Guilford Child Health GCH

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Guilford Child Health GCH Powered By Docstoc
					Your child’s health is our #1 priority.

• To serve the whole child, recognizing her/his relationships in the family, school, community. • To provide a medical home to the children and adolescents whom we serve

Achieving the Mission
GCH is a public-private partnership between: • Hospitals: The two community health systems. • Pediatric Teaching Program (Greensboro AHEC). (The pediatric residents come from UNC-Chapel Hill.) • Guilford County (Department of Public Health and the Department of Social Services).

GCH Is A Private Practice…
…serving children and adolescents whose families live at, or below, 200% of the Federal Poverty Level– accounting for 60-70% of the children with Medicaid in Guilford county. Insurance status of our patients: 87% Medicaid 6% NC SCHIP 7% uninsured (undocumented immigrants)

Visions for GCH
• “Cutting edge”: best practices, evidence-based protocols • Comprehensive: especially for children with complex/ chronic conditions • Medical Home: facilitate referrals, assist with logistics, and track referral completion

Visions for GCH
• Access and Continuity: meet family (as well as practice) needs • Community: be visible in the community and available/responsive to our community resources • Prevention: screen for developmental/behavioral and psychosocial risks and intervene

Visions for GCH
• Integrate & develop mental health services • Welcome different cultures: appropriate interpretive services. • Affect policy: eg, state Medicaid and SCHIP • Leadership and dissemination

Structure: Collaboration
• Specialty Staff: co-located and integrated into protocols and processes (including Wraparound services)
Asthma/Allergy, D&B Pediatricians, LCSW’s, Neurologist, PhD Psychologist, Child &Adolescent Psychiatrist, Speech & Language Pathologist

• GCH Staff: Community Liaisons arrange and track referrals, and link to community resources

Quality: Commitment
• Participant/pilot for initiatives and best practice protocols
for Medicaid (NC Community Care Network) • Leader in local network: – Protocols: ADHD, asthma, dental varnishing, developmental screening & surveillance, diabetes, ED utilization,Take Charge Weight Initiative - Mental Health Integration - Medical Home Project – Reach Out and Read – Advanced Access Scheduling (IHI)

Quality: Commitment
• On-site specialty care:
Asthma/allergy, development & behavior, LCSW’s, neurology, nutrition, psychology, psychiatry

• Regular compilation of process and outcome data and biannual chart audit of performance.

Quality: Outcomes
• 17% decrease in ED utilization for asthma in first year of collaborative protocol • Decrease in no-show rate from 40% 20% • Change in state policy in Medicaid and Public Health (ABCD project at GCH) • Adoption of GCH processes in other practices (e.g. developmental screening tool and community liaison type staff)

Leadership and Dissemination
• Locally • Statewide • Nationally – AAP – AHRQ – NICHQ – NASHP – Commonwealth Fund ABCD Project – APA Healthcare Delivery Award

The Challenges:
 44% of children in NC live in low-income families.  The use of “the most common and familiar” developmental screening tool was untenable in primary care practice (Denver).  The AAP recommends formal screening and surveillance at well child visits. Limited access to professionals with 0-5 expertise: psychiatry, psychology, counselors.

The Challenges Continue…
Division of MH, SA, and DD Reorganizing: “target” population not inclusive of children atrisk or with mild to moderate problems. Mental Health and Primary Care “Silos” The number of children served by early intervention (EI) is low (1999 Legislative Study indicated between 8-13% of the total 0-3 population could qualify and benefit from EI services - only 2.6 % were served.) Across Medicaid systems of care the average rate of developmental screening was low: (approximately 15.3%) ………

North Carolina Opportunities
Statewide promotion of screening and surveillance in Pediatric and Family Practice offices (ABCD, NCPS, NCAFP,
Health Check)

Early Intervention recognizes Established Risks (includes Reactive Attachment Deprivation) 18 regional CDSA’s (Children’s Developmental Services Agencies) Promotion of co-location models of MH staff in primary care practices.

Opportunities continued….
Division of Child Development 5 Star Childcare Licensing System Smart Start Partnerships statewide

Regional Child Health Consultants
18 Regional Resource and Referral Centers County Childcare Nurses through Public Health and Smart Start

Opportunities continued….
Both Health Check (EPSDT) and Health Choice (SCHIP) allow 26 MH visits annually, with a non-specific diagnosis code allowed for the first 6 visits. Directly-enrolled Medicaid Mental Health providers available to PCP for referral and/or co-location. Social/Emotional Screens for children identified “at risk” from personal/social on developmental screen-facilitated by case managers within local community networks. NCCCN Mental Health Integration Pilots

Practice Process
SUMMARY OF SOCIAL-EMOTIONAL/BEHAVIORALPROTOCOLS & FLOW PROCESSES visit screen/concern 2nd screen/by referral variation problem AGE 0-5 YEARS 2 mo. & 4 mo. Edinburgh CareManager support LCSW or Maternal Depression or LCSW brief counsel MH provider 6,12,18 or 24, ASQ - at-risk score on Personal- ASQ-SE support 36,48,60 mos. Social CareManager parent educ. LCSW or or LCSW Head Start MH provider any At-risk psychosocial situation ASQ-SE " " (I.e. mat dep, DV, SA) CareManager or LCSW any Parent concern ASQ-SE " " CareManager or LCSW AGE 6-18 YEARS every PE Pediatric Symptom Checklist Depressive symptoms CDI by support LCSW or provider/SW brief counsel MH provider and/or psychiatry Learning/School Behavior packet by School for screening Problems school, then packet completion sent to PCP
CDI = Children's Depression Inventory

Co-located MH Services in Primary Care
Not just a mental health clinic in a primary care practice: more flexible services, may be brief sessions • MH provider partners with PCP during course of regular visits: as needed or crisis. • MH provider involved routinely in visits for children with chronic/complex conditions • MH provider sees child and family for several visit course

Benefits of Co-location
• Reduction of stigma • Greater convenience for family • Enhanced communication between PCP and MH provider, with opportunity to encourage therapeutic goals. • Improved adherence to treatment • “Cross fertilization” learning for PCP and MH provider • Interdisciplinary team: reintegration of mind and body

Community Networking
• Attendance at Advisory meetings of LME • Inventory of Resources • Mixer: PCP’s, Psychiatrists, Psychologists, and therapists • Meetings with psychiatrists • Meetings with school personnel, DSS, Juvenile Justice, etc.

State & National Activities
• NCPS Mental Health/School Health Committee • AAP Task Force on Mental Health • Rethinking Well-Child Care • Commonwealth Fund ABCD Projects • Commonwealth Fund State Technical Assistance

• Earls, M, Hay, S, “Setting the Stage for Success: Implementation of Developmental & Behavioral Screening and Surveillance in Primary Care Practice-The North Carolina Assuring Better Child Health & Development (ABCD) Project,” Pediatrics, Vol. 118, No. 1, July 2006. • Foy, J, Earls, M, “A Process for Developing Community Consensus Regarding the Diagnosis and Management of Attention Deficit Hyperactivity Disorder,” Pediatrics, Vol. 115,No. 1, January 2005. • Foy, J, Earls, M, Horowitz, D, “Working to Improve Mental Health Services: The North Carolina Advocacy Effort,” Pediatrics, Vol. 110, No. 6, December 2002.

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