41
Management of Pediatric Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor Baylor College of Medicine, The Center for Children and Women Arlene Gordon-Hollingsworth, PhD, Assistant Professor Baylor College of Medicine, The Center for Children and Women Stephanie Marton, MD, Assistant Professor, Baylor College of Medicine, Associate Medical Director, The Center for Children and Women Mudassar Tariq, MD, Assistant Professor, Baylor College of Medicine, The Center for Children and Women Session # CFHA 19 th Annual Conference October 19-21, 2017 Houston, Texas

Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Management of Pediatric Behavioral Health Disorders In

An Integrated Pediatric Medical Home

Stephanie Chapman, PhD, Assistant Professor Baylor College of Medicine, The Center for Children and Women

Arlene Gordon-Hollingsworth, PhD, Assistant Professor Baylor College of Medicine, The Center for Children and Women

Stephanie Marton, MD, Assistant Professor, Baylor College of Medicine, Associate Medical Director, The Center for Children and Women

Mudassar Tariq, MD, Assistant Professor, Baylor College of Medicine, The Center for Children and Women

Session #

CFHA 19th Annual ConferenceOctober 19-21, 2017 • Houston, Texas

Page 2: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Faculty Disclosure

The presenters of this

session have NOT had any

relevant financial

relationships during the

past 12 months.

Page 3: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Conference Resources

Slides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=Resources_2017

Slides and handouts are also available on the mobile app.

Page 4: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Learning Objectives

Learners will be able to describe

• Clinic process that support successful

interdisciplinary and integrated treatment of

pediatric behavioral health care

• Interdisciplinary skill competencies and care roles

in the treatment of pediatric behavioral health

care

Page 5: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Management of Pediatric Behavioral Health Disorders In An Integrated Pediatric Medical Home

Page 6: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

6

TCHP The Center for Children and Women

Page 7: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

The Center for Children and Women

– A Hybrid Model

MinimalCoordinated –At a Distance

Co-locatedFully

Integrated

1) Independent outpatient behavioral health services2) Just in time behavioral health services during medical appointments

Page 8: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Medical Home Model

8

Capacity and Accountability

Provider Led Teams

Care Coordination& Integration

Whole Person Orientation

Safety and Quality

Continuity of CareEnhanced

Access

Page 9: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Center Patient Race/Ethnicity

67

25

41

0

10

20

30

40

50

60

70

80

Latino Black White Asian

Percentage

9

Page 10: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Funding – Capitated Payment

• Flat fee per patient member

• 100% Risk model

Value:

• No fee for service = ability to innovate

• Value on prevention and maintenance

• Incentives for reducing costs

10

Page 11: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Access

Hours

Pediatric Hours:

Sunday 9 AM – 7 PM

Monday 7 AM – 11PM

Tuesday 7 AM – 11PM

Wednesday 7 AM – 11PM

Thursday 7 AM – 11PM

Friday 7 AM – 11PM

Saturday 9 AM – 7 PM

11

Page 12: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Integrated Care = Easy Access

OB/GYN PediatricsBehavioral

HealthOptometry

Speech Nutrition PharmacyHealth

Education

Dentistry Lab RadiologyCare

Coordination

Page 13: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

OVERVIEW OF BEHAVIORAL

HEALTH

13

Page 14: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Interdisciplinary BH Team

14

5 FTE BH clinicians

2 social workers

1 psychiatrist

6 pediatricians5 nurse practitioners

Page 15: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

BEHAVIORAL HEALTH CARE –

ADHD AND DEPRESSION /

ANXIETY

15

Page 16: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

16

Screening

Care Coordination

Diagnostic Assessment

Medication Management

School Accommodations

Evidence-based Therapy

Care Interventions for ADHD at the Center

Page 17: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Use of Screening and Psychological Assessment Tools

Page 18: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

18

Page 19: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

19

Page 20: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Evidence-Based Treatments

Parent Management Training

– A brief (4-10 session) therapy

designed to teach parents skills to

change child behavior

– Effective for a variety of presenting

problems:

• Enuresis/Encopresis

• Sleep disturbances

• Feeding difficulties

• ODD, ADHD, and DBD

Page 21: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Thoughts

Feelings Behavior

Page 23: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Evidence-Based Treatments -

