Abstract
Problem:
In Kentucky, one in five children live in poverty, with only 4 other states having a higher rate. Children of color and younger children have a higher rate of poverty. For many of the impoverished counties in Kentucky, access to primary care services or other specialty services is limited. With 24% of Kentucky children diagnosed with emotional, behavioral, or developmental conditions, access to care is critical to ensure ongoing screening, evaluation and treatment is available for children. In Kentucky, childhood suicide deaths continue to rise with suicide ideation rates rising in children at younger ages and some deaths at the age of 10. From a variety of surveys and work done by the Kentucky Maternal and Child Health Division, it is known that Kentucky providers report having minimal training and feel they are not comfortable with management of the mental health needs of children. This problem is pervasive across health care providers in clinical settings, and educational staff who may be the first person to interact with a child. Over the past 10 years, the MCH Title V program has noted a need for improved behavioral and mental health services. The Kentucky MCH Title V Director, administrator and coordinator currently serve on multiple committees and initiatives aimed at improving access to care and improving outcomes.
Goals and objectives:
(1) Increase the availability and accessibility of regional networks of pediatric mental health teams; (2) Conduct training and provide technical assistance to primary care providers to enable them to conduct early identification, diagnosis, and treatment for children with behavioral health conditions; (3) Provide information to pediatric providers about and assist pediatric providers in accessing pediatric mental health care providers; and (4) Through telehealth, improve access to treatment and referral services for children and adolescents with identified behavioral health disorders, especially those living in rural and other underserved areas.
Methodology:
The Kentucky project plans to improve access for children to mental health services. It will build upon the current strong infrastructure that currently exists to increase the number of children screened by their primary care provider with rapid referral to Early Childhood Mental Heal professionals for tertiary consultation through the University of Kentucky and University of Louisville mental health clinics. Currently, in Kentucky screening is done by practitioners but this is not a universal practice, even if this can be done in person, or via telehealth or teleconsultation; platforms in existence with both universities. This plan is inclusive of the support of the Kentucky Chapter of the American Academy of Pediatrics. Goals include increasing pediatric mental health surveillance capacity and quality, use of pediatric mental health data to inform prevention and treatment interventions, enhancement of telehealth capacity, and dissemination of prevention materials. Initially, Kentucky has identified key staff and leadership for the project. Kentucky will hire additional staff to coordinate many aspects of the project. An Advisory Board with multidisciplinary and multiagency representation will be convened. The Advisory Board will include a variety of providers from primary care, pediatrics, behavioral health, education, local health departments, and providers for children with special health care needs. The Advisory Board will be involved to develop a comprehensive needs assessment tool. With data gleaned from the needs assessment, a website will be designed to create a repository of trainings, resources, data, and consultation communications for follow-up or intervention by the ECMH staff. Practice sites will be designated within current infrastructure.
Coordination:
Shared between DMCH, BHDID, ECMH, UK and UL, KY AAP. Staffing will be hired to ensure workforce capacity is available to coordinate the various aspects of the project. Training for providers will be provided and monitored by the coordinating agency.
Evaluation:
Dissemination of survey tools, and data evaluation/analyzation will occur in collaboration with all supporting agencies. Evaluation will be completed internal with review of multiple data sets and by independent evaluators. The independent evaluators will coordinate the data collection tools, data entry requirements and definitions, data evaluation/analysis, and program reporting.