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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The Partnership Access Line Enhancing the Capabilities of Primary Care Mental Health Services. Terry Lee, MD University of Washington Evidence Based Practice Institute. PAL Program Funded By:. WA Medicaid (DSHS/HRSA) WA State Legislature. Our Call to Action. - PowerPoint PPT Presentation
Transcript of The Partnership Access Line Enhancing the Capabilities of Primary Care Mental Health Services
The Partnership Access Line
Enhancing the Capabilities of Primary Care Mental Health Services
Terry Lee, MD University of Washington
Evidence Based Practice Institute
PAL Program Funded By:►WA Medicaid (DSHS/HRSA)►WA State Legislature
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
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%)
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
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
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
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”
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”
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
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
Care Guide, Distributed to all PCP’s:
www.palforkids.org
PAL Site Assignment
Calls Are Slowly Increasing
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
Getting the Word Out► Mailings► Phone calls► Office visits► Conferences► Word of Mouth► Building
professional relationships takes time
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
Age of PAL Call Subjects
Age 6-12
Age 12+
Age 0-6
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
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
Satisfaction Measures►PCP and family satisfaction very high
Average 4.8 on 5 point scale►Collected testimonials have all been
positive
Research►Need quality research done on impact
of PAL to justify its continued existence►DSHS IRB approved study
Evaluation by EBPI
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
Collaborating with Psychiatrists
►HIPAA►Exchange information
