Abstract
Problem:
Addressing the tremendous mental health disparities and barriers to treatment in the United States Virgin Islands (USVI//VI) remains a priority. For many years, the territory has faced an overall shortage in pediatric primary care providers and pediatric specialties. Pediatric mental health providers are on the top of the list. Currently the VI Government has one psychiatrist that spread among three islands in the service area. To make matters worse some private providers only accept new patients that can pay out of pocket. There remains a major health service gap in the availability of behavioral health programs and services for children between the ages of 0 and 21 in the USVI. The VI is also faced with the lack of trained child psychologists and psychiatrists. These factors contribute to the mental health disparities and barriers to treatment in the territory.
Goals and objectives:
To establish and implement a mental health and psychiatry access program via a regional network of primary care providers (VICPAP), and to provide teleconsultation, care coordination and referral assistance to primary care providers. Other objectives are to conduct training and provide adult-learning educational opportunities for providers regarding telehealth identification/management of behavioral health conditions, and to determine the effectiveness of VICPAP to ensure its sustainability and expansion.
Methodology:
The primary goal of this project is to establish a new pilot regional pediatric mental health care telehealth access program-VICPAP- for the psychiatric consultation, care coordination, and referral to behavioral health services in the USVI. The project will help consultation to increase the psychiatry and behavioral health access needs for primary care physicians, pediatricians, family physicians, nurse practitioners and physician assistants in the territory. The VIPAP will be administered by the Virgin Islands Department of Health. VICPAPwill collaborate with pediatric primary care providers in the territory to provide access to behavioral health services using a swift approach that will reduce barriers and improve responsiveness to the needs of families and frontend providers.Over the five (5) year grant period, VICPAP will create, sustain, and gradually increase the network of participating primary care providers and practices that participate and rely on the referral and consulting services. Additionally, the program will provide training in evidence-based screening, assessment, invention (behavioral and medication management) and referral practices in professionals in the VICPAP network to improve the workforce development capability of medical and behavioral health providers in the USVI to identify and manage the mental health needs of USVI youth. Through key partnership with patient and parent advocacy groups, an advisory committee, partnerships, and outreach strategies, we will build a "go-to" service that is engrained as a reliable and efficient means of breaching the service access and available workforce gap for child behavioral health problems.
Coordination:
Care coordination and referral will be provided by a dedicated mental health coordinator. A Family Partner advocate will conduct community- and family-level care coordination and training. An online repository of referral options will be collated and shared with providers. At the systems-level, coordination between, the MCH Title V program, Behavioral Health, Alcoholism and Drug Dependency Services Division (BHADDS) and multiple state agencies and insurer stakeholders will occur. A VICPAP Advisory Council will be formed to help coordinate efforts for program evaluation, expansion, and sustainability.
Evaluation:
The principles of Rapid Cycle Quality Improvement (RCQI) will be utilized with each Objective. Incorporating the framework of Plan-Do-Study-Act, we will utilize the VICPAP team to revise and implement a program wide RCQI procedure with guidance from Mississippi CHAMP and Massachusetts's MCPAP. We expect our RCQI procedures to continue throughout the course of this project for each Objective. Within this ongoing process, we will continuously assess our Objectives, describing specific problems observed by the program team as well as incorporating continuous feedback from primary care providers and stakeholders to initiate a cycle of Plan-Do-Study-Act. We will review the performance data that are reported to HRSA monthly to assess our progress meeting project goals, objectives, and outcomes, and to inform necessary improvements to our project management strategies. We will also examine monthly usage rates and encounters for VICPAP to help determine whether VICPAP is having the intended impact on expanding the access to psychiatry teleconsulting, care coordination and referrals.