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Pediatric Integrated Care, An Issue of Child and Adolescent Psychiatric Clinics of North America, E-Book

Pediatric Integrated Care, An Issue of Child and Adolescent Psychiatric Clinics of North America, E-Book

Tami D. Benton | Gregory K. Fritz | Gary R. Maslow

(2017)

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Book Details

Abstract

This issue of Child and Adolescent Psychiatric Clinics of North America, edited by Drs. Gregory Fritz, Tami Benton, and Gary Maslow, will focus on issues surrounding Integrated Care in child and adolescent psychiatry. Topics covered in these articles will include: Telephonic Service and Telemedicine; the Massachusetts Access Program; Integrated Care Model for Adolescent Substance Use; Combined Training for Pediatrics and Psychiatry; Integrated care within a rural setting; Interdisciplinary Training for Integrated Care; Emergency Department Interventions; Economic Considerations for Integrated Care; A Lifespan Approach to Integrated Care; and Essential Elements of a Collaborative Mental Health Training Program for Primary Care, among others.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Pediatric Integrated Care i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents ix
Preface: Healthy Minds–Healthy Kids: Integrating Care ix
Telemedicine for Child Collaborative or Integrated Care ix
Massachusetts Child Psychiatry Access Project 2.0: A Case Study in Child Psychiatry Access Program Redesign ix
Using Effective Public Private Collaboration to Advance Integrated Care ix
From Theory to Action: Children’s Community Pediatrics Behavioral Health System x
Preparing Trainees for Integrated Care: Triple Board and the Postpediatric Portal Program x
Incorporating Trainees' Development into a Multidisciplinary Training Model for Integrated Behavioral Health Within a Pedia ... x
Competencies and Training Guidelines for Behavioral Health Providers in Pediatric Primary Care x
Family-Based Integrated Care (FBIC) in a Partial Hospital Program for Complex Pediatric Illness: Fostering Shifts in Family ... xi
Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic xi
The Emergency Department: Challenges and Opportunities for Suicide Prevention xi
Integrated Behavioral Health Care in Pediatric Subspecialty Clinics xii
Evaluating Integrated Mental Health Care Programs for Children and Youth xii
Comparing Two Models of Integrated Behavioral Health Programs in Pediatric Primary Care xii
Payment for Integrated Care: Challenges and Opportunities xii
Essential Elements of a Collaborative Mental Health Training Program for Primary Care xiii
The Basic Science of Behavior Change and Its Application to Pediatric Providers xiii
CHILD AND ADOLESCENT\rPSYCHIATRIC CLINICS\r xiv
FORTHCOMING ISSUES xiv
January 2018 xiv
April 2018 xiv
July 2018 xiv
RECENT ISSUES xiv
July 2017 xiv
April 2017 xiv
January 2017 xiv
Preface:\rHealthy Minds–Healthy Kids: Integrating Care xv
Telemedicine for Child Collaborative or Integrated Care 637
Key points 637
INTRODUCTION 637
TECHNICAL CONSIDERATIONS FOR TELEVIDEO TELEMEDICINE 639
USES OF TELEVIDEO TELEMEDICINE 641
TELEVIDEO TELEMEDICINE FOR COLLABORATIVE CARE 641
