massachusetts child psychiatry access project newsletterbipolar disorder conduct disorder thank you...
TRANSCRIPT
Massachusetts Child Psychiatry Access Project
Newsletter May 2013 Vol. 2 No. 5 May Issue – Mental Health Awareness Month
In this issue Thank You to Our Heroes
May is Mental Health
Awareness Month
How MCPAP Supports New
Models of Health Care
Delivery
Concerns about Energy
Drinks
Response to New York Times
Article: ADHD Seen in 11
Percent of U.S. Children as
Diagnoses Rise
Announcements
Webinars/Podcasts
About Us
About MCPAP
MCPAP Data
Frequently Asked Questions
Contact Us
Services
Services for Primary Care
Clinicians
Toolkits
Toolkits
Diagnoses
ADHD
Autism
Bipolar Disorder
Conduct Disorder
Thank You to Our Heroes During the Boston Marathon bombings, there were many heroes --
physicians, nurses, EMTs, and others who rushed toward the
bombings to help those who needed medical attention. They
included some MCPAP-enrolled clinicians.
We would like to thank all of our MCPAP-enrolled physicians and
nurses who helped during this
terrible tragedy. We would also like
to thank all of you for what you do
every day – keeping our children
happy and healthy, alleviating pain
and sickness (physical and mental), and saving lives.
To understand what it was like to be a physician at the bombings,
there is a very well-written account in the New England Journal of
Medicine at http://www.nejm.org/doi/full/10.1056/NEJMp1305299.
Dealing with the Emotional Impact of the Boston Marathon Bombings
MCPAP Telephone Consulting If you need assistance with patients who are having difficulty dealing
with the Boston Marathon bombings, please be assured that MCPAP
teams are available to answer questions Monday through Friday, 9
a.m. to 5 p.m. You can find the telephone number for your MCPAP
regional hub at http://www.mcpap.com/aboutContact.asp.
Hotlines for Patients and Families
Substance Abuse and Mental Health Services Administration
(SAMHSA) Hotline
People experiencing emotional distress related to the Boston
Marathon bombings can call the SAMHSA hotline toll-free (1-800-
985-5990) or SMS (text 'TalkWithUs' to 66746) for crisis counseling
and support. This service is available 24/7. Download the hotline
brochure or wallet card.
Boston Mayor’s Health Hotline
Boston residents who need help dealing with the bombings can
speak to a counselor at the Mayor's Health Line at (617) 534-5050
He who saves a life saves
the entire world.
- Babylonian Talmud
Depression
Eating Disorders
Obsessive Compulsive Disorder
Oppositional Defiance Disorder
Post-Traumatic Stress Disorder
Postpartum Depression
Schizophrenia
Substance Use
Team Bios
Tufts Medical Center
Baystate Medical Center
UMass Medical Center
North Shore Medical Center
Massachusetts General Hospital
McLean-Brockton
Website
www.mcpap.com
or toll-free at 1-800-847-0710 (available Monday through Friday, 9
a.m. to 5 p.m.).
Riverside Trauma Center Hotline
Massachusetts residents outside Boston who are still experiencing
strong reactions to the bombings, such as anxiety or inability to
sleep, can call the Riverside Trauma Center toll free at 1-855-279-
0632, Monday through Friday, 8 a.m. to 6 p.m. This is a special
hotline dedicated to assisting people in the aftermath of the Boston
Marathon bombings. Callers will receive telephone support along
with referrals to additional services, including support groups specific
to the bombings, and/or individual counseling.
May is Mental Health Awareness Month May is Mental Health Awareness month, a valuable opportunity to
raise awareness about mental health concerns and issues. This is a
good time for MCPAP-enrolled primary care clinicians to stock up on
free materials offered by or distributed through MCPAP. (Please note
that MCPAP will distribute materials to MCPAP enrolled primary care
practices only.) The following materials are available:
“How’s Your Child’s Mental Health?” brochure
A May 2011 National Alliance on Mental Illness survey found that
families of children with mental health issues were more comfortable
in primary care settings when mental health resources were
available in the waiting room. Study results are available at:
www.nami.org/primarycare. MCPAP recommends keeping “How’s Your Child’s Mental Health?” brochures in your waiting room. They
are available in English and Spanish. To request a stack of
brochures, contact Irene.
