Funded Projects

Problem:

Behavioral health disorders affect approximately 20% of the child, youth, and young adult population while access to appropriate mental health services is severely deficient, especially in rural communities. Barriers include lack of mental health providers, geographical distance, cultural beliefs, and the stigma of seeking behavioral health supports in small communities, aiding in the creation of significant disparity. Unmanaged behavioral health issues are significant to life course and trans-generational life course outcomes in the population. There is a need for systems-level approaches to enhance and integrate the impact of local projects and systems level approaches to assure all are served and resources are used to greatest impact.

Goals and Objectives:

1. Enhance screening and early identification of behavioral health disorders of childhood and adolescence. Obj. 1.1CD Survey primary care providers regarding current screening practices for behavioral health needs of children ages 6 mos. to 16+years. Obj. 1.2CD: Provide evidence-based protocols for the application of screening tools. Obj. 1.3 SI: Cross-sector promotion of best practices in screening and referral for behavioral health issues. 2. Develop the capacity of the primary care workforce to offer behavioral health and integrated practice. Obj. 2.1SI: Educate primary care and pediatric providers about screening, use of telehealth, protocols for behavioral health referrals, social determinants of mental well-being, two-generation practice. Obj. 2.2SI: Promote the adoption of family-centered and culturally- and linguistically appropriate services in telebehavioral health. Obj. 2.3SI: Form a cross-sector advisory committee including families. Obj. 2.4SI: Develop a compendium of available resources in the state for use by primary care physicians and clinicians. 3. Conduct a clinical demonstration project in a network of providers to expand access to behavioral health and integrated practice for children and youth. Obj. 3.1CD: Offer behavioral telehealth and telephone consultation services to clinics in a network of integrated primary care practices through a subrecipient agreement. Obj. 3.2CD: Increase numbers of rural clinics utilizing an integrated behavioral health in primary care approach. Obj. 3.3CD: Increase the diversity and cultural competence of the primary care behavioral health providers in integrated care settings. Obj. 3.4CD: Expand the scope and scale of the project by creating a network of telehealth hubs and satellite sites to further expand access. 4. Conduct a multi-level evaluation of the project to inform expansion of project scale and scope. Obj.4.1CD: Evaluate the effectiveness of the clinical demonstration project. Obj. 4.2SI: Evaluate effectiveness of efforts to increase screening Obj. 4.3SI: Evaluate methods to incorporate CLAS and literacy, family inclusion, social determinants of health Obj. 4.4SI: Evaluate trends in Medicaid reimbursement requests for tele-behavioral health services. Obj. 4.5SI: Evaluate replication and sustainable aspects of project.

Methodology:

A clinical demonstration project of statewide significance enhances access to: care coordination and integrated care, expert behavioral health team consultation for providers in an existing clinical network in rural and underserved areas, expert behavioral health consultation by referral for children and youth with severe needs by referral. Systems-level activities enhance integration and impact, increasing the level of screening by pediatric providers across sectors, educating providers about mental health referrals for children, and identifying opportunities for replication, dissemination, and spread of the project activities. Populations Served: Children, Youth, and Families with behavioral health needs and access to primary care in areas underserved by pediatric behavioral health professionals. Primary care providers in rural and underserved areas.

Coordination:

The applicant is uniquely placed to integrate and align these activities across systems and sectors. Systems partners will be engaged in the clinical demonstration project and the project advisory committee.

Evaluation:

NDHHS Title V MCH staff will conduct evaluation of the program with individual, practice, and population measures.