The American Academy of Pediatrics (AAP) Task Force on Mental Health (TFOMH) has developed Strategies for System Change in Children’s Mental Health: A Chapter Action Kit to assist AAP chapters in addressing and improving children’s mental health in primary care in their state. The Chapter Action Kit focuses on the following 6 core action areas that provide strategies for improving children’s mental health programs and services:
Within each core action area, information is included on the overall issue, implications for AAP chapter work, suggested chapter strategies, resources for further information, and selected tools related to the topic. The Chapter Action Kit is not intended to be exhaustive but rather to help serve as a starting point for chapter efforts. Each AAP chapter will want to consider and tailor their activities and strategies specific to their own state issues, needs, and chapter resources.
Download the full Chapter Action Kit
(pdf 6.62M)Chapter Action Kit Contract AwardeesAlabama Chapter, AAP
The Alabama Chapter is building on past success from a Healthy People 2010 grant by conducting regional roundtable dinner sessions and community service provider forums for local pediatricians in 3 – 4 new areas of Alabama in an effort to establish additional local mental health networks and identify community referral resources to increase access in those areas. Coordinated by a key local pediatrician, the meetings will bring together pediatricians, community mental health center professionals, psychiatrists, early intervention professionals, and others serving the needs of children’s mental health. The meetings will be planned by the already established Chapter Mental Health Advisory Committee, which includes representatives from the Chapter Committee on Mental Health, the Alabama Department of Mental Health, the Alabama Department of Public Health, Alabama Family Ties, and the National Alliance on Mental Illness—Alabama, in cooperation with local arms of each agency and local primary care and mental health providers. The roundtable sessions will serve as springboards for future collaboration at the local level. The goal of the project will be to increase pediatricians’ comfort level in accessing mental health services for their patients and families in these areas. Arkansas Chapter, AAP
The Arkansas Chapter will increase coordination and collaboration between primary care clinicians and professionals within the fields of mental health and early child health and development. Examples of early child health and development professionals include, but are not limited to those providers participating in the Early Childhood Comprehensive Systems Initiative, Early Intervention Program, Child Health Management Clinics, and Developmental Day Treatment Clinic Services.
To that effect, the chapter will build on the children's behavioral health care reform efforts, in addition to the activities in the early child health community, already underway within the state to: 1) improve coordination of mental health and primary care services and 2) develop collaborative relationships between primary care clinicians; professional organizations and mental health organizations, schools, and child serving agencies. In this manner, we strive to effectively promote early identification and referral of children with mental health needs and improve overall coordination and collaboration of primary care clinicians.
The project will occur in two phases:Phase 1:
The chapter and its partners will design a brief interview survey (approximately 15 questions) to obtain feedback on the barriers and possible solutions facing primary care clinicians trying to effectively collaborate with mental health and developmental disabilities providers. The Arkansas Foundation for Medical Care will administer this survey to those physicians throughout the state who currently have the highest rate of referral for mental health and/or developmental services.Phase 2:
The chapter will host community discussions in conjunction with System of Care outreach sessions, to provide a forum for primary care clinicians and other interested stakeholders to learn more about the children's behavioral health reform efforts underway within the state. It is expected that continuing education credits will be available for discussion participants.Kansas Chapter, AAP
The Kansas Chapter will use a collaborative approach to assess the needs of multiple stakeholders for improving mental health promotion, diagnosis, and treatment of mental health disorders. Building on the ABCD developmental screening project of the Kansas Health Policy Authority (Medicaid) in which the chapter is now involved, the chapter will expand the project to include the social-emotional and postpartum depression screening of mothers and children. The needs assessment report will serve as a working guide for planning communication and information distribution. Objectives include:
- Assess perceived problems in the system of care from the perspective of physicians and office staff as well as the advisory group.
- Research and evaluate existing materials for supporting primary care professionals in identifying children with social-emotional risk factors or with diagnosable mental health disorders.
- Collaborate with other community entities to make available descriptions of existing resources and their services (eg, HealthyKC.com).
- Help health professionals and consumers understand mental health in the context of families and their cultures, and be aware of evidence-based, culture specific interventions.
The program will occur in 2 phases:Phase 1:
Needs Assessment, Gap Analysis, and Implementation Plan
- Brief Kansas Child and Adolescent Health Council at their next quarterly meeting in December and discuss the need and potential candidates for an advisory board for the program.
- Review and summarize accepted sources for standards of care in pediatric mental health and preferred educational materials.
- Summarize meetings, identify long-term indicators (eg, public health indicators, improved access to care) and collaborators who track them, and confirm implementation plan.
Several meetings with collaborating organizations, with frequency to be determined by the group, will be held to share upcoming events and opportunities for promotion of mental health through multiple activities. Phase 2:
Survey of Services Pre-intervention
Mississippi Chapter, AAP
- Survey of Kansas area pediatrician and physician practices to determine use of psychosocial screening tools, knowledge of community resources, and use of family educational materials.
- Collection and summary of indicators from other collaborating organizations (eg, number of communications trainings with pediatric mental health focus).