Safety Planning Guide: A Quick Guide for Clinicians
This guide explains what a safety plan is, who should have one, and
how to develop and implement one. It includes a six-step process
for implementing a safety plan. Copies of the guide were provided
to MCPAP through the generosity of the Suicide Prevention Resource
Center (SPRC) and the Western Interstate Commission for Higher
Education (WICHE). To request the guide, contact Irene.
A Toolkit for Well Child Screening of Military Children
In Massachusetts, 231,000 family members have lived through two
or more deployments. Research suggests that a child’s functioning
and coping are affected by a parent’s deployment.
This toolkit was designed to assist the primary care clinician and
practice staff to:
1. Identify children and parents within their practices who are
members of a military family;
2. Assess the degree of distress that a child and his or her
caretaking parent experience as a result of their military
family member’s deployment and re-integration;
3. Give resource materials during the well child visit to children
and parents whose stress can be managed by psycho-
education; and
4. Determine whether the child’s or the caregiver’s distress is
significant enough to warrant consultation with MCPAP.
Download A Toolkit for the Well Child Screening of Military Children
or request a hard copy by e-mailing Irene.
How MCPAP Supports New Models of Health Care Delivery By Elaine Gottlieb
As pediatric practices increasingly adopt the patient-centered
medical home (PCMH) model, patients with behavioral health
conditions should receive more comprehensive, coordinated care.
The PCMH incorporates the methods, tools, and organization,
including information technology, quality metrics, and team care, to
address both medical and behavioral health conditions. “The PCMH
is designed to care for patients with special health care needs,
including psychiatric illnesses and behavioral health conditions,” says
Barry Sarvet, MD, child psychiatrist and statewide MCPAP medical
director. “The mental health system is complicated and fragmented;
the medical home is the only place that can provide continuity of
care for patients with behavioral health conditions.”
Patient-centered medical homes include a team of professionals –
pediatricians, nurses, care coordinators, and social workers - who
provide interdisciplinary care and ensure the patient’s and family’s
needs are addressed. The care coordinator plays a key role in care
delivery, identifying health care providers and outside resources,
providing referrals, using patient registries to track health care, and
following up with families to see that treatment is implemented.
A growing number of medical homes and other primary care
practices are employing therapists or social workers, known as co-
located therapists, as members of the practice team. These
practices are sometimes called co-located practices. Co-located
therapists handle behavioral health care coordination and provide a
range of other services, such as counseling and short-term
treatment, to families and patients. “When a practice employs a
mental health professional, it compels the primary care physician to
focus more attention on behavioral health care and handle
responsibilities, such as writing prescriptions, that the therapist isn’t
trained to do. Most pediatricians who have a co-located therapist
would never practice without one,” says John Straus, MD, MCPAP
executive director.
At Child Health Associates in Auburn, Mass., Social Worker Elaine
Cahill meets with all parents who have concerns about their
children’s behavior. Parents can contact her directly or are referred
by one of the practice’s clinicians. If care is needed, she develops a
plan with the parents’ assistance and provides referrals. “Parents
need to talk to a professional who can respond to their concerns and
answer their questions,” says Cahill.
MCPAP’s Role in Supporting New Health Care Models MCPAP fully endorses the PCMH and is committed to supporting
practices as they implement this model. “We will provide whatever
assistance medical homes need to deliver comprehensive behavioral
health care services,” says Dr. Straus.
MCPAP can help practices provide the long-term care coordination
central to mission of PCMHs. “MCPAP is the mental health expert to
teach pediatricians how to track patients with chronic mental health
conditions, interpret problems as they arise, and develop plans to
address needs as they change,” says Dr. Sarvet.
