Mental Health Care is a Team Sport
After a series of violent outbursts at home and truancy problems at school from their nine-year-old son David, David’s parents took him to the local hospital where he was admitted to a psychiatric unit. Hospital staff prescribed medication for David and instructed him upon discharge to visit a nearby outpatient clinic weekly for therapy.
Imagine David’s pediatrician’s surprise when David’s mother asked her to fill behavioral health prescriptions. Because mental health and primary care are so often disconnected, the pediatrician was unaware of David’s situation.
Rather than turn David away, the pediatrician reached out to a mental health clinician he knew to develop a collaborative plan to meet David’s immediate and ongoing needs. In addition to medication and regular psychotherapy, the plan included collaboration with school personnel to ensure that David could be successful in the school setting. The plan also outlined strategies for everyone to work together on David’s behalf.
Bridging the Gap
Historically, in Connecticut and nationally, primary health and mental health are handled by two very different systems that have not always talked to each other. The result has been gaps in care for kids like David, who often don’t receive the treatment they need.
Policy-makers and providers in Connecticut, such as David’s pediatrician, have been working together to close those unintended gaps in care. The overarching strategy has been to bolster the role of primary care in addressing mental health needs. Here are some critical steps taken in our state:
- In 2005, Connecticut developed the Behavioral Health Partnership (BHP) providing incentives for mental health agencies to collaborate with primary care practices to improve integration between health and primary care services for Medicaid recipients. Through the partnership, 39 mental health center sites have now been designated as Enhanced Care Clinics (ECC) serving children and adolescents. The BHP requires each ECC to have a formal memorandum of understanding with a primary care site.
- In 2009, the Child Health and Development Institute of Connecticut (CHDI) worked with four primary care sites to help them establish working partnerships with local mental health providers. Results showed improved detection of children with behavioral concerns and better connection to behavioral health interventions. One practice implemented universal mental health screening and greatly increased the number of children connected to mental health services.
- Connecticut is also on the brink of implementing a new system to ensure that children’s mental health needs are met. The State’s FY ’14 and FY ’15 budget includes funds to support the establishment of regional behavioral health consultation and care coordination teams for pediatric primary care providers to call when they have questions about mental health treatments for their patients. This program will offer timely telephone access to a consultation team that includes child psychiatrists, social workers and care coordinators. The program has been effective in Massachusetts and Washington in increasing children’s access to mental health services without creating additional burdens on the mental health system. (See CHDI’s IMPACT – Pediatric Psychopharmacology: Improving Care Through Co- Management – for descriptions of these two state programs.)
- To help child health providers optimally use the new consultation program, CHDI, with funding from the Children’s Fund of CT, developed a Co-management program for anxiety and depression. Co-management entails shared responsibility and authority for patient care between pediatric primary care and behavioral health providers. It is a promising strategy for improving patient outcomes and increasing the ability of primary care providers to address mental health concerns.
Bringing it Back to David
Connecticut’s vision for integrating pediatric primary care and mental health services for children is becoming a reality. What does all of this mean for David? His primary care physician reports, “Once we all got on the same page for David, his school and home behavior improved significantly. He’s not out of the woods yet, but our practice is now in the loop. We can monitor progress and have ongoing communication with the community providers that are treating him. Together we can make sure that he won’t fall through the cracks again.”
Collaborative approaches to care give pediatricians needed support to identify and address mental health concerns effectively. These strategies are an important step in improving access to, and delivery of, health and mental services for children in Connecticut and making sure kids like David get the full range of treatment they need to thrive.
For more information on integrating children’s health and mental health systems in Connecticut, please visit www.chdi.org.