Expanding The BRIC Program: (Building Resilience for Children with Mental Health Issues in Pediatric Primary Care) to BRIC FIT (Families Infants and Toddlers)
Grant Status: Active
Training Category: Healthy Tomorrows Partnership for Children Program (HTPCP)
Yonit Lax, MD, FAAP
Department of Pediatrics
Maimonides Infants and Children's Hospital of Brooklyn
977 48th St
Brooklyn, NY 11219
Phone: 718.283. 7132
The Building Resilience in Children, Families, Infants and Toddlers (BRIC FIT) initiative addresses a critical need for early childhood mental health services within the pediatric medical home at the Maimonides Children's Hospital by using collaborative care to address psychosocial needs for our most vulnerable families with children ages zero to five. Using an evidence-based model of care to identify families of children 0-5 years of age with behavioral or developmental concerns, adverse childhood experiences (ACEs) or Social Determinants of Health (SDH) risk factors, BRIC FIT will deliver integrated early childhood mental health care, and parent education and support as a part of pediatric primary care visits. The BRIC FIT program's core intervention focuses on building parenting skills and resilience through an attachment and trauma informed lens, and is augmented by systematic screening for social determinants of health and direct linkages to health promoting community-based organizations. Building on the success of the HTPCP-funded Building Resilience in Children (BRIC) Program, which utilizes collaborative care to deliver behavioral health interventions for school-aged children who are identified as having mild to moderate mental health problems, BRIC FIT will expand mental health services to an underserved early childhood population with identified psychosocial and developmental needs.
Goals and Objectives:
1) In Year 1, to train 10 pediatric primary care providers, 58 residents, and 25 nurses and medical assistants to conduct ACEs and SDH screening using validated tools and quality improvement methodology; 2) In Year 1, to build a comprehensive network of community-based providers who offer developmental and behavioral programs and psychosocial services to parents and children under age five; 3) In Years 2-5, to screen 3,000 children/year seen in primary and specialty services for ACEs and SDH; 4) In Years 2-5, to enroll 1,000 families in the BRIC FIT program, and enhance resilience and parenting skills through attachment and positive parenting education and support, as measured by functional assessment scores; 5) In Years 2-5 to refer 500 families to community based organizations based on psychosocial needs assessed through screening tools; and 6) In Years 2-5, to provide integrated behavioral and developmental services for parents and young children within primary care visits through a collaborative care model implemented by an early childhood mental health specialist in partnership with primary care pediatricians.
The BRIC FIT program will provide comprehensive training and education to clinic staff and pediatric providers around early childhood mental health, ACEs, SDH and trauma informed care. Once initial staff training and education is complete, we will pilot universal screening for postpartum depression, ACEs, and SDH as part of routine well child care for infants and children 0-5 years of age at one Maimonides pediatric primary care clinic. Screening will identify families of children 0-5 years old who are eligible for BRIC FIT and will occur according to a prescribed schedule during well child visits. Prior to their visit with the provider, parents will complete screening tolls in the waiting area with responses entered by nursing staff and medical assistants into the electronic medical record (EMR). In addition to paper-based screening tools, we will also pilot the use of electronic tablets linked to the EMR to help facilitate efficient screening completion. The BRIC FIT psychologist will treat families according to a two-generational approach that is modeled after the Healthy Steps initiative and tailored based on level of need. This approach includes working with both the parent and child, and in a consultative and collaborative role with the pediatrician to address specific developmental, behavioral and/or parental mental health concerns and needs; and short or long term individual parent and child sessions, group-based parenting workshops, and joint visits with pediatricians during well-child and follow-up visits. BRIC FIT's innovative and holistic approach to family well-being will include screening for and addressing SDH through linkages to additional community-based services that address psychosocial concerns.
The BRIC FIT model takes an interdisciplinary and collaborative approach to care that involves care and service coordination between an early childhood mental health specialist, pediatric primary care providers, community health coaches, and community-based organizations. Care and service coordination and referrals will occur on three levels based on identified needs: 1) within the pediatric primary care clinic between the BRIC FIT psychologist, pediatric providers, community health coaches, and parents; 2) in collaboration with adult psychiatry, primary care-based adult mental health providers, and adult health home care management providers at Maimonides for parents with moderate to severe mental health and psychosocial needs; and 3) within the Brooklyn community between the BRIC FIT psychologist, pediatric providers, and community-based organizations that provide psychosocial services and supports to the child and family. To optimize effective and comprehensive care coordination among providers within primary care and the community, we will optimize use of our electronic medical record by documenting care plans with each patient encounter, as well as tracking referrals made both internally and to external community partners. Strong collaboration with BRIC FIT Community Advisory Board members, the Maimonides Family Advisory Board, and other community-based organizations will build a strong foundation for care coordination among stakeholders serving our patients and families.
The key metrics that will be used to evaluate the effectiveness of the BRIC FIT program include: 1) surveys conducted pre- and post-training to evaluate provider comfort, attitudes and practices related to SDH and ACEs screening and referrals; 2) SDH, ACEs and postpartum depression screening rates and proportion of positive screens; 3) BRIC FIT program referral and engagement rates; and 4) referral rates to community-based organizations, and proportion of families engaging in services provided by CBOs. Additionally, we will assess the proportion of BRIC FIT participants with missed visits for well child care and with vaccination delays to determine whether BRIC FIT participation improves engagement in preventive care.