The Partnership Access Line Enhancing the Capabilities of Primary Care Mental Health Services
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Transcript of The Partnership Access Line Enhancing the Capabilities of Primary Care Mental Health Services
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The Partnership Access Line
Enhancing the Capabilities of Primary Care Mental Health Services
Terry Lee, MD University of Washington
Evidence Based Practice Institute
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PAL Program Funded By:►WA Medicaid (DSHS/HRSA)►WA State Legislature
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Our Call to Action►Primary Care Providers (PCPs) are the
Front Line of mental health care Nationally PCPs reported to provide
about half of all common mental disorder care
1 in 5 child PCP appointments are for a behavioral health chief complaint
►PCPs are typically uncomfortable with this role Simply were not trained in mental health
W Gardner and K Kelleher, 2000
New Freedom Commission, 2003
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Why do all of these kids see their PCP instead of a
psychiatrist?►6.6 child psychiatrists per 100,000 WA
children►This calculates to 1 child psychiatrist
for every 820 children with serious emotional disturbance (GAF <50) in Washington
C Thomas and C Holzer, 2006
Shaffer et al. 1996 (SED rate 5.4%)
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Lack of Access to Child Psychiatrists
►Rural area access is abysmal, and is not likely to improve US mean of 0.3 child psychiatrists per
100,000 youth ►We will not train our way out of this
bind by producing more child psychiatrists No significant increase in trainees for
years Average age of a child psychiatrist is >50WJ Kim, 2003
C Thomas and C Holzer, 2006
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Access to Mental Health Therapists
►Psychiatrist access not the only problem
►National shortage of skilled child therapists
►It’s why you’re all here—our therapist workforce needs both expansion in numbers, and training in current best practicesNew Freedom Commission, 2003
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How Can Mental Health Become Part of the Child’s Medical
Home?►Provide PCPs with:
Mental health education Rating scales/tools Resource finding assistance
►When PCP wants to engage outside resources, it must be a real option
Rapid consultation for any difficult cases Care collaboration with specialists
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Telephone Based Consultations► Get “just in time” processing
offer assistance only when provider wants it► Teachable moments
“problem based learning” on provider’s own patient
► Reach a large audience with few resources use our limited specialist resources more
efficiently In-person consults are less resource efficient
► Match intervention to the level of primary care provider engagement call as often as they want “raise all the boats”
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Design of PAL►“PAL” stands for “Partnership Access
Line”►Started April 2008
PCP develops any MH question about a child
PCP or assistant calls the PAL toll free number
►1-866-599-PALS (7257) PAL assistant answers, asks basic
questions Child psychiatrist on duty picks up line, or
is paged►“When in Doubt, Call Your PAL”
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PAL:How It Works Continued
► PCP and child psychiatrist talk if a FFS Medicaid client, PCP can get
reimbursement Diagnosis/therapy/medication recommendations
► If questions remain, a rapid patient consult appointment is offered (Medicaid/Healthy Options) Patient can come to Seattle Children’s Hospital
►Or new office in Spokane for PAL program When more convenient, a telemedicine
appointment is offered►Olympia or Longview
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PAL Consult Appointments►Consultant will not prescribe, or take
on case themselves►Referral to other specialists for
ongoing care MSW on our team now an expert on the
regional referral process provide bibliotherapy and other resource
recommendations
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Care Guide, Distributed to all PCP’s:
www.palforkids.org
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PAL Site Assignment
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Calls Are Slowly Increasing
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Continuing to Recruit New Users
Figure 3: Number of Providers Using PAL for First Time
0
5
10
15
20
25
30
35
Apr May Jun Jul Aug Sep Oct
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Getting the Word Out► Mailings► Phone calls► Office visits► Conferences► Word of Mouth► Building
professional relationships takes time
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Types of PAL Calls►Calls tend to be about difficult cases
86% had estimated GAF <60►Topics are all over the map
medications part of the question for 2/3rd ►About 1 in 10 calls lead to in person
consults
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Age of PAL Call Subjects
Age 6-12
Age 12+
Age 0-6
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Medicaid Impact►Despite the open invitation to call us,
most calls are about Medicaid clients 37% of all the state’s children are enrolled
in Medicaid 64% of calls to the PAL program have
been about DSHS clients
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Therapy►½ the time when a provider called to
discuss a medication, the call ended with recommendation to start a new evidence based psychotherapy
►Now employ 2 social workers who assist providers with connecting to therapists
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Satisfaction Measures►PCP and family satisfaction very high
Average 4.8 on 5 point scale►Collected testimonials have all been
positive
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Research►Need quality research done on impact
of PAL to justify its continued existence►DSHS IRB approved study
Evaluation by EBPI
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Take Home Points► PAL is a primary care provider service► Therapists might want to encourage
PCP’s to utilize the PAL service► PAL makes referral recommendations
based on information provided to us by therapists
i.e. someone doing CBT gets a CBT referral
call Lauren or Jessica at 866-599-7257 to let them know your referral preferences
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Collaborating with Psychiatrists
►HIPAA►Exchange information