Like the PCMH model, the MCPAP model is based on a team
approach, with MCPAP staff members becoming part of the practice
team. “We build a strong relationship with the practice, ensure that
we send documentation every time we see a patient, and help team
members find services,” says Dr. Sarvet.
“MCPAP provides immediate access to best practices and evidence-
based information to pediatricians who are managing patients with
behavioral health needs in the medical home and need the advice of
a mental health provider,” says Wanessa Risko, MD, a pediatrician at
Children’s Hospital Primary Care Center.
MCPAP care coordinators work closely with PCMH care coordinators
and co-located therapists to provide resources and referrals (see
below). “Our practice staff members have good relationships with
MCPAP,” says Susan Swain, senior quality consultant, Pediatric
Physicians’ Organization at Children’s (PPOC), which is helping its
practices adopt PCMH capabilities.
MCPAP Services for New Health Care Models MCPAP is continually evaluating its services to ensure that they
support the needs of MCPAP-enrolled practices, including patient-
centered medical homes and co-located practices. The following
MCPAP services help practices following these models to serve
patients with behavioral health needs:
Compiling a Resource List MCPAP care coordination teams can assist PCMH care coordinators
and co-located therapists compile an initial list of behavioral health
resources, such as pediatric mental health providers, inpatient and
outpatient treatment programs, and community-based programs.
PCMH care coordinators can always contact MCPAP when they need
additional referrals.
Finding Specialized Resources MCPAP care coordinators can identify resources for specialized
needs, such as a Spanish-speaking therapist or a social skills group
for autism spectrum disorder (ASD) patients. When Elaine Cahill had
a teenage patient with autism who needed toilet training, MCPAP was
able to find facilities that offered that service. Please note: if the
situation involves medication or a referral to a prescriber, the
request must be made by a physician or nurse practitioner.
Identifying Available Mental Health Providers
One of the biggest challenges in providing behavioral health care is
finding mental health providers who are available to see new
patients. MCPAP care coordinators maintain close relationships with
intake coordinators at community mental health centers and other
behavioral health providers within their regional hubs and keep
updated information on availability and waiting times for providers
for special populations.
MCPAP care coordination teams can also assist medical home care
coordinators in using the Massachusetts Behavioral Health Access
(MABHA) website (www.mabhaccess.com), which shows current
openings for Children’s Behavioral Health Initiative (CBHI) services.
Following Up with Families A new MCPAP service, Family Follow Up, will be available at all
MCPAP regional hubs by June. MCPAP coordinators who provide a
referral directly to a patient or parent will follow up to find out if the
patient actually connected with the recommended resource and
inform the pediatric office. This service will be particularly helpful to
PCMH care coordinators who use registries to track patients with
special health care needs.
Presenting Onsite Orientations When a practice enrolls with MCPAP, the MCPAP regional team offers
an orientation session at the practice office. In addition, MCPAP
teams can provide educational sessions at any time, such as when a
practice hires new staff members.
Supporting Co-Located Therapists When co-located therapists, who are often the only mental health
providers at medical homes, need assistance from a fellow mental
health professional, they can consult with the MCPAP social workers
at their regional hubs.
Consulting on Diagnosis and Treatment As they assume greater responsibility for managing behavioral
health care, PCMH pediatricians may need additional assistance with
diagnosis and treatment, such as determining whether medication
treatment within the primary care setting is appropriate or if
specialty care is needed. MCPAP child psychiatrists are always
available for consultation and care coordinators can provide referrals
to outside resources if needed.
Providing Quality-Based Care As practices move from a fee-for-service model to a patient-
centered, quality-based model, measuring outcomes and improving
quality will be increasingly important. MCPAP teams are
knowledgeable about quality care guidelines and standards for long-
term behavioral health care and can provide assistance as issues
arise.
