Behavioral-Health Integration in Pediatric Primary Care and Race to the Top Project 7

 Made possible through: Funding support from DHMH/MHA and MSDE No cost to providers or patients  no insurance requirements  Collaboration among University of Maryland, Johns Hopkins Bloomberg School of Public Health, Salisbury University, and community/ advocacy groups

 PCP are frontline.  Reduce common barriers  Include social emotional development in screening process  Develop trauma and family informed approach to care and consultation

 To support the capacity of primary care providers to participate in the mental health care of children and youth, thus increasing access to child mental health services

Phone Consultation Service – Clinical questions – Referral information – Links to family navigators Continuing Education – Training and QI/MOC opportunities Referral & Resource Networking – Building connections among PCPs and mental health professionals – Connecting providers with referral resources

 Enrolled providers call (or fax) 855-MD-BHIPP  Call is answered by a master’s level clinician Will address questions as appropriate  Dependent on what is needed to address question, passes call to consultant who calls PCP back Child psychiatrist Psychologist Social worker specializing in trauma or young children

 Early maladaptive behaviors can be indicators of acute stress or early signs of persistent maladaptive trajectories (Egger & Angold, 2009; Angold & Egger, 2007).  Incidence of psychiatric disorders in children ages 2-5 is 16% (Egger, et al., 2006), compared to 13% in older children (Costello, Mustillo, Erkanli, Keeler, & Arnold, 2003).  Early aggression and post-traumatic stress, are persistent over time with long lasting effects (Zeanah, 2009) that can lead to serious psychological disorders in later childhood (Keenan, Shaw, & Delliquardi, 1998; Shaw, Gilliom, & Ingoldsby, 2003).

 Early aggression has been linked to increased expulsion rates from pre-K programs (Gilliam, 2005), later aggression at age 9 (National Institute of Child Health and Human Development Early Child Care Research Network, 2004).  Identification of and connection with mental health services can ameliorate the long term impact of early childhood mental health difficulties (Knitzer & Lefkowitz, 2006; National Council on the Developing Child, 2008; National Scientific Council on the Developing Child, 2004)..  The National Early Intervention Longitudinal Study (NEILS, 2007) found that 32% of parents receiving Part C services reported having difficulty managing their child’s behavior, but only 4% of children were referred for social/emotional or behavior challenges.

 Vision: “Start early and the benefits can last a lifetime: Integrative services in the earliest years of life are smart (high yield on investment) and essential to building healthy brains and productive and safe communities.”  Foundation: Partnerships  Building Blocks: Grant Opportunities- (RTT, PL); Research Projects; Policy Efforts, Workforce Development

 Addressing the health and behavioral needs of children through a coherent set of early intervention and prevention programs.

 Early Childhood Mental Health (Race to the Top): Consultation and training focused on the youngest children (ages 0-5) Comprehensive integration with B-HIPP  overlap in staff, resources, phone consultation service, evaluation, and training  Project Launch: Pediatric consultation and training focused on children ages 0-8 in Prince George’s County

7.1 Early Childhood Mental Health Phone Consultation for Pediatricians: Develop and implement phone consultation services for primary care providers in concert with the B-HIPP Project.  The goal was to enroll a minimum of 20 pediatric PCPS, and that goal has been surpassed. There are 110 providers enrolled, and 60% are pediatricians and the remaining 40% are family physicians, nurse practitioners, or another type of primary care provider.  The phone consultation line is operational and has conducted 47 consultations and 26% of the case consultations are for children under the age of 6

7.2 Early Childhood Mental Health Consultation Training for Pediatricians: Recruit and train primary care providers (PCP) and Early Childhood Mental Health (ECMH) consultants  Clinical team is completely clinical manual  Innovative ways to reach out to physicians  Research strategies and stakeholder input to develop a training manual and booster for primary care and ECMH certificate graduates

 REDCap  Qualitative interviews  Referral database and GIS  Coming Soon-training evaluation

 Stakeholder input  Recruit a corpe of PCP in PG  Develop curriculum  Pilot it and evaluate  Disseminate more broadly

Encourage connections/partnerships among PCPs and mental health professionals, ECMH consultants and other Project Launch partners and services.

 Look at what other states are doing  contact ryland.edu ryland.edu and.edu and.edu