OTHER WAYS TO USE TELEMEDICINE FOR COLLABORATIVE CARE 642
THIRD-PARTY REQUESTED TELEMEDICINE CONSULTATIONS 643
SUMMARY 643
REFERENCES 644
Massachusetts Child Psychiatry Access Project 2.0 647
Key points 647
INTRODUCTION TO THE CHILD PSYCHIATRY ACCESS PROGRAMS MOVEMENT 648
THE MASSACHUSETTS CHILD PSYCHIATRY ACCESS PROJECT EXPERIENCE 2004 TO 2016 648
THE NEED FOR REDESIGN 649
Program Performance Issues 650
Care coordination 650
Multiple Massachusetts Child Psychiatry Access Projects 651
Inconsistency in response times 651
Environmental Change: Pediatric Primary Care Networks and Behavioral Health Integration 651
THE REDESIGN PROCESS: ASSESSMENT, RECOMMENDATIONS, REPROCUREMENT 652
Assessment 652
Recommendations 654
Reprocurement 656
MASSACHUSETTS CHILD PSYCHIATRY ACCESS PROJECT 2.0: KEY ELEMENTS AND CHANGES 657
Structural Change 657
Change in Care Navigation Support 658
Outreach to Primary Care Practices 658
Clinical Practice Guidelines and Peer Review 659
TRANSITION AND LAUNCH OF MASSACHUSETTS CHILD PSYCHIATRY ACCESS PROJECT 2.0 659
INITIAL IMPRESSIONS AND CHALLENGES GOING FORWARD 660
SUMMARY 661
ACKNOWLEDGMENT 662
REFERENCES 662
Using Effective Public Private Collaboration to Advance Integrated Care 665
Key points 665
BACKGROUND 665
THEORETIC FRAMEWORK 666
THE DC COLLABORATIVE FOR MENTAL HEALTH IN PEDIATRIC PRIMARY CARE 666
KEY ELEMENTS OF SUCCESSFUL IMPLEMENTATION 669
Community Engagement and Leadership 669
Evaluation of Impact 670
POLICY AND ADVOCACY 671
RECOMMENDATIONS AND SUMMARY 672
REFERENCES 673
From Theory to Action 677
Key points 677
INTRODUCTION 677
CONSIDERATIONS WHEN BUILDING A SYSTEM 679
SELECTING THERAPISTS 681
SUPPORTING SUCCESSFUL PSYCHIATRY ROLES 683
FROM THEORY TO ACTION: CHILDREN’S COMMUNITY PEDIATRICS BEHAVIORAL HEALTH SYSTEM 683
CLINICAL AND FINANCIAL MODEL 684
THE ROLE OF A TRIPLE-BOARDED PHYSICIAN 685
AREAS OF OPPORTUNITY 685
SUMMARY 686
REFERENCES 686
Preparing Trainees for Integrated Care 689
Key points 689
INTRODUCTION: RATIONALE FOR COMBINED TRAINING 689
DEVELOPMENT OF TRIPLE BOARD PROGRAMS 690
OVERSIGHT OF TRIPLE BOARD PROGRAMS 691
TRIPLE BOARD PROGRAM REQUIREMENTS 691
THE TRIPLE BOARD ORGANIZATION 693
TRIPLE BOARD OUTCOMES 694
Pilot Program 694
2005 Survey 694
2012 Survey 695
DEVELOPMENT OF THE POSTPEDIATRICS PORTAL PROGRAMS 696
OVERSIGHT 697
POSTPEDIATRIC PORTAL PROGRAM REQUIREMENTS 697
POSTPEDIATRIC PORTAL PROGRAM OUTCOMES 697
Discussion 700
SUMMARY 701
REFERENCES 701
Incorporating Trainees' Development into a Multidisciplinary Training Model for Integrated Behavioral Health Within a Pedia ... 703
Key points 703
INTRODUCTION 704
SETTING 704
INTEGRATED CARE MODEL 705
DEVELOPMENTAL APPROACH TO LEARNERS 706
Pediatric Residents and Others Training in Pediatrics 706
Psychologists 708
Child and Adolescent Psychiatrists 711
Data 712
Learners 712
Pediatric trainees 712
Psychology trainees 712
Child and adolescent trainees 712
Other trainees who have participated in research and evaluation efforts with the behavioral health team 712
Trainees that have gone on to work in integrated care settings 712
Scholarship 712
Patient-related outcomes 713
New developments in integrated systems 713
SUMMARY 714
REFERENCES 715
Competencies and Training Guidelines for Behavioral Health Providers in Pediatric Primary Care 717
