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Innovative approaches help reintegrate mental health care into pediatrics
AAP News
James M. Perrin, M.D., FAAP

Rates of children's mental health conditions continue to grow, with attention-deficit/hyperactivity disorder (ADHD), depression, anxiety or substance abuse now estimated to affect well over 25% of children ages 5-18 years.

Pediatricians in all types of practice experience mental health problems in their patients regularly. AAP priorities focus on issues associated with higher rates of mental health disorders, including toxic stress in early childhood, poverty and chronic health issues (where rates of mental health disorders generally are twice that of children without chronic disorders). More than half of mental health disorders diagnosed in adults had their origins evident before 14 years of age, making identification of mental health symptoms an important pediatric problem.

Advocate Healthy Steps Sponsoring Technical Assistance Training Calls Through September 2014!

Advocate Healthy Steps (formerly EDOPC) will be facilitating an in depth discussion on the various screening tools used in pediatric practice. Please join in with other participates to ask questions regarding implementation, timing and frequency, and road blocks to these screening tools. Staff from primary care sites will have opportunities to share successes and get help with areas they may be struggling with.

See the schedule below for the list of dates and topics:

March 19: Developmental Screening (ASQ-3) - the Ages and Stages Questionnaire (ASQ-3) is a screening tool designed to help parents check their child’s development in the areas of communication, gross motor skills, fine motor skills, problem solving, and personal social and overall development over time.*** Reminder there is still an Illinois Health Connect Bonus for Developmental Screening available!!!!

April 16: Social Emotional Screening (ASQ-SE) - the Ages and Stages Questionnaire Social Emotional (ASQ-SE) is a screening tool that focuses on children’s social and emotional development. It allows you to quickly pinpoint behaviors of concern and identify needs for further assessment or ongoing monitoring.

May 21: Depression Screening (Edinburgh and PHQ9) - Screening tools that assist clinicians in screening, identifying, diagnosing, monitoring and measuring the severity of perinatal depression.

June 18: Hurt, Insult, Threaten and Scream (HITS) - A short Domestic Violence Screening tool used to identify intimate partner violence.

July 16: Pediatric Symptom Checklist (PSC)- A brief screening questionnaire that is used by pediatricians and other health professionals to improve the recognition and treatment of psychosocial problems in children.

August 20: Modified Checklist for Autism in Toddlers, Revised (MChat/ MChat- R) - An Effective reliable screening tool for detecting Autism in toddlers.

Sept. 17: Trauma –Childhood Stressful Adverse Event Survey-A survey to determine the health and social well-being of children exposed to adverse and stressful childhood experiences.

Positive Parenting: Coaching Families and Modeling Positive Parenting in the Medical Home

Wednesday, February 26, 2014
12:00 PM - 1:00 PM CST
Space is limited

Reserve your Webinar seat now at:
https://www3.gotomeeting.com/register/935090078

A nurturing relationship between a parent and child is an important buffer against toxic stress related to exposure to violence. Health care providers can encourage positive parenting skills that foster nurturing relationships. This webinar will enable listeners to identify parenting practices that can build resilience in children exposed to violence, identify ways to model positive parenting practices in the medical home, and provide specific and practice guidance on parenting to families in the medical home setting. With support from the Department of Justice, The AAP Medical Home for Children Exposed to Violence is proud to present Kimberly Randell, MD, MSc, FAAP and Lisa Spector, MD, FAAP. Dr. Randell is a past co-chair and current member of Children’s Mercy Hospital’s Council on Violence Prevention and co-chairs the Intimate Partner Violence (IPV) Work Group. Dr. Spector is the Medical Director of the Safe and Healthy Families (SAHF) Trauma Prevention and Treatment Program and Medical Director of the Sexual Assault Nurse Examiner (SANE) Program at Children’s Mercy Hospital.

After registering you will receive a confirmation email containing information about joining the Webinar.

Resource Poor or Rich?: Asset Building to Provide Behavioral Health Services for Children, Youth and Families in Rural Communities

http://www.tapartnership.org/events/listView.php?id=1250
August 28, 2013 from 3:00 PM to 4:30 PM Eastern Time (ET) 

This webinar will focus on practical strategies for harnessing the assets that exist within rural communities and among families, children and youth to address behavioral health needs and well-being. By emphasizing the principles of family-driven and youth-guided approaches, presenters will discuss the importance of meaningful integration of these principles into the delivery of services and programs in rural communities. The webinar will highlight the wraparound/advocacy model utilized by Youth Advocate Programs, Inc., in working with cross-system involved youth and families in its upstate New York locations, including a tribal community. The webinar will also highlight time banking as a strategy for effective asset building in a rural community in northern California. Time banking is a reciprocal service exchange where community members share time for services, where each hour of service is valued the same. Presenters will discuss the efforts of two rural communities to identify and maximize community assets. 

