Hello, and welcome to the third installment in our "Approaches to Measuring Quality Improvement in Public Health" series! While quality improvement principles have traditionally been implemented in clinical settings, this series is focused on unpacking a measurement framework to apply a Q.I model/ lens to public health, systems-level work. In our most recent post, we focused on the leveraging existing initiatives part of the framework, which featured how the South Carolina Adolescent and Young Adult Behavioral (AYA BH) CoIIN team prioritized this domain as a part of their work to align efforts and enhance synergy for improving AYA emotional well-being in their state.
The Augmenting MCH Capacity and Strategies of this QI framework emphasizes increasing and enhancing the capabilities and skillsets of the workforce and sectors that are essential to addressing the emerging issues related to AYA emotional well-being. This can include training MCH staff on understanding the mental health needs and conditions that arise during adolescent years, utilizing strategies to identify and prioritize AYA populations and communities that may experience inequalities that contribute to mental health disparities, or efforts to assist providers in their ability to screen and refer their AYA patients for depression, anxiety, and other conditions accordingly. Read on to learn about the systems in place in Wisconsin to support primary care providers on addressing mental health needs of patients through a statewide psychiatry consultation program.
Supporting Wisconsin Primary Care Providers in Caring for Children, Adolescents and Young Adults with Mental Health Problems: Wisconsin Child Psychiatry Consultation Program
By: Arianna Keil, MD, Quality Improvement Director, Children's Health Alliance of Wisconsin & Wisconsin Department of Health Services' Family Health Section
Wisconsin is pleased to be participating in the public health and primary care arms of the adolescent and young adult (AYA) behavioral health Collaborative Improvement and Innovation Network (CoIIN). Over two thirds of Wisconsin counties do not have a child psychiatrist, so AYAs commonly receive mental health care from primary care providers (PCPs). Many of these PCPs, however, say they did not get enough training to provide the scope of mental health services asked of them. One part of the solution to this complex problem is the Wisconsin Child Psychiatry Consultation Program (CPCP).
The CPCP offers real-time telephone and email support to Wisconsin PCPs who have questions about how to best care for children and AYA with mental health problems. Available in 65 of 72 counties, the CPCP is staffed during normal office hours by child psychiatrists and a pediatric psychologist, as well as mental health professionals knowledgeable about services available in specific communities. The program is administered through Children's Wisconsin and the Medical College of Wisconsin, and funded in part through a grant from the Wisconsin Department of Health Services' Maternal Child Health Program. Wisconsin is part of a national network offering this type of support.
Since launching in 2015, the CPCP has offered over 3,000 consultations and enrolled over 750 providers. Over half of the contacts are by email, and nearly all questions are answered within one day. Depression is the fourth most common presenting issue, behind anxiety, attention deficit hyperactivity disorder (ADHD) and disruptive behavior. Medication questions are by far the most common reason why PCPs contact the program. PCPs are very satisfied with the support they receive: nearly all (97%) indicate that CPCP consultations have helped them more effectively manage patient care, and that information learned will be used in future care of patients.
"The CPCP has been a wonderful resource for me as a primary care provider. The ability to have direct access to psychiatrists has helped me to treat and give resources to children I normally wouldn't have been able to help. The program helps reassure me that my treatment decisions are appropriate and it guides me when complex patients walk in the door that I normally would be uncomfortable treating on my own. Without the program, I would have many patients who would not have access to proper mental health treatment. It truly is a great program!"
WI CPCP also offers educational opportunities to enrolled providers. Topics include:
- Psychopharmacology - includes pharmacologic management of ADHD, depression and anxiety, and atypical antipsychotic agents
- Rating scales and suicidality - includes general screening tools, specific rating scales, and assessment and triage suicidality
- Trauma informed care - includes awareness of the impact of traumatic events, and safe, compassionate and respectful partnering
- Behavioral interventions - includes behavioral dysregulation
- Parents often appreciate and see the benefit of clinician-to-clinician support.
"My son's pediatrician told me of the CPCP services that she was enrolled in and how it worked. She said my son's treatment was outside the scope of her practice but that she could consult with child psychiatrists through this program. I agreed and trusted her. It was a quick turn-around in which my son's pediatrician called me to discuss medication and treatment options. He is currently stable and doing great in school, and he is even excelling in math! I have more respect for my pediatrician for seeking out assistance and using CPCP because we all don't know everything and need help. As the saying goes: It takes a village to raise a child."
Wisconsin providers enrolled in the AYA behavioral health CoIIN will learn about the CPCP on a webinar in March on state-specific resources.
To learn more, visit www.chw.org/CPCP or watch https://www.youtube.com/watch?v=ZTp94VPG2VU&feature=youtu.be