Key points 717
INTRODUCTION 718
CURRENT INTEGRATED CARE COMPETENCIES ACROSS BEHAVIORAL HEALTH DISCIPLINES 718
Psychiatry 718
Psychology 719
Social Work 721
INTEGRATED GUIDELINES FOR TRAINING ACROSS DISCIPLINES 723
INTERPROFESSIONAL COLLABORATIVE PRACTICE COMPETENCIES CLUSTERS 725
Interprofessional Communication 725
Professionalism 725
Integrated Care Systems Practice 725
Practice-Based Learning and Education 726
Preventive Screening and Assessment 726
Cultural Competence 727
CHILDREN'S HOSPITAL OF PHILADELPHIA HEALTHY MINDS, HEALTHY KIDS INTEGRATED BEHAVIORAL HEALTH CARE ROTATION 727
SUMMARY AND FUTURE DIRECTIONS 728
REFERENCES 729
Family-Based Integrated Care (FBIC) in a Partial Hospital Program for Complex Pediatric Illness 733
Key points 733
OVERVIEW 734
Basic Construct of Family-Based Integrated Care 734
The Primacy of Working in the Context of the Family 734
Interdisciplinary Care 734
Advantages of Day Treatment 735
The Family-Based Integrated Care Model 735
The Family-Based Integrated Care Graph 735
Beliefs Axis 736
Relationships Axis 737
Interdisciplinary Value of the Family-Based Integrated Care Model 738
Message Magnification Across Providers 740
Case Example 1: Family-Based Integrated Care Case Conceptualization 740
Family-Based Integrated Care Case Example 2: Case Conceptualization 741
Family-Based Integrated Care Case Example 3: Case Conceptualization 742
THE PARTIAL HOSPITAL PROGRAM MODEL 742
Program Mission 742
Program Development 743
Program Beliefs 743
Population Served 744
Staffing 745
Structure of the Day 745
Admissions 747
Length of Stay 748
Check-In/Check-Out 749
Physical Space 749
The Milieu 750
Nutrition 751
School 751
The Point System 752
The Process of Collaborative Care 752
Patient Experience 754
Family Experience 754
Fiscal Considerations 754
Case Example 1: Family-Based Integrated Care Treatment Course 755
Case Example 2: Family-Based Integrated Care Treatment Course 755
Case Example 3: Family-Based Integrated Care Treatment Course 756
SUMMARY 756
REFERENCES 757
CLINICAL/RESEARCH MEASURES OF HCPHP 758
Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic 761
Key points 761
INTRODUCTION 761
METHOD 762
Evaluation Center Intervention 762
Review of the Evaluation Center Use and Overview of the Data Analysis Plan 765
RESULTS 766
DISCUSSION 768
REFERENCES 769
The Emergency Department 771
Key points 771
INTRODUCTION 772
THE EMERGENCY DEPARTMENT 772
MODELS OF EMERGENCY PSYCHIATRIC/BEHAVIORAL HEALTH CARE 773
SCREENING AND BRIEF INTERVENTIONS IN THE EMERGENCY DEPARTMENT 774
CURRENT GUIDELINES AND PRACTICE PARAMETERS 776
CARE PROCESS MODEL FOR YOUTHS PRESENTING WITH A RISK FOR SUICIDE AND SELF-HARM 777
SUMMARY 780
REFERENCES 780
Integrated Behavioral Health Care in Pediatric Subspecialty Clinics 785
Key points 785
INTRODUCTION 785
PEDIATRIC ONCOLOGY 786
Evaluating Integrated Mental Health Care Programs for Children and Youth 795
Key points 795
INTRODUCTION 795
DEFINING INTEGRATED CARE 797
AN EVALUATION FRAMEWORK FOR PEDIATRIC INTEGRATED CARE 798
Inner and Outer Practice Context 798
Changes to Primary Care Structure and Staff Expertise 798
Patient Engagement 802
Social Determinants of Care 802
Coordinated, Stepped, Evidence-Based Care 802
STUDY DESIGNS 802