To access any of the above services, contact your MCPAP regional
hub coordinator.
To suggest additional services to complement PCMH, contact Irene
Tanzman or Dr. John Straus.
Disseminating Information about Nationwide Practices As a member of the National Network of Child Psychiatry Access
Programs (NNCPAP), MCPAP stays current with how other child
psychiatry access programs are adapting to new health care models
and will share this information with practices and use it to serve
MCPAP-enrolled medical homes.
Concerns about Energy Drinks Energy drinks are flavored beverages containing high amounts of
caffeine and other additives, such as vitamins, taurine, herbal
supplements, creatine, sugars, and guarana, a plant containing
concentrated caffeine. While the average American consumes about
200 mg/day of caffeine (equivalent to about two cups of coffee),
some energy drinks contain as much as 500 mg per serving.
Individual tolerances vary widely, and tolerance typically develops
with regular use.
Symptoms of acute caffeine intoxication can include: restlessness,
nervousness, excitement, insomnia, flushing, sweating, headaches,
GI disturbance, muscle twitching, rambling thoughts, tachycardia
and arrhythmia, agitation, and seizures.
A growing body of evidence documents caffeine’s harmful health
effects, particularly for children, adolescents, and young adults. Fifty
percent of Emergency Department admissions for caffeine overdose
involve children and, though rare, serious health consequences can
arise.
For patients using alcohol, high levels of caffeine intake present a
risk because caffeine can mask the symptoms of intoxication.
Health professionals can discourage use of energy drinks by
explaining that perceived benefits are hyped by marketing and that
scientific evidence shows that the short-term stimulus of a bolus of
caffeine has limited sustained benefit on concentration and
performance. Because of the drinks’ widespread use, medical
personnel may want to inquire about the use of energy drinks when
assessing each patient’s use of medications or other drugs.
Tips for primary care clinicians:
Ask about the use of energy drinks and provide guidance
about the risks and limited benefits.
Advise patients that energy drinks may trigger serious
physiologic and psychological problems.
Make patients aware of the risks of mixing these drinks with
alcohol (or other illicit drugs).
This article is based on the The DAWN Report: Update on Emergency
Department Visits Involving Energy Drinks: A Continuing Public
Health Concern, Substance Abuse and Mental Health Services
Administration (SAMHSA), Center for Behavioral Health Statistics
and Quality, Rockville, MD, January 10, 2013.
Many thanks to our sister program, SmartCare PC2 of San Diego, for
bringing this issue to our attention in their newsletter.
Response to New York Times Article: ADHD Seen in 11 Percent of U.S. Children as Diagnoses Rise (This response was originally written as a letter to the editor to The
New York Times but was not published.)
Over the past year-and-a-half, The New York Times has published
three articles regarding ADHD and stimulant medications: "Ritalin
Gone Wrong," "Drowned in a Stream of Prescriptions,” and most
recently, "ADHD. Seen in 11 Percent of U.S. Children as Diagnoses
Rise." As doctors and nurses working with the Massachusetts Child
Psychiatry Access Project (MCPAP), a program which is designed to
improve access to mental health care for the 1.5 million children and
adolescents in the Commonwealth, we are concerned by the Times'
coverage of issues related to the diagnosis and treatment of ADHD.
We agree that the apparent increase in the diagnosis of ADHD raises
a variety of concerns and that the phenomenon needs to be carefully
examined. At the same time, studies show that a significant portion
of children with ADHD remain unidentified and untreated. ADHD has
been extensively studied and validated as a neurobehavioral
diagnosis, and, if left untreated, there is a significant risk of it having
a profound impact on long-term health and development. Therefore,
we strongly believe that news coverage and public education about
the increasing rate of ADHD diagnosis must be nuanced and, most
importantly, not deter parents of children with behavioral health
symptoms from seeking help.
