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Society of Professors of Child and Adolescent Psychiatry Annual Meeting May 8, 2014

Collaborative program improving mental health services for children and adolescents in NY State by enhancing PCPs' skills and fostering health-mental health collaboration. Offers education, consultations, and referrals. Includes evaluation team for outcomes assessment.

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Society of Professors of Child and Adolescent Psychiatry Annual Meeting May 8, 2014

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  1. CAP PCChild and Adol. Psychiatry for Primary CareNew York State’s Public-University Collaborative Care Program Society of Professors of Child and Adolescent Psychiatry Annual Meeting May 8, 2014 David L. Kaye MD Project Director University at Buffalo

  2. Disclosures of Potential Conflicts

  3. The Future Is Now!

  4. History NYS OMH puts out RFP 9/09 Verbally notified in January 2010 Funded 2 programs: CAP PC 92% population (CAPES covers Albany and North) Began planning in March 2010 Written notification July 2010 Opened doors in Fall 2010

  5. CAP PCChild and Adolescent Psychiatry for Primary Care

  6. The Big Goals of CAP PC To improve the public health of children and adolescents across New York state by addressing the unmet need for mental health services by 1. Bolstering primary care physicians’ ability to assess and manage mild-moderate mental health problems and 2. Promoting collaboration and integration of health and mental health services.

  7. Methods of CAP PC • Educationin child mental health for PCPs starting with the REACH Mini-Fellowship for Assessing and Managing Mental Health Problems in Children and Adolescents, and other programs • IN SYNERGY WITH • Consultationservices for PCPs: • One toll free phone line (1-855-227-7272) for “curbside consults” • CAP phone access Monday-Friday 9 AM-5 PM • LC Referral/linkage assistance • Selected face to face evaluations • Website with clinical rating scales

  8. CAP PC: A Collaboration Between 5 University Based Divisions Of Child Psychiatry and funded by NYS OMH

  9. MONDAY - Upstate Medical U. Syracuse Team: Terri Hargrave MD, Wanda Fremont MD, Maureen Ryan Psy.D. TUESDAY - North Shore/LIJ Team: Carmel Foley MD, Victor Fornari MD, Leslie Cummins MSW WEDNESDAY - Columbia University Team: Rachel Zuckerbrot MD, Jennifer UhrlassMSW THURSDAY - University at Buffalo Team: David Kaye MD, Beth Smith MD, Pam Myers MSW FRIDAY - University of Rochester Team: Jim Wallace MD, Mike Scharf MD, Amy Lyons MS LCAT Site Teams

  10. Our Primary Care Partners AAP NYS Chapter, District II NYSAFP

  11. Our Education Partner: The REACH Institute • National organization established 2006 to develop education for PCPs in child mh • Peter Jensen MD, President and CEO • www.thereachinstitute.org • Mini-Fellowship in Assessment and Management of Child and Adolescent Mental Health • Developed by national team of CAPs and PCPs

  12. The REACH Mini-Fellowship • Two full days (over 3 days) of choreographed, intensive, interactive, hands-on training • Team taught by CAPs and PCP Champs • Covers common problems: complex ADHD, Depression, Anxiety, aggression • Emphasis on evidence based assessment and treatment • Followed by 12 biweekly case based conf calls • Up to 28 CME credits; No cost to PCPs

  13. Content of REACH Weekend • Assessment of pediatric mental health problems, including the use of rating scales I n practice • Overview of pediatric psychopharmacology, with emphasis on SSRIs, Stimulants, other ADHD meds, Atypicals • Anxiety disorders: assessment and treatment • The FDA Black Box Warning on SSRIs • Pediatric depression: assessment and treatment • Bipolar disorder: what it is and recognition

  14. Content of REACH Program Contd. • Finer points of ADHD Assessment • Treating ADHD: Getting the Most out of Meds • Aggression in Kids: Assessment and Treatment • Psychosis in Kids: Recognition • Atypical Antipsychotics: practical use and side effects • Getting Your Office Team Together for Efficient Organization of Clinical Tasks • Getting it Paid For

  15. The Big Picture Numbers

  16. Growth of Registered PCPs

  17. #Calls by Specialty

  18. Reason for Calls

  19. Top Clinical Problems Anxiety or Fear 477 Inattention or Hyperactivity 394 Sad or Depressed 324 Aggression 276 Oppositional, defiant 173 Self injury 101 Obsessional thoughts 65 Hallucinations 56 PDD 40

  20. Callers: To REACH or Not to REACH

  21. Two Week Satisfaction Survey

  22. Annual Survey

  23. Annual Survey 2013

  24. www.cappcny.org

  25. Evaluation Team Kimberly Hoagwood PhD Anne Gadomski MD Larry Wissow MD OMH staff

  26. Outcomes Projects Quantitative analysis: Increasing the detection and treatment of mental health issues by pediatric providers in NY State: An Evaluation of Project TEACH Qualitative study: Mechanisms for Encouraging and Sustainng Integration of Child Mental Health into Primary Care: Interviews with primarcy care providres participating in Project TEACH

  27. Quantitative Evaluation: MA Database (PSYCKES) 176 CAP PC trained PCPs 200 non-trained NYS PCPS Training 7/10-2/12 MA claims data Analysis: 1 year BEFORE training vs. 3/12-2/13

  28. Quantitative Evaluation: Data Considered Overall psychotropic meds prescribed Antipsychotic polypharmacy (>2 concurrently) Dx Depression, Bipolar Treatment for depression Antidepressant use Other service use

  29. Conclusions: Trained vs. Untrained PCPs Increase in overall med use (ADHD meds) Increase in depression diagnosis Very low antipsychotic polypharmacy Trend to decrease use of ER

  30. Qualitative Evaluation • 40 randomly selected PCPs from 6 training regions • 30 trained and 10 PCP who had signed up for training but had not yet trained • $100 incentive • Pre-interview on line questionnaire • Semi-structured telephone interviews • Audio-taped • De-identified • Analyzed using grounded theory methods

  31. Qualitative Evaluation:Findings • Training increased confidence and willingness to ask & do more. • Components are synergistic. • Increased MH diagnosis & prescribing. • No change in utilization of MH services. • Qualitative findings supported quantitative findings.

  32. Toto, I’ve a feeling we’re not in Kansas anymore…….

  33. Results I: Overall Meds and Dx

  34. Results II: Prescription and Service Use for Depression

  35. Trained vs. Untrained PCPs:Baseline 21K children vs. 47K Twice as likely to prescribe meds Much less likely to prescribe multiple antipsychotics More likley to diagnose depression, Bipolar

  36. “How comfortable are you prescribing the following medications?” 1= not comfortable, 10 =very comfy

  37. Distribution of Child Psychiatrists U.S.

  38. U.S. Health Care Workforce 7K Child psychiatrists 45K pediatricians 80K FPs + NPs, PAs in primary care The majority of psychotropic medication prescriptions are written by PCPs!

  39. You don’t need a weatherman to know which way the wind blows... --Bob Dylan

  40. NYS DOH OMH

  41. The Big Picture Numbers

  42. CAP PC Timeline 2009-13

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