The mental health system in Alabama is in crisis. Our state ranks at or near the bottom in virtually every relevant measure of access to mental health services for all of our citizens, but especially for children. Fifty-nine of Alabama's 67 counties are rural and nearly all qualify as medically underserved. Indeed, Alabama's shortage of mental health professionals ranks as the most dire in the nation. There is not an established infrastructure to help children and youth address the growing stress points in their lives. Long wait times for mental health appointments delay critical interventions which lead to an increasing crush in the state's lone pediatric ER at Children's Hospital of Alabama and some regional hospital ERs without pediatric expertise. Alabama's rural profile, coupled with a population that ranks near the bottom in many socioeconomic categories, makes transportation and availability of care even more challenging. Medicaid and Blue Cross Blue Shield of Alabama are the two largest payors for pediatric services and until recently did not recognize telehealth as a reimbursable expense, therefore onsite consultations were the main avenue for mental/behavioral health delivery.
Goals and Objectives:
1. Use evidence-based telehealth methods to train, educate, and equip primary care providers to support the early identification, diagnosis, treatment, and referral of children/adolescents with behavioral health conditions in a timely manner. 2. To methodically expand access to collaborative telemental health opportunities within the pediatric primary care community, beginning in 7 regions of the state. 3. To provide more children with access to the Right Care (pediatrician/family practitioner, child/adolescent psychiatrist/psychologist), in the Right Place at the Right Time and prevent unnecessary urgent care or emergency care visits. 4. By year five, engage 70% of pediatric practices located in Alabama's rural counties as participants in the Clinical Telemental Health Network to enhance care for children in rural/underserved areas.
The project's methodology involves two primary components. The first component is the development of a clinical network of pediatric primary care practices who will work closely with the mental health team to deliver telemental health (Clinical Telemental Health Network). The model will provide direct consultation and guidance between a professional on the team and primary care providers, as well as mental health consultations for patients via videoconferencing or telephone for comprehensive health care management. The second component will be a broad group education of primary care providers and other health professionals via the ECHO (Extension of Community Healthcare Outcomes) model (Group Telementoring). Through the evidence-based telementoring program, interactive relationships will be formed with a large number of providers across Alabama to disseminate subspecialty knowledge and experience.
The Alabama Department of Mental Health (ADMH) will work in partnership with the Children's Hospital of Alabama (COA), the Alabama Department of Public Health (ADPH), and the University of Alabama at Birmingham (UAB) School of Public Health to coordinate and implement the Alabama Pediatric Telemental Health Project effectively.
The evaluation of the program will be led by the UAB School of Public Health.