Maryland Behavioral Health Integration in Pediatric

Behavioral-Health Integration in
Pediatric Primary Care and
Race to the Top Project 7
 Made
possible through:
• Funding support from DHMH/MHA and MSDE
• No cost to providers or patients
 no insurance requirements
 Collaboration
among University of Maryland,
Johns Hopkins Bloomberg School of Public
Health, Salisbury University, and community/
advocacy groups
are frontline.
 Reduce common barriers
 Include social emotional development in
screening process
 Develop trauma and family informed
approach to care and consultation
 To
support the capacity of primary care
providers to participate in the mental health
care of children and youth, thus increasing
access to child mental health services
Phone Consultation Service
– Clinical questions
– Referral information
– Links to family navigators
Continuing Education
– Training and QI/MOC opportunities
Referral & Resource Networking
– Building connections among PCPs and mental
health professionals
– Connecting providers with referral resources
 Enrolled
providers call (or fax) 855-MD-BHIPP
 Call is answered by a master’s level clinician
• Will address questions as appropriate
 Dependent
on what is needed to address
question, passes call to consultant who calls
PCP back
• Child psychiatrist
• Psychologist
• Social worker specializing in trauma or young
Early maladaptive behaviors can be indicators of
acute stress or early signs of persistent maladaptive
trajectories (Egger & Angold, 2009; Angold & Egger,
 Incidence of psychiatric disorders in children ages
2-5 is 16% (Egger, et al., 2006), compared to 13% in
older children (Costello, Mustillo, Erkanli, Keeler, &
Arnold, 2003).
 Early aggression and post-traumatic stress, are
persistent over time with long lasting effects
(Zeanah, 2009) that can lead to serious psychological
disorders in later childhood (Keenan, Shaw, &
Delliquardi, 1998; Shaw, Gilliom, & Ingoldsby, 2003).
Early aggression has been linked to increased expulsion
rates from pre-K programs (Gilliam, 2005), later aggression
at age 9 (National Institute of Child Health and Human
Development Early Child Care Research Network, 2004).
Identification of and connection with mental health services
can ameliorate the long term impact of early childhood
mental health difficulties (Knitzer & Lefkowitz, 2006; National
Council on the Developing Child, 2008; National Scientific
Council on the Developing Child, 2004)..
The National Early Intervention Longitudinal Study (NEILS,
2007) found that 32% of parents receiving Part C services
reported having difficulty managing their child’s behavior,
but only 4% of children were referred for social/emotional
or behavior challenges.
 Vision:
“Start early and the benefits can
last a lifetime: Integrative services in the
earliest years of life are smart (high yield
on investment) and essential to building
healthy brains and productive and safe
 Foundation: Partnerships
 Building Blocks: Grant Opportunities(RTT, PL); Research Projects; Policy
Efforts, Workforce Development
 Addressing
the health and behavioral
needs of children through a coherent set
of early intervention and prevention
 Early
Childhood Mental Health (Race to the
• Consultation and training focused on the
youngest children (ages 0-5)
• Comprehensive integration with B-HIPP
 overlap in staff, resources, phone consultation service,
evaluation, and training
 Project
• Pediatric consultation and training focused on
children ages 0-8 in Prince George’s County
7.1 Early Childhood Mental Health Phone
Consultation for Pediatricians: Develop and
implement phone consultation services for primary
care providers in concert with the B-HIPP Project.
 The goal was to enroll a minimum of 20 pediatric
PCPS, and that goal has been surpassed. There are
110 providers enrolled, and 60% are pediatricians
and the remaining 40% are family physicians, nurse
practitioners, or another type of primary care
 The phone consultation line is operational and has
conducted 47 consultations and 26% of the case
consultations are for children under the age of 6
7.2 Early Childhood Mental Health
Consultation Training for Pediatricians:
Recruit and train primary care providers
(PCP) and Early Childhood Mental Health
(ECMH) consultants
 Clinical team is completely clinical manual
 Innovative ways to reach out to physicians
 Research strategies and stakeholder input
to develop a training manual and booster
for primary care and ECMH certificate
 REDCap
 Qualitative
 Referral database and GIS
 Coming Soon-training evaluation
 Stakeholder
 Recruit a corpe of PCP in PG
 Develop curriculum
 Pilot it and evaluate
 Disseminate more broadly
Encourage connections/partnerships
among PCPs and mental health
professionals, ECMH consultants and
other Project Launch partners and
 Look
at what other
states are doing
 Email
• Kconnors@psych.uma
• kcoble@psych.umaryl