Hawaii Pediatric Mental Health Care Access Project

Abstract

Problem:

Hawaii's Family Health Services Division (FHSD) is applying for the federal Health Resources and Services Administration (HRSA) American Rescue Plan Act -- Pediatric Mental Health Care Access grant. The purpose of the program is to promote behavioral health integration into pediatric primary care by supporting pediatric mental healthcare telehealth access programs. Hawaii will consider the use of HRSA's model of pediatric mental healthcare teams who provide teleconsultation, training, technical assistance, and care coordination for pediatric primary care providers to diagnose, treat, and refer children who may have behavioral health conditions. Hawaii recognizes that there are primary care shortages statewide (412 FTEs needed across all islands based on the 2020 University of Hawaii Annual Report). Psychiatrists also have a shortage where there is a 17.9 FTE shortage. There are shortages in neighbor islands as well, which highlights the need to examine the geographic disparities in access to care in our rural and other underserved areas.

Goals and objectives:

Goal 1: Increase accessibility of behavioral health services for children through statewide PMHCA teams.

• 1.1. Develop and deploy PMHCA Team model for Hawaii;

Goal 2: Conduct training/ technical assistance to pediatric providers on early identification, diagnosis, treatment for children with behavioral health needs.

• 2.1: Develop and implement training curriculum for providers;

Goal 3: Provide information on providing timely detection, assessment, treatment, and referral of children with behavioral health thru telehealth.

• 3.1: Explore referral system with partners to track and monitor referrals;

Goal 4: Improve access thru telehealth for treatment and referrals for rural communities.

• 4.1: Leverage and build on existing platforms serving neighbor islands;

Goal 5: Increase state capacity to advance health equity and improved access to services for underserved populations.

• 5.1: Set measurable health equity goals in action plan; and

Goal 6: Sustain use of telehealth, PMHCA Teams and warmline, and PMHCA Curriculum Training.

• 6.1: Leverage and advocate for funding for sustainability of model.

Methodology:

An Advisory Council will be formed to oversee implementation of a comprehensive needs assessment; development of a strategic plan to see what works best at the state and community level; development of an online database and communication mechanism; and explore clinical telephone or telehealth consultations when requested between pediatric mental healthcare teams and pediatric primary providers. There will be extensive training and technical assistance to primary care providers to support the early identification, diagnosis, treatment, and referral of children with behavioral health concerns. By implementing a successful model in Hawaii, it is anticipated that this program will address the rural and underserved access to pediatric mental healthcare across the state.

Coordination:

FHSD will integrate efforts to support the PMHCA program across three branches: Maternal and Child Health Branch (MCHB); Children with Special Health Needs Branch (CSHNB); and Women Infants and Children (WIC).

Evaluation:

The evaluation is grounded in the public health approach of working towards a coordinated statewide system and county-based community's approach for pediatric mental health of children and adolescents. Hawaii's evaluation aims not only to monitor the PMHCA initiative's process and outputs, but also to promote systems' change and improve child and family outcomes through the Continuous Quality Improvement efforts. A mixed-method evaluation is underway that will monitor and assess:

1. Project Design will be evaluated by implementing a Data Tracking System to ensure Grant Activities and Deliverables are met by looking at contractors' data around timely early identification, diagnosis, and treatment;
2. Feedback and Fidelity will be measured through Partner and Stakeholder Satisfaction by collecting information on the implementation through interviews, surveys, focus groups; and;
3. Impact and Outcomes will be processed through measuring the impact of the PMHCA project on the children's mental health system by monitoring the Hawaii logic model and review of comparison data from before and after the project implementation.