1. Establishing a Behavioral Health Clinic within a Primary Care Site Stephanie Cooper, Ph.D. Hastings Behavioral Health Clinic Children and Adolescent Clinic, P.C.

2. Previous Research Twenty percent or more of pediatric primary care patients have developmental or mental health problems (American Academy of Pediatrics, 1978, & Anderson, Cooper, Polaha, Valleley, Evans, 2004). Average length of physician visits are 11 to 12 minutes which limits the amount of time physicians have to spend on addressing behavioral concerns.

3. A large proportion of primary care patients prefer to receive mental health services within medical settings rather than private mental health facilities (deGruy, 1997). Therefore, behavioral health services should be seen as an extension of the services provided within primary care settings.

4. Reasons for BHC in Primary Care Improved physician practice. Better continuity of care. De-stigmatization of behavioral health services. Potential for better early intervention/maximized services.

5. Services provided in BHC Direct outpatient treatment for behavioral, academic, developmental, or social concerns.  Defiance/Aggression  ADHD  Elimination problems (enuresis, encopresis, toilet training)  Sleep problems (bedtime resistance, night-time awakening, and sleep/wake schedule problems)  Feeding Difficulties  Anxiety and Depression  Tic and habit disorders

6. In-hall consults with physicians about their patients On the spot consults with patients directly Didactic training for staff in primary care Community liaison for mental health

7. First Steps Contact clinic either by letter or phone ( See Cate’s letter to Chadron clinic ) Discuss with the physicians what their needs are, and how you can be helpful. If they are interested, then another meeting should be held where specific details are discussed.

8. Specifics:  Referral system (see form used in Hastings and Kearney clinics)  Designate staff member to handle scheduling new and/or return patients.  Consider how waiting list will be maintained (clinic referrals vs. outside referrals)  Where will patients be seen? Where will files/toys be located?

9. Specifics  How will patients get from waiting room to exam room.  Where will schedule be located in the office, where will blank referrals forms be kept, where will completed referral forms be kept?  Will reminder phone calls be made and who will make them?  Who will be in charge of getting authorizations and handling billing?

10. Get Involved in the Community Give talks to Head Start and Daycares Brief lunch talks to physicians Present at Grand Rounds Schedule lunch with other professionals such as wrap-around, healthy beginnings, etc. Teach college class

11. Questions? Comments?