Holy Cow! Mental Health:

It’s not all it’s cracked up to be…yet!Kristine Hobbs, LMSW – DHHS

July 2011 Learning Collaborative

Remind me why we’re talking about this?

From the grant:“Behavioral health is fully

integrated into our demonstration grant as Category C which specifically focuses on the integration of behavioral health care within the medical home…”

Remind me why we’re talking about this?

• 21% of children and adolescents in the US meet diagnostic criteria for MH disorder with impaired functioning

• 13% of school-aged, 10% of preschool children with normal functioning have parents with “concerns”

• Children with chronic medical conditions have more than 2X the likelihood of having a MH disorder

• 8 % of adolescents (2 million youths aged 12 to 17) are estimated to experience a major depressive episode each year, with only two-fifths receiving treatment.

Stats: http://www.teenscreen.org/images/stories/PDF/TS_PC_FactSheet_1.18.11.pdfhttp://gucchdtacenter.georgetown.edu/resources/Call%20Docs/2011Calls/Foy%20Earls%20Georgetown%20-%20Final.pdf

QTIP Doctor - “1/4 to 1/3 of patient visits are mental health related”

Remind me why we’re talking about this?

• 80 % of mentally ill youth are not identified and do not receive mental health services.

• The first symptoms of mental illness typically occur two to four years before the onset of a full-blown disorder, leaving an important window of opportunity for prevention.

• 90% of adolescent suicide victims have a psychiatric disorder, with 63% exhibiting symptoms identifiable by screening for at least a year before their death.

• 50% of all life-time mental health disorders start by age 14.

Stats: http://www.teenscreen.org/images/stories/PDF/TS_PC_FactSheet_1.18.11.pdfhttp://gucchdtacenter.georgetown.edu/resources/Call%20Docs/2011Calls/Foy%20Earls%20Georgetown%20-%20Final.pdf

QTIP Doctor - “1/4 to 1/3 of patient visits are mental health related”

Questions from Site Visits…

• Ultimate success?• Dismal Failure?• Realistic?• Factors Contributing to Success?• Challenges?• What are you doing already?• How can I best assist you?

Summary of Site Visits

No one feels they are meeting the needs completely – they feel the current state of mental health services for kids is the worst case scenario

Summary of Site Visits

Needs -• Effective screening, • More service providers, • Easier access to services, and • Billing issues resolved.

Summary of Site Visits

Strengths – • Some have systems in place that support having

or adding additional services in-house,• Some of you have expanded your capacity to

provide limited services,• All of you are dedicated, creative practitioners.

Summary of Site Visits

• Challenges – • Limited capacity of caregivers, • Limited resources, • Limited specialist, • Limited knowledge of resources, • Financial issues.

What You Are Doing Now…

• 18 practices• 7 of 14 practices interviewed have some form

of mental health service provider with the practice (9 total with self-report)

• Co-location ranges on-site psychologist 4 hours/week to a full-time mental health counselor– 2 have PT psychiatrist with the practice

How can I best assist you?

“Create resources out of dust”“Another form is not the answer”“I want to know what other people do”“Aren’t you a social worker? Come do

case management for us.”

Where are we going?

In the words of Dr. Rushton…

–Prevention–Skill building in the medical home–Better back up and support to front-

line medical staff

“Parties who want milk should not seat themselves on a stool in the middle of the field in hopes that the cow will back up to them.”

~Elbert Hubbard

In General

• Provide options for screening and evaluation tools,

• Figure out the fiscal issues,• Skill enhancement for pediatricians and pediatric

staff around prevention, treatment, referral,• Other training opportunities – enhance

prevention and pediatricians skills,• Sharing resources and educational opportunities,• Linkages and support to the medical home.

Resources and referrals• Identify local resources as

outlined with NCQA• Build bridges and connections

with local resources• Provide ideas for building

local networks around resource development and knowledge

• Psychometric testing• Benchmarking around

referral processes and feedback loops

Co-location & Integration

• Ways to identify staff appropriate for co-location

• Funding options• Piloting some ideas• Training opportunities for Behavioral Health

Staff• Training opportunities for Medical Staff

Psychiatry • Psychiatry Consultation with the

Pediatrician• Mini-fellowship in psychiatry• Access to more child psychiatrists

DMH 24/hr ER Telepsychiatry Consultation

You should have…

Ready to take the bull by the horns?

Using your handout, indicate your top 3 mental/behavioral health priorities for the next 6 months…