Motivational Interviewing

Medication and Treatment AdherenceSubstance ReductionHealth Goal maintenance

Page 24: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Coordination of Care

Patient Registries

Staffed regularly by social work and care

coordinators

• ADHD Follow-Up

• 7 and 30 Day Psych Hospital Follow-up

• Maternal Depression Screen Follow-up

24

Page 25: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Telehealth Increases Access

Telehealth = 7% of Psychiatry encounters

Contributes to 100% psychiatry template utilization

Page 26: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

PCP – Medication Management

Psychiatry – Formal Consult Role

BH Clinician – Assessment & Therapy

Social Worker-Resources

Patient

Collaborative Medication

Management

• Protocols standardize care

• Increase timely access to care for medication titration

Page 27: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Medication Management

BH Clinicians and PEDI/OBGYN

providers partner to manage the majority of BH medications

• ADHD

• Anxiety

• Depression

• Sleep

Psychiatry - 30 % of time allocated to curbside consult

Psychiatrist only sees patients with complex psychiatric disorders

27

Page 28: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Center PEDI Medication

Management

28

Good Psychiatry Referrals• Patients with complex psychotropic medications• Patients with psychiatric histories other than

ADHD / depression/anxiety• Lack of progress with first line treatments• Children under 6 years

Psychiatry can always be consulted• Inbasket• Curbside consult• Patient office visit

Page 29: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Case Example – John

16 yo male who presents for his well child check

• PSC-17 is elevated; pediatric provider asks

further questions of child

– Concerned that child may be depressed

– Real time behavioral health consult

• Depression diagnosed at visit by psychologist

– SSRI started same day

29

Page 30: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

John returns

• Behavioral health team calls John in one week to

check on his symptoms, he is doing well with no

side effects noted

• At follow-up in clinic in 2 weeks John has had

some stomach aches and no real change in

mood

– Pediatric team increases SSRI dose

– Behavioral health team provides therapy same day

30

Page 31: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

John continues to return

• Over next month behavioral health team sees

John twice

• He returns to pediatric clinic and reports he has

more energy but still does not see a change in

his mood

– Pediatric team briefly curbsides psychiatry to enquire

as to how long should John stay on same medication

with no change in his mood

31

Page 32: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

John returns

• John is maintained same dose of SSRI for an additional month with continued therapy

• After 2 months John reports he is having more energy and improved mood

• Therapy continues. Behavioral health team messages pediatric team that he is doing well and pediatrician team refills medication for an additional month.

• John stops coming to therapy; pediatrician continues SSRI and checks in with therapist when he comes for medication management visits.

32

Page 33: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

John

• John’s symptoms were caught early through annual

screening exam and he was never hospitalized.

• A team of multidisciplinary healthcare providers

were able to manage John’s symptoms; he was never

seen by psychiatry.

• John’s treatment was successful due to frequent

communications and a modifiable treatment plan.

• John received cost-effective, quality care.

33

Page 34: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

CENTER OUTCOMES- ADHD

EXAMPLE

34

Page 35: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

ADHD / Depression/Anxiety

Screening Rates - % of Screening

Completed at Well-Child Checks

Page 36: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

36

CENTER ADHD PATIENTS and VISITS 2016

Page 37: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Members with ADHD Treated

by PCP VS Psychiatrist

40%

22.80%

60%

77.20%

TCHP 2016 Center 2016

Psychiatry PCP

Page 38: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Use of Generic Pharmaceuticals

ADHD Meds

Center Psychiatry 42.30%

TCHP top prescribers 28.00%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

Page 39: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

PEDIATRIC BH HEDIS METRICS

ADHD stimulant initiation

95th Percentile

ADHD continuation/maintenance

95th Percentile

7 Day psychiatric hospitalization follow-up 75th Percentile

30 Day psychiatric hospitalization follow-up 50th Percentile

Page 40: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

RIGHT CARE / RIGHT PLACE -

BEHAVIORAL HEALTH Behavioral Health Integration Increases

Engagement in Underserved Communities

Page 41: Session # Behavioral Health Disorders In An Integrated ...€¦ · Behavioral Health Disorders In An Integrated Pediatric Medical Home Stephanie Chapman, PhD, Assistant Professor

Thank you!

41