Missouri Child Psychiatry Access Project (MO-CPAP)
Grant Status: Active
Training Category: Pediatric Mental Health Care Access Program (PMHCA)
Angeline Stanislaus, MD
Missouri Department of Mental Health
St. Louis, MO 63141
Phone: (573) 751-2794
Youth behavioral health issues are prevalent and increasing. One in six U.S youth aged 6-17 experience a mental or behavioral health disorder each year and over 68,000 Missourians between the ages of 12-17 have depression1. A report by the American Psychological Association2 states that, “more U.S. adolescents and young adults in the late 2010's versus the mid-2000's experienced serious psychological distress, major depression or suicidal thoughts and more attempted suicide.”
1. National Association for Mental Illness. (2021). Mental Health in Missouri [Fact Sheet]. Fact sheet references (apa.org)
2. American Psychological Association (2017). Stress in America: Coping with Change. Stress in America™ Survey. Retrieved from: https://www.apa.org/news/press/releases/stress/2016/coping-with-change.PDF
Goals and Objectives:
The purpose of the project is: (1) increase the number of providers using the program for real-time behavioral consultations and/or care coordination support services (including referrals); (2) increase the number of providers trained on child and adolescent behavioral disorders, including screening, diagnosis, and treatment;(3) increase the number of provider trainings that incorporate equity and respectful or culturally and linguistically responsive care, and (4) increase the number of children and adolescents for whom a provider contacted the program for consultation and/or care coordination support services, especially those living in rural and other underserved areas.
Five expansion activities are associated with Program Goals 1 and 4: (A) MO-CPAP will increase the number of enrolled healthcare providers, (B) MO-CPAP will expand provider enrollment to additional pediatric healthcare workers, (C) MO-CPAP will improve the quality of behavioral health services that PCPs and other provider can provide, (D) MO-CPAP will actively collaborate with existing MO-CPAP Schools and developing MO-CPAP Maternal Mental Health programs, (E) MO-CPAP will enhance and expand current consultation services to include a Clinical and Behavioral Health Consultant. The expansion activity associated with Program Goals 2 and 3 is: (F) MO-CPAP will promote trauma-informed care in Missouri.
MO-CPAP will continue to systematically evaluate program implementation and outcomes using existing methods and measures, making adaptations to data collection processes and tools if necessary. Most MO-CPAP evaluation is closely connected to service provision, maximizing the utility of all data collected while optimally minimizing the burden on busy professionals using MO-CPAP supports. To briefly overview (preliminary changes/additions to evaluation plan based on specific expansion activities):
1. Pediatric primary care providers enroll in MO-CPAP using an online enrollment form that collects individual and practice information. When enrolling, providers supply their professional credentials/affiliations and demographics, and give basic information about their practice (contact, type, # of providers in practice). They indicate how they heard about MO-CPAP (used to track & evaluate marketing/promotion). They also complete a baseline self-report that assesses: the ability to meet the behavioral health needs of their patients; their knowledge of, comfort with, and use of evidence-based practices - including use of standardized validated screening tools. Enrollment processes and surveys will be reviewed and adapted to accommodate additional provider types, including pediatric specialty care providers (e.g., current enrollment forms already differentiate prescribing and non-prescribing provides, enrollment was successfully augmented for Type I Diabetes pilot).
2. When enrolled providers request MO-CPAP support (by calling the dedicated phone line or using the online consultation request form), they indicate their reason for calling (suspected or diagnosed behavioral health conditions) and the support they need (psychiatric consultation and/or Care Coordination). Requests are associated with the enrolled provider. Available supports will be expanded to include Clinical & Behavioral Health Consultant as member of pediatric mental health care team; current forms track requests for Care Coordination, which will also increase with continued/expansion funding. At the time of the request, demographics for child/adolescent patients are collected (e.g., age, sex, race/ethnicity, zipcode, insurance). Each child/adolescent is assigned a unique ID through BHR.
3. Members of the pediatric health care team document their supports for each provider using unique forms customized by role that 1) facilitate streamlined collection of common data required for each consultation/patient (e.g., date/time and duration, use of standardized validated screening tool to screen patient) and 2) capture the distinct support provided by different members of the team (e.g., psychiatry consultation and medication changes, care coordination and behavioral health referrals). Customized form and process will be developed to accommodate addition of Clinical & Behavioral Health Consultant on pediatric mental health care team; current form for Care Coordination will be used for expanded supports in that role. Providers receive written documentation via email following psychiatric consultation - and upon initiation and conclusion of Care Coordination; brief feedback survey link is embedded in that documentation. Process will be adapted to accommodate addition of Clinical & Behavioral Health Consultant; current process used for expanded Care Coordination supports.
4. Enrolled MO-CPAP Providers are surveyed annually on items from baseline survey to monitor self-reported knowledge of, comfort with, and use of evidence-based practices.
Common items assessing providers' perspectives on access to and needs for behavioral health supports are included in that annual survey, as well as the brief feedback survey distributed with every consultation/Care Coordination documentation. Annual MO-CPAP Provider Survey includes satisfaction items for all supports and services. Current surveys will be adapted to accommodate additional provider types, including pediatric specialty care providers; expanded Care Coordination supports; and the inclusion of the Clinical & Behavioral Health Consultant on the pediatric mental health care team. 5. MO-CPAP evaluates ongoing educational opportunities using standard online training metrics (e.g., registration), training evaluations (e.g., pre/post-surveys, CMEs/CEUs), and web metrics (e.g., online traffic for modules). MO-CPAP also tracks distribution of educational materials (e.g., handbook). Current evaluation of educational supports will be expanded to accommodate additional trainings on trauma-informed care.
6. MO-CPAP currently monitors technical assistance (TA) activities, including outreach and engagement, via an internal REDCap project used by team members to track date/time, duration, topic, audience, reach, materials, etc. Current TA tracking system will be expanded to accommodate expanded outreach associated with existing MO-CPAP Schools and developing MO-CPAP Maternal Mental Health programs. Materials/information from expanded outreach associated with existing MO-CPAP Schools program will be shared with MO-CPAP Schools leadership to explore opportunities to further amplify this collaboration.
The Missouri Department of Mental Health (DMH) and the University of Missouri will work together to achieve the goals of MO-CPAP.
DMH has partnered with the University of Missouri Department of Psychiatry who are leaders in pediatric behavioral health, evaluation, and project management.