The Mississippi (MS) Chapter will implement strategies to assess the service environment as well as strategies to collaborate with mental health professionals and educate pediatricians. It is the intent of the chapter to nurture improved collaboration of mental health and primary care providers. Collaboration can be improved if primary care physicians and the local community mental health centers and private mental health service providers know what each has to offer (eg, counseling, nursing services, day treatment, family/parent education). Improving, or in some cases, establishing this collaboration would advance the referral process, enhance 2-way communication, and take steps toward providing a more seamless treatment system. In addition, mental health and primary care providers need to be provided ongoing opportunities for dialogue and interaction.
The chapter will begin by assessing what mental health services are available in the Metro Jackson, MS area (the capital city and largest city in our state), including the state’s community mental health centers and the state medical center’s Department of Psychiatry. The MS Department of Mental Health has a mental health resource directory available that includes all state-supported services, which will be made available to pediatricians. Other mental health resources will be surveyed, utilizing tools from the Chapter Action Kit. A directory will be assembled based on the survey results.
In targeted areas of the state, including the Jackson metro area, the project will establish a task force or work group including primary care and mental health providers, Chapter representatives, representatives of the MS Department of Mental Health’s Division of Children and Youth Services, state mental health provider professional organizations, the Division of Medicaid, educators, the University of MS Medical Center’s Department of Psychiatry, and local pediatricians. This task force will address collaboration and information sharing between mental health professionals and pediatricians. Again using resources from the Chapter Action Kit, the chapter will create improved procedures for information sharing between those professionals serving children’s mental health needs building on a framework already established. Many of the state’s school districts have interagency agreements with community mental health centers regarding the provision of mental health services (eg, nursing, case management, crisis intervention, counseling). However, absent in this information sharing are pediatricians and other primary care physicians. It will be the chapter’s goal to assure that pediatricians are “brought to the table” in these communications. Realizing that local communities and school districts are unique in terms of their level of services and needs, the task force may also address other issues such as a more standardized referral process, the need for parent education, and other concerns. Depending upon the speed and success in opening up communications between providers in the Jackson, MS area, this model may be replicated in other areas of the state (eg, Meridian, Tupelo).
As both pediatricians and pediatric residents have expressed the need for additional training about mental health issues in children, the chapter will host, in conjunction with its Spring CME meeting, a workshop on mental health issues in children. Workshop topics will likely include care integration, behavioral health management, psychopharmacology, early identification of mental health disorders, the use of mental health screening tools, and related topics.
Although during this project the chapter does not seek to directly address mental health financing, the state’s Division of Medicaid will be invited to participate with all task force activities in order to create an awareness of the need for and utilization of mental health services and issues related to the provision of services for children. It is hoped that this involvement will consequently help in the future efforts to improve mental health financing.
The chapter has, for a number of years, had a committee and/or liaison on children’s mental health/mental illness. Through this project the chapter will develop an expanded group of pediatricians interested in mental health issues that can expand the reach of this project around the state. All of the chapter’s membership will be invited to become involved in the mental health committee, will be informed of this project, and the activities being pursued through the project. In particular, pediatricians who attend the chapter’s mental health workshop will be asked to participate. Once involved, members will be invited replicate similar initiatives in their geographic areas of the state. Oregon Chapter, AAP
The Oregon (OR) Chapter, in collaboration with the Oregon Council of Child and Adolescent Psychiatry, will build the local relationships and infrastructure needed for successful pediatric – mental health collaboration in primary care, targeting sustainability and system change. This project targets a particularly challenging barrier for practicing pediatricians of accessing child psychiatric/mental health education, consultation and collaborative case management and the financing structures that support these processes.
The OR Chapter will continue the momentum begun in Oregon with the Oregon Pediatric Society (OPS)/Oregon Chapter of Child and Adolescent Psychiatry (OCCAP) collaboration meeting of June 2007, by facilitating periodic “dialogues in mental health in primary care” meetings between pediatricians, family practitioners, child psychiatrists, and community mental health providers toward capturing experiences, relationship building, networking, collaborative planning, and small project development.
The project will promote, support and gather learning’s from local pediatrics/child psychiatry consultation teams across the state. Individual child psychiatrists will be assigned to local pediatric practices to build relationships and explore best use of time, consultation and collaboration based upon individual practice need. These teams will identify opportunities and barriers, and the project coordinator will gather experiences that will be brought forth toward a MH Financing summit.
As part of this effort, the chapter will identify and shine light on policy barriers that need to be addressed to create sustainability and significant “mental health in primary care” system change. The chapter with many strategic partners will convene a financing planning summit of funders, private and public, with the OPS/OCCAP Collaborative Project to create the financial structures that support primary care/mental health integration. .
Goals of the project include:Goal 1:
To establish a 2 year commitment from the OCCAP leadership to create frequent and ongoing meetings of pediatric practice/child psychiatry consultation teams in at least 5 primary care pediatric practices for education, case discussion, and referral processes. .Goal 2:
To convene and facilitate a summit for “Integration and Financing for Children’s Developmental and Mental Health Services within Primary Care Settings.”
To provide 3 facilitated “dialogues in mental health in primary care” meetings with pediatricians, child psychiatrists and MH community focused on discussion and planning for practice level processes that promote primary care
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