ILLINOIS CHILDREN’S HEALTHARE FOUNDATION Children’s Mental Health Initiative, Building Systems of Care, Community by Community ILCHF’s Commitment to the Concepts of A Medical Home Webinar, Tuesday, February 8, :00-3:00 pm 1

Ground Rules/Items to Note: A Few Ground Rules/Items to Note: Please submit questions along the way – we will make every attempt to answer or will provide a follow-up memo on those that weren’t addressed. There will be an open Q&A at the end of the session as well. Power point presentations and the documents referred to in the presentation will be available to download at after the presentation. 2

ILCHF’s Commitment to the Concepts of a Medical Home Presenters: Tammy LemkeAnita Berry MSN, CNP, APN PresidentDirector Healthy Steps Program Illinois Children’s Healthcare FoundationProject Director EDOPC 1200 Jorie BoulevardAdvocate Health Care Suite W Touhy, Suite 125 Oak Brook, IL 60523Park Ridge, IL Office: Office:

ILCHF’s Commitment to the Concepts of a Medical Home CMHI GUIDING PRINCIPLES Illinois Children’s Healthcare Foundation has adopted the following Guiding Principles for the Children’s Mental Health Initiative. These Principles must be agreed to by the Community Teams that are funded to implement their plans. – Incorporates the concept of a medical home. The community system of care must include linkages to and integrate with a primary health care system. 4

ILCHF’s Commitment to the Concepts of a Medical Home KEY DEFINITIONS: Commitment to the Concepts of a Medical Home ILCHF is committed to a cost-effective, patient-centered medical home strategy whose benefits to children can be demonstrated with empirical evidence. The Foundation expects physicians will be a key resource for identifying children at risk for developmental, mental health and other behavioral health difficulties. Furthermore, the Foundation expects that once a child is identified as being at risk and is scheduled to undergo a full assessment, a physician will be an integral part of a child’s ongoing care, ensuring a continuum across health and mental health services. 5

ILCHF’s Commitment to the Concepts of a Medical Home What Makes A Good Plan? Nine Considerations and What to Look For: – Focus and Direction – Operational Excellence – Professional Excellence – Human Resource Systems – Evaluation – Organizational Structure – Management Leadership – Commitment to the Concepts of a Medical Home – Financial Sustainability 6

What Makes a Good Plan? Positive Signs: Medical Home : – Medical providers understand the medical home feature of the system of care and how they and their patients can benefit from it. – There is a strategy for re-directing a child/family from relying upon ERs and ambulatory care settings for primary care to a medical home. – The schools and other touch points in a child’s life play a role in helping a child/family establish a medical home. – The system of care facilitates the sharing of information needed to support a medical home approach, especially the communication among providers. – There is a plan to link all children who receive an assessment to have a physician integrated into the assessment team. 7

What Makes a Good Plan? Negative Signs: Medical Home: – Referring a child/family to a medical provider without follow-up is the extent of the medical home feature of the system of care. – Medical providers are unclear on how the medical home feature of the system of care works. – The concept of a medical home is seen as a mechanism to build medical practices rather than as a key feature of a system of care. – The sharing of information among providers is inconsistent leading to poorly coordinated assessment and treatment. 8

ILCHF’s Commitment to the Concepts of a Medical Home A review of ILCHF’s prior funding in the area of integration of primary care and mental health services: All Funding since Inception$42.3 million 273 grants Mental Health/Integration$15 million 92 grants 35.5% of total 9

ILCHF’s Commitment to the Concepts of a Medical Home A review of ILCHF’s prior funding in the area of integration of primary care and mental health services: Significant Areas of Funding: Initial Funding ILCMHP – Implementation of Act Development & Expansion of Resource Link Early Intervention/Developmental Screening Integration of Primary Care/Mental Health Start up Funding for TAP/LOSS program Funding for mental health awareness/stigma Expansion of EDOPC Statewide 10

ILCHF’s Commitment to the Concepts of a Medical Home A review of ILCHF’s prior funding in the area of integration of primary care and mental health services: Funding in each Community Selected for the 1 st round: Adams County – Integration of primary care and mental health services grant awarded to SIU, Quincy Family Practice Residency Program, a designated rural health clinic. Goal of the project is to establish new mental health services for children and adolescents within a patient-centered medical home. (co- location model). To date, the program has served/referred 215 unduplicated children with 1,474 patient contacts. 11

