Moving Mental Health Forward

1. Moving Mental Health Forward Barb Frankowski, MD, MPH, FAAP

2. Disclosure I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

3. Primary Care Advantage • Longitudinal, trusting relationship • Opportunities for prevention • Screen for psychosocial problems • Intervene early • Recognize & address barriers • Assessment / treatment • Referral and coordination

4. Challenges • Training • Time • Pay • Access • Administrative barriers • Feedback from specialists • Stigma

5. Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit 4 Approaches: • Paper Table of Contents • Practice Readiness Inventory • Clinical Algorithms • Cluster Guidance

6. Approach #1 Paper Table of Contents

7. Toolkit Contents

8. Approach #2 Practice Readiness Inventory

12. Practice Readiness Inventory • Community Resources • Inventory • Core services • Collaborative Relationships • Health Care Financing • Third-party payment • Coding

13. Practice Readiness Inventory Referral assistance Care coordination Special populations Family-centeredness Quality improvement • Support for Children & Families • First contact • Culturally effective care • Mental health promotion • Confidentiality • Adolescents • Engagement • Self-management & family management

14. Practice Readiness Inventory Tracking systems Care plans Collaborative models Interactive Web-based tools Screening assessment tools • Clinical Information Systems / Delivery System Redesign • Registry • Recall & reminder systems • Medication management • Emergency • Information exchange

15. Practice Readiness Inventory • Decision Support for Clinicians • Functional assessment • Clinical guidance • Protocols • Psychiatric consultation • Screening & surveillance

16. Approach #3 Clinical Algorithms

19. Algorithm A: Promoting Social-Emotional Health, Identifying Mental Health & Substance Use Concerns, Engaging the Family, & Providing Early Intervention in Primary care

20. Algorithm B: Assessment & Care of Children With Identified Social-Emotional, Mental Health, or Substance Abuse Concerns, Ages 0-21

22. Algorithm Resources • Description • Requisite competencies • Community resources • Coding assistance • Resources for children & families • Information systems / forms • Decision support

23. Approach #4 Cluster Guidance

25. Cluster Topics • Background information about the clinical guidance • Symptoms of social-emotional problems in children birth to 5 • Anxiety • Depression • Inattention and impulsivity • Disruptive Behavior and aggression • Substance use and abuse • Learning difficulties

27. Example: Anxiety Cluster • Introduction • Screening results • Symptoms and clinical findings • Conditions that mimic anxiety • Tools for further assessment • Evidence-based & evidence-informed interventions • Plan of care for children with anxiety • Resources for clinicians • References

30. Order from AAP Bookstore: www.aap.org/bookstore For institution or practice-wide site licenses, or to inquire about group discounts, contact aapsales@aap.org or call 800/433-9016, ext. 7114.

31. “This resource was created to help any primary care provider who works with children or adolescents, including physicians, residents, and nurse practitioners. This is an essential resource that was created in response to a critical need.” – Doody’s Book Review

32. Other Resources Available From the AAP

33. Strategies for System Change in Children’s Mental Health: A Chapter Action Kit Strategies to: • Partner with Families • Assess the Service Environment • Collaborate with MH Professionals • Education Chapter Members • Partner with Child-Serving Agencies • Improve Children’s MH Financing

34. Improving MH Services in Primary Care: Reducing Administrative & Financial Barriers to Access & Collaboration • Outlines issues and potential solutions • Makes recommendations to insurance purchasers, payers, & managed behavioral health organizations American Academy of Child and Adolescent Psychiatry Committee on Health Care Access and Economics, American Academy of Pediatrics Task Force on Mental Health. Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration. Pediatrics, Apr 2009; 123:1248-1251

35. The Future of Pediatrics: MH Competencies for Pediatric Primary Care (policy statement) • System-Based Practice • Patient Care • Medical Knowledge • Practice-Based Learning & Improvement • Interpersonal & Communication Skills • Professionalism Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health. The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care. Pediatrics, July 2009; 124:410-421.

36. Enhancing Pediatric MH Care: Report from the AAP TFOMH • Strategies for Preparing a Community • Strategies for Preparing a Primary Care Office • Algorithms for Primary Care Task Force on Mental Health. Enhancing Pediatric Mental Health Care: Report From the American Academy of Pediatrics Task Force on Mental Health. Pediatrics, June 2010; 125;S69-S125.

38. www.aap.org/mentalhealth

39. Check the AAP mental health Web site for “Tool Time” presentations • Brief presentations about specific tools from the toolkit that you can view at your leisure • Quickly learn about a tooland how to use it • Includes case examples

40. www.aap.org/mentalhealth Join the AAP mental health listserv! Have a question? E-mail mentalhealth@aap.org