Abstract
Problem:
Despite high and increasing rates of mental health conditions among children and adolescents, particularly in the wake of the COVID-19 pandemic, workforce shortages and uneven distribution of resources leave the majority of California youth suffering from mental illness without timely diagnosis or treatment. Gaps in care access are particularly dire for children and families in rural and underserved areas, and for those with medical and/or psychiatric complexities that are harder to diagnose and treat.
Goals and objectives:
The Child & Adolescent Psychiatry Portal (CAPP) aims to optimize and expand its current scope of supporting pediatric primary care providers (PCP's) across northern California with real-time consultative guidance on common pediatric mental health concerns. Specific goals are:
- Increase access through geographic expansion from 17 to 48 northern California counties, with data-driven outreach to improve health equity by addressing racial, ethnic & geographic disparities
- Optimize consultation services through: expanded care coordination, refined information technology and workflows, and stakeholder input from an expanded advisory board, emphasizing trauma-informed, measurement-based and evidence-based care
- Expand the scope & availability of current training & educational programming for PCP's, including direct consultation, Project ECHO and didactic series, along with clinical and educational website resources for both providers and patients/families
- Pilot school-based consultation at school-based federally qualified health centers through expanded interprofessional consultation that includes PCPs, behavioral health providers, and school staff
Methodology:
The UC Board of Regents will build upon the programs and networks throughout the University of California system through the University of California San Francisco (UCSF) School of Medicine/Department of Psychiatry operated Child and Adolescent Psychiatry Portal (CAPP). It will optimize current engagement, enrollment, consultation, education and screening methods already successfully used in CAPP through a participant-informed and data-driven iterative quality improvement process, and revise the current database to include specific information on key metrics of interest to HRSA, program leaders, advisors and other major stakeholders.
Coordination:
The University of California, led by UCSF, will coordinate with the key stakeholders including HRSA, CAPP, California Department of Public Health Maternal, Child and Adolescent Health, the Advisory Committee, and UCSF, UCLA and other UC faculty, leveraging a well-established framework of infrastructure, expertise, and existing UC, state and local partnerships to bring together leaders in mental health as well as health services research and dissemination science.
Evaluation:
Input will be solicited from a diverse representation of key stakeholders through focus groups, surveys, and review of consultation records, in order to assess the mental health needs of children and families, common questions asked by primary care providers, and barriers to implementation of consultation recommendations, with a focus on under-represented minority and rural populations. We will also evaluate the effectiveness of our consultation and educational programs and the sustainability of these interventions. Metrics on CAPP's consultation service include number of providers enrolled, number and types of consultation questions, diagnoses, recommendations, referrals, as well as use of validated screening instruments, geographic location, and demographic characteristics of patients. Metrics for educational programs include the number and types of trainings, number and types of attendees (by provider type and location), participant satisfaction and gain in knowledge (on quizzes), and burnout assessment. Additional metrics include network productivity measured by work products and their dissemination.