PediPRN Pediatric Psychiatry Resource Network Rajvi Broker-Sen, MD Clinical Director, PediPRN

PediPRN - Innovative program designed to help pediatric primary care providers meet the needs of children with behavioral health struggles - Lifespan Funding SIM grant Rhode Island Foundation vanBeuren Charitable Foundation Modeled after MCPAP- Massachusetts Child Psychiatry Access Project Service is available to all Pediatric Primary Care Providers (PPCP’s) in the state of RI at no cost Offered by Bradley Hospital under a grant awarded by RI’s executive office of Health and Human Services through the SIM and RIF grant and Newport Van Beurent grant. MCPAP – innovative model of consultation and collaboration between pediatric primary care and child psychiatry providers initially started in 2004 and the concept has then inspired 27 other states across the US. We will be the 28th state.

Need Increasing prevalence of behavioral health problems in children National shortage of child psychiatrists Pediatric feedback Requested training in screening, diagnosing and treating behavioral health problems Requested information about community behavioral health referrals and resources Which can influence their desire to do early screenings. A report of the surgeon general indicates that nearly 20% of youth have a diagnosable mental disorder, less than 20% receive treatment – shortage of CAPs, stigma,

Goals Increase PPCP’s knowledge, skill and confidence to screen and manage children in primary care with mild to moderate mental health needs Promote the rational utilization of scarce specialty resources for more complex and high risk children Advance integration of children’s behavioral health and pediatric primary care Supporting PCP makes sense – Families feel more comfortable going to their PCPs first Reduced stigma by care given in medical setting Achieving familiarity with the most common psychiatric diagnoses, strategies for assessment, and treatment appropriate for the primary care setting Gaining confidence in your expertise including recognizing the limits of your knowledge Becoming familiar with the wide variety of community-based private and public behavioral health resources and how to make effective referrals Helping parents become effective advocates for their children Coordinating care for patients receiving behavioral health services in the community

Goals Less Complex More Complex PCP ChΨ PCP ChΨ Primary Care Taking Lead Child Psychiatrist Taking Lead ChΨ PCP

DESIGN Lifespan Hospital Sites - Bradley, RI, and Newport Behavioral Health Team 1 FTE Psychiatrist/APRN Rajvi Broker-Sen, MD Richard Smith, MD Leila Sadeghi, MD Bev Rich, APRN 1 FTE Social worker 1 FTE Care coordinator 0.1 FTE Psychologist David Barker, PhD

Orientation Start date – December 15th, 2016 Enrollment process – Enrollment form and Survey Fax both forms to (401) 432-1506 Scan and email forms to PediPRN@Lifespan.org Forms will be available on the website Forms available for completion at this meeting Phone number (401) 432-1KID or (432-1543) Website – Lifespan.org – Bradley hospital - PEDIPRN Once practices are enrolled, overtime the team will reach out to individual practices to provide more orientation of services provided if desired

Child Psychiatrists/APRN Process (401) 432-1KID Assist with referring families for treatment in community Care coordinator Phone consultation Face-to-Face (if necessary) Child Psychiatrists/APRN Face-to-Face consultation Interim Therapy Social worker Care coordinator will receive your call – urgent (30 mins) or scheduled call She will then page the prescriber on call and you should hear back from them within 30mins.

Services Telephone consultation – 8:00 am – 5:00 pm on weekdays Face-to-Face consultation Care coordination Transitional therapy services while youth are waiting placement in outpatient behavioral health services Training and education through Bradley Conference, lectures, website, and e-blasts Provision of real-time case-based continuing education services regarding evidence and consensus based practice guidelines, assessment strategies, and appropriate use of community mental health resources. Building a collaborative relationship supporting the growth of the PCP’s expertise and confidence in the ability to provide clinical management and/or coordinate care for youth with mental health problems. Provide a triage function to identity0 those patients who truly require the direct care of a CAP and to help PCP’s define the limits of their own involvement in the mental health care of specific patients.

Consultation questions Diagnostic clarification Treatment planning Unable to access behavioral health resources Second opinion Screening support Pharmacological – side effect, selection, dosage, etc. Psychotherapy – selection, linkage, monitoring

References Massachusetts Child Psychiatry Access Program – www.mcpap.com National Network of Child Psychiatry Access Programs – www.nncpap.org Partnership Access Line (PAL) Washington -www.palforkids.org Integrating Behavioral Health and Primary Care for Children and Youth: Concepts and Strategies, http://www.integration.samhsa.gov/integrated- care models American Academy of Child & Adolescent Psychiatry Recommendation - When to Seek Referral or Consultation with a Child Adolescent Psychiatrist https://www.aacap.org/aacap/Member_Resources/Practice_Information/W hen_to_Seek_Referral_or_Consultation_with_a_CAP.aspx