Abstract
Problem:
Access to healthcare is extremely challenging due to high vacancy rates for primary care physicians, and extremely high shortages of specialized care providers. Medically Underserved Areas/Medically Underserved Populations (MUAs/MUPs) cover 98% of Alaska's land mass and 98% of the state's population. Approximately three in every ten (39%) Alaskans live in areas designated as HRSA Health Professional Shortage Areas (HPSAs) based on the lack of primary care physicians, dentists, and psychiatrists. Pediatric primary care providers serving Alaska's remote populations need improved access to current resources for screening, support for prescribing medication, making referrals, and connecting to behavioral health services.
Goals and objectives:
The goal is to increase routine diagnosis, treatment, and referral of child and adolescent behavioral health conditions in primary care including by reducing disparities in access to behavioral health care, especially in rural and other underserved areas.
Objectives are:
- By the end of Year 3, 25-50% increase of unduplicated pediatric primary care practitioners who request pediatric mental health consultations regarding their patients. Baseline is 20% of unduplicated pediatric primary care practitioners.
- By the end of year 3, increase the number of behavioral health cases seeking care coordination services as a result of HMG-AK outreach and SCH consultations.
- By the end of Year 3, the HMG-AK resource and referral database, including telehealth providers, will increase by at least 50% the number of included mental health and support service providers statewide for children and youth ages 0-26.
- Provide 5-6 trainings via webinar for school districts across the State
- Collaborate with key stakeholders on sustainability for PAL PAK after this 3 year grant.
Methodology:
Based out of Seattle Children's Hospital, The Partnership Access Line (PAL) offers mental health teleconsultations on weekdays from 7 a.m.- 4 p.m. Alaska time to any primary care provider, as well as to other prescriber-level providers such as emergency room physicians and hospitalists providing care to children. The PAL team consists of eight licensed pediatric psychiatrists based in the state of Washington, who are licensed to practice in Alaska. This allows them to provide case consultation/team conference services. In-state expertise regarding other Alaska-based mental health, health related social needs and other supports, as well as cultural and language considerations, is provided by HMG-AK, a program of the All Alaska Pediatric Partnership (AAPP). While PAL for Schools targets school-based providers and aims to increase service capacity and support for school counselors and school nurses working with children and youth with behavioral health needs in the school setting. The current focus is students in grades K-12. During year 2 of the grant, exploration of ways to align the school services with other behavioral health initiatives will occur, to improve the continuum of behavioral health care for infants, children, youth, and their families in Alaska.
Coordination:
The Division of Public Health will contract with the All Alaska Pediatric Partnership (AAPP) for all services relating to PAL-PAK, PAL for Schools, and care coordination for providers. AAPP will contract with Seattle Children's Hospital (SCH) for services relating to the PAL teleconsultation line and work with the University of Washington (UW), who offer the school based counselor activities for PAL for schools. Help Me Grow Alaska, a program of AAPP, will offer the care coordination. They currently have Alaska's only statewide Central Intake and Referral System (CIRS). Trainings to providers and school personnel will be offered through a variety of webinars, small group consultations, and in person conferences. HMG-AK will help with promotion and coordination of many of these trainings, while SCH and UW will offer content relevant to their specific area of expertise.
Evaluation:
The evaluation will use qualitative and quantitative methodologies to monitor and measure project utilization. The evaluation will include, but not be limited to: 1) analysis of utilization data from the Partnership Access Line (PAL) and HMG-AK; 2) performance assessment relative to overall project goals and objectives; and 3) annual evaluation reporting of patient, services, and systems-level data. Evaluation data collected for the school expansion efforts will be provided to the DPH Epidemiology Specialist for inclusion in the overall evaluation report. Ongoing process evaluation will focus on measuring whether activities are being implemented as planned and modified as appropriate.