Grant Status: Active
Grant Title: Training CED/COR Pediatric and Child Psychiatry
Barbara J Howard, MD
Johns Hopkins University
SOM Office of Research Administration
733 N. Broadway, MRB 117
Baltimore, MD 21205-1832
Once in practice pediatric primary care providers (PCPs) discover an urgent need to deal with behavioral health and psychosocial problems. Estimates show that 20-25% of children <17 have a diagnosable mental health condition with at least minimal impairment yet <50% of children in need of mental health support receive it. 25%-50% of well child visits include significant behavioral or developmental concerns – not all at the disorder level (Sturner, et al, 1980). 66-95% of families referred to on-site mental health services in PCPs' offices follow through whereas only 5-17% of families referred to off-site pediatric mental health services follow through with those referrals (Stancin and Perrin). Yet in 2013, 65% of PCPs surveyed by the American Academy of Pediatrics indicated that they lacked training in recognizing and treating mental health problems (McMillan). This Collaborative Office Rounds program is an ongoing monthly group learning program for 10 or more PCPs over 5 years to discuss their own patients with joint teaching by pediatric and child psychiatry co-moderators. Sessions will be conducted via live interactive webinar to allow participation by rural and distant PCPs and are recorded to be available to others. Brief didactics will be included in addition to the case discussion at each session with a range of topics assured including problems of adolescents, children with disabilities and special healthcare needs and aspects of comprehensive health supervision. The goals include improving PCPs' skills in detection, sorting severity, primary care management and referral to community resources with co-monitoring of child behavioral and psychosocial problems. Often beginning treatment with the familiar and trusted PCP can also lead to a more successful referral to specialized treatment, if necessary. In addition, the practical aspects of integrated behavioral healthcare will be problem-solved by having PCPs and mental health specialists caring for the same child both participate in some sessions. Members of existing MCPAP programs and FQHCs will be particularly invited. Our program will continue to provide practical education and support to PCPs in multiple areas of the US, especially those serving a low income families. An estimated 25% of the patients of participants have Medicaid insurance. This faculty has a special interest in the social determinants of health and COR participants will be recruited from one of our projects caring for patients in Federally Qualified Health Centers. Although not required for participation, some members will use the CHADIS system for screening, decision support and patient education and its care coordination functionality to share information and track success of referrals. Evaluation will include PCPs' demographics and population, goals with follow up, and perceived gains in competence on the range of topics. Increases in screening and referral will be assessed for those using CHADIS.