnors@psych.umaryland.edu • mcrosby@jhsph.edu • kcoble@psych.umaryland.edu