Integrating Behavioral Health into Wellness Visits in Pediatric Primary Care

1. Session #H3b Friday, October 11, 2013 Integrating Behavioral Health into Wellness Visits in Pediatric Primary Care Jean Cobb, Ph.D. J. David Bull, Psy.D. Behavioral Health Consultants, Cherokee Health Systems Collaborative Family Healthcare Association 15th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Objectives • Describe an effective clinical model that implements behavioral health as a routine part of pediatric primary care • Identify screening instruments that are clinically useful and easily implemented • Demonstrate working relationships between BHC, patient/family, PCP, and medical staff • Illustrate a team approach to address prevention, identification, and treatment of behavioral health problems within pediatric primary care

4. Well Child Checks A routine part of pediatric wellness Longevity of care Many areas covered (medical, developmental, social, behavioral) Challenges Busy schedules/ pace in pediatric primary care How to efficiently and effectively address prevention, identification, and treatment of behavioral health problems in pediatric primary care Overview and Rationale

5. Member of primary care team Screening, updating social history, anticipatory guidance BHC as behavioral “expert” Addressing holistic needs of patients , while working to increase efficiency/flow Role of BHC

6. Screening Instruments • Infant Development Inventory (IDI) • Child Development Review (CDR) • Pediatric Symptom Checklist (PSC) • Edinburgh Postnatal Depression Scale (EPDS) • Modified Checklist for Autism in Toddlers (MCHAT) • Adolescent Drug & Alcohol Use: CRAFFT

7. Clinical Flow • Nurse retrieves family from waiting room (vitals, place in exam room) • BHC reviews screening measures, reviews social history, and anticipatory guidance • BHC documentation is part of PCP’s WCC encounter and note

9. Clinical Flow • Any concerns identified by screening measures, social history, or through clinical contact are addressed either through brief intervention or follow-up with BHC • BHC provides immediate feedback and synopsis of any interventions offered to PCP before entering room

10. Outcomes • Enhanced quality of care • Implementation of consistent prevention component • Improved identification and increased intervention for children at-risk • Increased primary care productivity • Enabling PCP to have more patient visits • BHC service for WCC is billed as extension of PCP’s encounter

11. Case Examples • 2 month-old, White male, mother has elevated score (11) on Edinburgh Postnatal Depression Scale • 11 year-old, Hispanic male with BMI in the 83rd percentile, was on 70th percentile growth curve since age 6, gained 8 lbs in past year • 30 month-old, African American male, mother says “I am worried because he is not talking as much as his brother did at this age” • 15 year-old, White female with elevated score (22) of PSC, father reports they have been “arguing a lot more than usual”

12. Implementation • Before implementing, anticipate that pediatric providers may express concerns: • Disruption of clinical flow • Need for BHC expertise on topics typically covered by pediatricians • Emphasize to team that goal is to improve clinic’s efficiency, while also enhancing patient visit

13. Implementation • Scheduling • Make a 15 min block on BHC schedule for WCC • On provider’s schedule template schedule sick visits before and after WCC to maximize PCP work flow • If multiple providers try to stagger WCC by 15min, so BHC can be involved without disrupting clinical flow

14. Implementation • BHC must be aware of clinic flow – be an asset, not burden • Obtain helpful patient handouts that cover common concerns (tantrums, baby blues, sleep problems, weight management etc.) • Make plan for when BHC is not available (train nurses on reviewing screening measures, completing social history, knowing when to refer to BHC)

15. Discussion & Learning Assessment Jean.Cobb@cherokeehealth.com David.Bull@cherokeehealth.com

16. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!