ILCHF’s Commitment to the Concepts of a Medical Home A review of ILCHF’s prior funding in the area of integration of primary care and mental health services: Funding in each Community Selected for the 1 st round: Berwyn/Cicero - Partnership between The Children’s Clinic and Family Services of Cicero Planning and implementation for co- location of primary care and mental health services at the Community Clinic site in Oak Park- will have the capabilities to screen 0-18, assess and treat and have a solid referral system with follow-up. Program is in its initial implementation phase. 12

ILCHF’s Commitment to the Concepts of a Medical Home A review of ILCHF’s prior funding in the area of integration of primary care and mental health services: Funding in each Community Selected for the 1 st round: City of Springfield - Planning Grant awarded to Mental Health Centers of Central Illinois in conjunction with the Children’s Health partnership: Integrating Primary Care and Mental Health Services and Creating a Medical Home at Noll Pavilion. Based on this planning, Illinois passed an act to create a medical home pilot project for special needs children. 13

ILCHF’s Commitment to the Concepts of a Medical Home A review of ILCHF’s prior funding in the area of integration of primary care and mental health services: Funding in each Community Selected for the 1 st round: Livingston County- Livingston County/OSF Hospital in Pontiac is part of the expansion of Resource Link. The Resource Link program was established in 2005 by Children’s Hospital in Peoria and combines physician training on mental health, psychiatric consultation, and care coordination with large or small practices. 14

ILCHF’s Commitment to the Concepts of a Medical Home A review of ILCHF’s prior funding in the area of integration of primary care and mental health services: Funding in each Community Selected for the 1 st round: Carroll, Lee, Ogle and Whiteside Counties- Grant given in 2008 to Whiteside County Community Health Clinic. The project expanded comprehensive screening, referral and treatment networks between a primary care setting and mental health system. Lessoned Learned: the identity of a rural culture creates unique challenges to overcome. The values of privacy and being independently minded are difficult to overcome and highlights the value of developing trust and rapport with families. 15

Question & Answer Period 16

ILCHF as a Funding Partner: Enhancing Developmentally Oriented Primary Care Anita Berry MSN, CNP, APN Director, Healthy Steps for Young Children Program Advocate Health Care Project Director, EDOPC 17

Primary Care and Mental Health What Do Community Resources Tell Us about Communicating With Primary Care Providers? difficult to access needed records and forms lack of response to requests for medical records or prescriptions for service spend too much time on seemingly simple tasks – reaching the appropriate practice staff member, securing signed forms conflicting information regarding level of detail desired in reports

Objectives Participants will be able to Identify the importance of Integrating primary care and mental health Understand Enhancing Developmentally Oriented Primary Care (EDOPC) and how they work in Illinois Clarify the concept of a Medical Home

Primary Care and Mental Health What is it All about?

AAP Mental Health Task Force Plan* Facilitate needed system change Build skills Incremental practice change AAP Task Force on Mental Health, June 2010, Pediatrics

EDOPC Key Partners 22 Illinois Chapter American Academy of Pediatric Advocate Health Care Healthy Steps for Young Children Program

EDOPC Goals Improve delivery and financing of preventive health and developmental services for children birth to three Build on existing programs to develop a range of strategies for primary care settings 23

EDOPC Topics for Training Developmental Screening and Referral Social and Emotional Development: Screening Strategies for Primary Care Physicians Identifying Postpartum Depression During Well-Child Visit: Resources for Screening, Referral, and Treatment Early Autism Detection and Referral Domestic Violence Effects on Children: Detection, Screening and Referral in Primary Care Obesity Prevention in the Early Years 24

Additional EDOPC Topics for Training Effective Discipline in the Early Years Coordinating Care Between EI and the Primary Care Medical Home Project Psychosocial Developmental Screening and Referral for Children Aged Five to Eight Years Coordinating Care Between Early Intervention and the Primary Care Medical Home Bright Futures Guidelines for Health Supervision (beginning July 2011)

EDOPC Methods On site presentations to entire practice staff and topic specific community resources Educational Teleconferences Hospital Grand Rounds or Department Meetings Web based training Technical Assistance – , phone, on site Local and National Conferences