LEARNING HEALTH CARE SYSTEMS, THEORIES OF CHANGE, AND “DYNAMIC SUSTAINABILITY” 803
WHAT TO MEASURE 805
OBTAINING OUTCOME DATA 807
SUMMARY 808
REFERENCES 809
Comparing Two Models of Integrated Behavioral Health Programs in Pediatric Primary Care 815
Key points 815
INTRODUCTION 816
Adult Behavioral Health Integrated Care Models 816
Translating Adult Models of Integrated Care to Pediatric Populations 816
Design, Staffing, and Treatment Considerations in Pediatric Behavioral Health Integrated Models 817
METHODS 818
Study Design 818
Study Sample 819
Two Models of Care 819
Generalist behavioral health provider model 819
Pediatric behavioral health integrated program 819
Data Collection 820
Referrals 820
Satisfaction and competency 820
Importance of screening with validated tools 821
Analytical Plan 821
RESULTS 821
Referral Rates 822
Self-reported Satisfaction 822
Self-reported Competency 823
Importance of Screening with Validated Tools 824
DISCUSSION 824
REFERENCES 826
Payment for Integrated Care 829
Key points 829
INTRODUCTION 829
CHALLENGES RELATED TO PAYMENT FOR INTEGRATED CARE 830
VALUE-BASED PURCHASING HOLDS PROMISE FOR INTEGRATED CARE 831
NATIONAL EXAMPLES OF CAPITATED PAYMENT ARRANGEMENTS SUPPORTING INTEGRATED CARE FOR YOUTH 833
Health Homes: New York State 833
Blended and Braided Funding Streams: Wraparound Milwaukee 834
Creating Capitation Within Fee-For-Service: The Montefiore Health System 835
Patient-Centered Medical Home: Colorado 835
SUMMARY AND FUTURE DIRECTIONS 836
REFERENCES 837
Essential Elements of a Collaborative Mental Health Training Program for Primary Care 839
Key points 839
INTRODUCTION 839
LEARNING THE BASIC PRINCIPLES OF MENTAL HEALTH INTEGRATION IN PRIMARY CARE PRACTICE 840
DEFINING ACCOUNTABILITY FOR QUALITY AND CLINICAL OUTCOMES 840
RECOGNIZING THE DIFFERENCE BETWEEN CONSULTATION, COLOCATION, AND COLLABORATIVE CARE 840
UNDERSTANDING THE ROLES OF THE COLLABORATIVE CARE TEAM 841
Primary Care Clinician 841
Consulting Mental Health Professional 842
Care Coordinator 842
Tertiary Mental Health Services 842
IDENTIFYING OUTCOME MEASURES TO DETERMINE PROGRAM SUCCESS 842
UNDERSTANDING REFERRAL PATTERNS TO THE CONSULTING MENTAL HEALTH PROFESSIONAL 843
ADDRESSING THE FINANCIAL INCENTIVES AND DISINCENTIVES FOR COLLABORATIVE CARE 843
TEACHING MENTAL HEALTH COMPETENCIES IN THE PRIMARY CARE SETTING 844
Competencies of Mental Health Anticipatory Guidance 844
Competencies of Assessment 845
Competencies of Treatment and Monitoring 845
VARIOUS METHODS OF TRAINING PRIMARY CARE PROVIDERS FOR MENTAL HEALTH INTEGRATIONS 846
SUMMARY 847
REFERENCES 847
The Basic Science of Behavior Change and Its Application to Pediatric Providers 851
Key points 851
INTRODUCTION 852
Provider Education Programs Do Not Reliably Produce Practice Behavior Change 852
Behavioral Science Theories and Principles Can Be Incorporated into Provider Education Programs 853
Behavioral decision theory 853
Adult learning and education principles 856
Cognitive neuroscience research applications 857
Persuasive communication theory 858
Summary 860
The Application of Theory-based Training Strategies 860
Support for the Patient-Centered Mental Health in Pediatric Primary Care Fellowship program 864
DISCUSSION 871
REFERENCES 872