Due to the growing concern about the possible misuse of stimulant
medications to boost academic, athletic, or work performance,
MCPAP and similar programs emphasize the importance of using
established diagnostic procedures and judicious follow-up when
treating a child with ADHD.
While medications are considered to be necessary for many children
with a valid ADHD diagnosis, appropriate treatment plans include
regular reassessment, fine-tuning of medication treatment,
educational modifications, parent training, and various forms of
psychotherapy.
Child psychiatry/primary care collaborative programs such as MCPAP
foster this integrative and collaborative approach to address mental
health concerns within primary care. These programs enable
primary care physicians to consult with child psychiatrists about
behavioral health conditions, such as ADHD, and help prevent
misdiagnosis and inappropriate treatment.
John Straus, MD
Barry Sarvet, MD,
Jeff Q. Bostic, MD EdD
Eric Geopfert, MD
Sigalit Hoffman, MD
Enrico Mezzacappa, MD
John Sargent, MD
Neha Sharma, OD
John Fanton, MD
Paul Hammerness MD
Marjorie Williams, APRN
Stephen Luippold, APRN
Julie Bermant, NP
Announcement: MCPAP Available for
Urgent Calls Only on Tuesday, May 28, 2013; Call for Ideas from MCPAP-Enrolled Primary Care Clinicians MCPAP will be holding its annual all-MCPAP staff meeting on
Tuesday, May 28 and will be available for urgent calls only on that
day.
During the meeting, MCPAP staff will discuss our mission, vision, and
goals and consider how our goals fit into the changing environment
of health care reform.
MCPAP would like to better understand the needs of our enrolled
primary care clinicians and medical home care coordinators. If you
have an idea or topic that you think we should discuss, please e-mail
Irene with your thoughts.
Webinars/Podcasts Podcast: Tips for Helping Children and Youth Cope in the
Aftermath of Disasters
Children and youth affected by natural and human-caused disasters
react differently depending on their stage of development. In this
podcast, you will learn how to identify common reactions of children
and youth to disaster and trauma and discover helpful approaches,
including modeling, to support a child's immediate and long-term
recovery. Presenters include Robin Gurwitch, PhD, Clinical
Psychologist, Center for Family Health, Duke University Medical
Center; and Russell T. Jones, PhD, Professor of Psychology and
Clinical Psychologist, Virginia Tech. Slides and a transcript are also
available for download.
Webinars: Preventing Underage Drinking
The Interagency Coordinating Committee on the Prevention of
Underage Drinking is developing a series of webinars to address
underage drinking. These webinars will feature national leaders and
experts discussing the extent and nature of the problem, lessons
from recent research, and evidence-based strategies. The first
webinar, “Preventing Underage Drinking: Introduction and Series
Overview,” is available online. Additional webinars will be archived
for viewing.
Webinar: The Medical Home in Pediatrics: The HOW TO
Webinar Series
The American Academy of Pediatrics (AAP) and its National Center
for Medical Home Implementation (NCMHI) are hosting a free, four-
part webinar series February through May 2013 on how to effectively
deliver care through the medical home model. The target audience
is pediatric primary care providers, specialists, patient and family
advocates, policy administrators, and anyone wanting to advance the
medical home model for children and youth. The webinar schedule
is available at: http://www.medicalhomeinfo.org/training/cme/2013.aspx.
Webinar on Teen Depression
Families for Depression Awareness (www.familyaware.org) is
presenting a free, one-hour webinar on teen depression on
Wednesday, May 29 at 7:30 p.m.
Designed to educate parents and adults who work with youth, the
webinar addresses:
what teen depression is
behaviors of concern, including self-injury
how to talk to teens about depressive disorders
treatment options
where to get help
how to address difficulties that may arise, such as teens refusing help
The webinar presenter is Mary Fristad, PhD, ABPP, Director of
Research and Psychology Services at the Ohio State University
Division of Child and Adolescent Psychiatry.
Register at https://www.etouches.com/63356
©MBHP May 2013