EDOPC Training in Illinois 1250 primary care providers 3200 allied healthcare staff 80% of Federally Qualified Health Centers 153 private practices 30 Residency, Nurse Practitioner, and Physician Assistant programs

EDOPC Provider Survey Providers who received intense EDOPC training, which includes technical assistance, were more likely to have a higher screening rate than providers with little or no EDOPC training. Trained Little or no training PPD-59% PPD-25% Dev-89% Dev-69% SE-37% SE-17%

Medicaid Data Analysis Rise in percent of well child visits with developmental screen 2002 = 15% 2009 = 32% percent of providers conducting at least one developmental screen in a year increased 2002 = 13% 2009 = 46% The percent of EI recipients screened for development by primary care provider before beginning EI services = 18% 2009 = 54%

So Where Are We Going?

Task Force on Vision in Pediatrics By the year 2020 Mental health care will constitute a significant part of pediatric practice

Why do this? Research findings Unique Access of Pediatric PCP High prevalence of mental health problems Mental health service shortage

AAP Task Force on Mental Health* Transformation of practice New knowledge and skills Payment structures Collaborative relationships Office systems and resource Greater role for pediatric PCP in mental health care Prevention Early recognition Referral Treatment Medical home enhancement AAP Task Force on Mental Health, June 2010, Pediatrics

Proposed Mental Health Screening of Children and Adolescents * Use of validated screening tool for those with abnormal developmental or autism screening results For any child with poor growth, behavioral, psychosocial concerns Age 0-5 Use validated screening instruments for all children in this age group at health maintenance visits Use also at time of family disruption, school problems, behavioral problem, recurrent somatic complaints etc 5- Adolescence Screen all adolescents for substance abuse at health maintenance visits Other appropriate times Adolescence AAP Task Force on Mental Health, June 2010, Pediatrics

Proposed Screening and Surveillance of Family and Social Environment for Risk Factors* *AAP Task Force on Mental Health, June 2010, Pediatrics Update child and family psychosocial history at each health maintenance visit Screen for maternal depression in the first year of life of the child or when indicated

Pediatric Primary Care Providers as a Mental Health Provider? ???

Developing collaborative relationships

Definition of HEALTH/MEDICAL HOME Accessible Family-Centered Comprehensive Continuous Coordinated Compassionate Culturally-effective Care that is: A partnership between primary care physicians/ nurse practitioners and families

Care Coordination is Key Through a Medical Home partnership, PCPs can help the family access and coordinate – specialty care – educational services – in and out-of-home care – family support – other community services PCPs and Community Resources must work together to coordinate care 40

Summary Primary care needs to be included in planning for a system of mental health care EDOPC training and technical assistance improves providers ability to screen, treat, and follow up with children and make appropriate referrals to community resources A medical home is a partnership to help families access and coordinate care

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ILCHF’s Investment in EDOPC Goals and Objectives January 1 – December 31, 2011 Establish a policy framework for a statewide Bright Futures (BF) Initiative. Building on the previous work of EDOPC, improve the quality of preventive health and developmental services for young children within primary care medical homes as outlined in these guidelines. – Bright Futures Integration Committee to be established 43

ILCHF’s Investment in EDOPC January 1 – December 31, 2011 Continue to strengthen capacity of FQHC’s and other primary care practices outside of the metro Chicago area to provide developmental screening and referral through training and technical assistance. – Present 25 new trainings to FQHCs outside of the metro Chicago area and already involved in EDOPC – Focus training and technical assistance on 4 FQHCs and their individual clinic sites outside of Chicago Metro area who are most likely to attain sustainability – Complete infrastructure for two of the remaining “hubs” – Offer group regional technical assistance to the 5 ILCHF Funded CMHI Communities, if requested 44

ILCHF’s Investment in EDOPC January 1 – December 31, 2011 Implement coordinated evaluation activities in order to continue to assess the impact of EDOPC training, technical assistance and policy initiatives in the state of Illinois.| – See for copies of two evaluation papers: June, Developmental Screening by Pediatricians in Illinois: Understanding the role of Training June, Developmental Screening of children insured by Medicaid in Illinois: An examination of training to facilitate referrals for Early Intervention Services

Question & Answer Period 46