Facilitator:
Karen B. Francis, Ph.D., Senior Researcher, TA Partnership

Presenters:
Gary Blau, Ph.D., Branch Chief, Child, Adolescent and Family Branch, CMHS/SAMHSA
Michael Marks, Ph.D., Senior Researcher, American Institutes for Research
Stephanie Hart, President, New York State, Youth Advocates Program, Inc.
Terry Daniels, Co-Founder, Hourworld, Lake County, California

Register Here: http://events.tapartnership.org/register.php?eid=101

Updated version of DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association provides a common language and standard criteria for the classification of mental disorders. An Updated version is scheduled for release on May 27th, 2013. The attached PDF is a summary of major changes from the current version, DSM IV-TR. Please call Illinois
DocAssist at 1-866-986-ASST (2778) if you have questions about the changes or diagnostic coding issues for childhood mental health conditions in the primary care setting.

Two Special Training Opportunities in April 2013 for Primary Care Providers...
DocAssist consultants recommend the following parent management training courses as offered by 1-2-3 Magic.  PCPs should consider sending a clinical staff member from their practice to the training(s). Ideally a nurse or co-located mental health professional would participate in the training and then co-lead multi-family groups, one-on-one sessions, and consult to PCPs.  Details are listed below on the train-the-trainer sessions being offered in April.


1-2-3 Magic Train-the-Trainer

When / WHERE:

CHICAGO, IL

Saturday, April 13, 2013

8:30 a.m. – 4:00 p.m.

Saturday, August 17, 2013
8:30 a.m. – 4:00 p.m.

Hilton Garden Inn Chicago O’Hare Airport

2930 S. River Rd.
Des Plaines, IL 60018

Cost:
$445
per person (includes the1-2-3 Magic Presentation Package, a $295 value)
Early-bird registration: $375

If you register before April 5 or August 9, respectively.

FOR MORE INFORMATION, PLEASE VISIT: http://www.123magic.com/123TTT

Surviving Your Adolescents Train-the-Trainer
When / WHERE:

CHICAGO, IL

Friday, April 12, 2013

8:30 a.m. – 4:00 p.m.
 

Friday, August 16, 2013
8:30 a.m. – 4:00 p.m.

Hilton Garden Inn Chicago O’Hare Airport

2930 S. River Rd.

Des Plaines, IL 60018

Cost:
$445
per person (includes the Surviving Your Adolescents Presentation Package, a $295 value.)
Early-bird registration: $375

If you register before April 4 or August 8, respectively.

FOR MORE INFORMATION, PLEASE VISIT:  http://www.123magic.com/SYATTT

Upcoming webinar

December 5, 2012
1:00 pm ET / 12:00 noon CT /11:00 am MT / 10:00 am PT (90 minutes)

American Academy of Pediatrics Webinar:Mental Health in the Medical Home Setting

Presented by Jane Meschan Foy, MD, FAAP and Marian F. Earls, MD, FAAP.

Many patient-centered medical home (PCMH) demonstration projects have been initiated across the United States. Although a few have included treatment for depressive disorders as a component of a larger intervention (Bitton et al, 2010), most have not explicitly addressed mental health. Consensus has yet to emerge on whether strategies used to deliver mental health treatment in primary care are consistent with the core elements of the PCMH or the extent to which adoption of the PCMH concept will facilitate the delivery of such treatment in primary care.

To address the following 4 questions, this webinar examines the PCMH concept and successful approaches to delivering mental health treatment in primary care:

1. Why should mental health problems be priorities for the PCMH?

2. Are evidence-based strategies used to deliver mental health treatment in primary care consistent with PCMH core components?

3. How can the PCMH meet the needs of diverse patient populations with complex mental health and related problems?

4. What policy and programmatic actions are needed to ensure the feasibility of integrating mental health treatment into the PCMH?

OBJECTIVES

*Raise awareness of the need for mental health care in the medical home setting.
*Prevent patient harm by implementing patient safety techniques.
*Improve health care outcomes by adhering to proven best practices for integrating mental health services into your medical home.
*Promote mental health in your medical home.

This live 60-minute session will be presented December 5, 2012, and will include time for questions and answers. If you are unable to attend the live event, the archived event will be available until March 4, 2013.
The registration fee is $134.95.

For more information or to register for this event,click here

Upcoming TeenScreen webinar

Teens with Depression & Anxiety: Practical Strategies for Primary Care

 Tuesday, March 20, 1-2 pm ET
What Can I Do With All the Depressed or Anxious Teens in My Practice? Practical Strategies for the Primary Care Provider. Register here. Learn the skills you need to better diagnose and manage the two most common mental health concerns of adolescents.
Speaker: Jefferson Prince, MD, Director of Child Psychiatry for the North Shore Medical Center, Salem, MA and Instructor, Harvard Medical School

AAP OFFERS SOUND ADVICE ON MENTAL HEALTH

Children’s mental health is an important part of their overall well-being. To help guide parents, the American Academy of Pediatrics (AAP) offers a collection of interviews with pediatricians about child behavior, emotions and other mental health topics.
Listen to Sound Advice on Mental Health on the AAP parenting website at http://www.healthychildren.org/SoundAdviceMentalHealth

Eating Disorders in Adolescents: Strategies for the Primary Care Provider
January 12, 2012, 1 pm – 2 pm, ET

Complex and multi-factorial, eating disorders can be challenging to detect and manage. But, primary care providers are in a unique position to identify them in their earliest stages, when treatment can be most effective.

