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