B. Timothy Walsh, M.D, the Ruane Professor of Pediatric Psychopharmacology, Department of Psychiatry, Columbia University and Director of the Division of Clinical Therapeutics at the NY State Psychiatric Institute is one of the leading experts on eating disorders.

Join him for a discussion on the signs and symptoms of eating disorders, the latest treatment strategies, and co-managing these disorders with the clinical team to avoid relapse and achieve a successful outcome.

Visit http://www.teenscreen.org/resources/events-webinars/jan-2012-eating-disorders/  to register.


HFS has added 3 long/intermediate-acting stimulants (all of them are methylphenidate products) to its Preferred Drug List (PDL) as of Oct 1, 2011. The new medications are boldfaced and in red at the bottom of page 14 in the attached PDF :

amphetamine salts +
dexmethylphenidate
methylphenidate +
methylphenidate SR
Metadate ER
Methylin ER
Ritalin SR

Since April of 2011, methylphenidate SR had been the only long/intermediate-acting stimulant on the PDL. The bad news is that Ritalin SR, methylphenidate SR, Methylin ER, and Metadate ER are the same formulation and have the same drug delivery system, which has some evidence showing that it is a suboptimal delivery system. There is no component that is immediate-release and many children may need an immediate-release dose in the morning to cover symptoms. The morning dose can be taken with the long-acting dose or 60-90 minutes before the Ritalin SR, methylphenidate SR, Methylin ER, and Metadate ER is given. Another potential and frequently reported problem with these medications is that coverage of symptoms has a highly variable duration. Duration is supposed to be 6-8 hours. Many clinicians also report that a number of patients taking these medications seem to require more medication on average compared with other long/intermediate-acting methylphenidate products. The good news is that, whereas Ritalin SR only comes in a 20 mg sized tablet, Methylin ER and Metadate ER come in 10 mg and 20 mg sized tablets.

For more information and consultation please call DocAssist, 1-866-986-ASST (2778) or visit us at www.psych.uic.edu/docassist.

Please visit the Psychiatric News website at http://pn.psychiatryonline.org/, find the Past Issues, December 17, 2010, Volume 45 Number 24 Page 18 and find the article “Screening Mandate Will Be Boon to Early Mental Illness Detection” by Rich Daly for details about how mental health advocates are encouraged that mental illness will be better detected and treated since the new healthcare laws require coverage of preventive measures such as routine mental health screenings.

9/4/09 New Policy Helps Pediatricians Sharpen Psychiatric Skills

A Side of Behavioral Counseling with your Visit

A new model of care integrates counseling into the main-course medical visit, with simple techniques that can be very effective. The Philadelphia Inquirer, By: Don Sapatkin

The effort is part of a national movement to embed a form of mental health in primary care. The idea is to give simple interventions in 15- to 30-minute visits that will address behavioral issues ranging from stress to traumatic reactions that often go untreated. Read More in Philly.com.

U.S. Family Doctors Prescribe Most Mental Health Drugs
By: David Morgan

Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, not psychiatrists, raising concerns about the quality of some treatments, according to a study released on Wednesday. Read More in Reuters.com.

Prior Approval for Atypical Antipsychotics and ADHD Medications for Young Children

Effective August 24,2009, the HFS will require prior approval for all Attention Deficit/Hyperactivity Disorder (ADHD) medications for children under the age of 6, and for all Atypical Antipsychotics for children under the age of 8.  Please see the HFS Provider Notice regarding this matter.  Please also refer to the prior approval forms:

ADHD Medication (under 6 years) Prior Approval Form.pdf

Atypical Antipsychotic Medication (under 8 years) Prior Approval Form.pdf

Clarification on the "grandfather clause":  All children meeting criteria for consent will, at some point, receive a prior approval edit and subsequent rejection from the pharmacy.  HFS is allowing some existing patients to be "grandfathered" for the short term.  The grandfathering is temporary and only being allowed to stagger the implementation of the process.  The prior approval edit I will likely occur in the next few months and providers are encouraged to complete the consent the consent as soon as possible and not wait for the rejection.

 

June 4, 2009: HFS Provider Informational Notice to Physicians and Community Mental Health Providers with progress updates about Illinois DocAssist.

January 29, 2009: Provider Notice: Increases to Reimbursement for Physician Services Effective February 1, 2009

Provider Reimbursement for Child and Adolescent Mental Health and Substance Abuse Screening: The Illinois Department of Healthcare and Family Services (IDHFS) will only reimburse for child and adolescent mental health and substance abuse screening using approved tools. To access additional information about IDHFS approved screening tools please click here.

Is routine screening that important?  Curious to see what the evidence shows as to whether screening for depression in primary care really helps?  Click on the link to view the 2009 U.S. Preventative Services Task Force recommendation for primary care providers to perform routine depression screening for all adolescents.  For assistance with choosing a screening tool and training clinic staff on its use and implementation, contact DocAssist.   

Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration is a joint position paper written by the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) to ensure the mental health and wellness of our children and adolescents. The full article is available in PEDIATRICS, the official journal of AAP.