The Chapter Action Kit was developed to support AAP Chapters in addressing and improving children's mental health in primary care. Review the information below for strategies on collaborating with mental health professionals to improve mental health services.
Identify insurance barriers that impede payment of mental health professionals co-located in a primary care practice, community health center, or school-based health center (eg, behavioral health carve-outs with closed provider panels, mental health service authorization requirements, prohibition against payment to the pediatrician and mental health professional on the same day, restrictive visit limits, etc). Provide education, technical assistance, or perhaps a learning collaborative to chapter members on integrating a mental health professional into their practice. Provide opportunities for members to share lessons learned about matters such as renting space, recruiting a mental health specialist, billing and collecting fees, defining the role of an integrated mental health specialist, and planning the care process. Develop a training program and resources for mental health professionals who want to integrate within a pediatric primary care practice, community health center, or school-based health center.
Establish (or join) a state or regional child psychiatry consultation system. Such systems currently exist in more than 30 states. Pediatricians ideally develop a personal relationship with the consulting psychiatrist(s), then call for advice in real time or arrange for an expedited psychiatric assessment of the patient, receive a hand-off back to primary care and guidance in on-going care, and/or receive recommendations about referral for other mental health services.
Identify providers’ barriers to coordinating and co-managing children’s mental health services. Examples include lack of knowledge about each other’s credentials and scope of practice, lack of knowledge of evidence-based mental health interventions and the professional qualifications of those who provide them, omission of pediatricians from community mental health service systems and care coordination mechanisms, families’ lack of capacity to navigate the mental health system and insufficient (or absent) payment for co-management activities.
Strategies to consider (in addition to improvement of communication mechanisms, as described above) include (1) clarification of the scope of practice of non-physician mental health and substance abuse providers in various settings (eg, schools, public agencies, private practice); (2) promotion of and training opportunities in evidence-based therapies for pediatric mental health providers; (3) inclusion of primary care physicians (or their staff representatives) in care planning conferences for children with mental health disorders; (4) linkage of mental health care managers, primary care managers and key school and human service personnel; (5) use of trained lay navigators to assist youth and families in navigating systems of care; and (6) payment of both primary care and specialty mental health providers for time spent in care planning and consultation.
Identify mechanisms for improving communication between pediatricians and the professionals who provide mental health and developmental services to children (see above). Development of mutually-agreeable forms and processes for exchange of information is a good starting place for these efforts. Behavioral health “carve outs” in some public and private insurance plans create separate authorization processes, co-pays, and provider panels for mental health services; almost invariably, carve-outs exacerbate communication challenges. Chapters that have established “pediatric councils” to engage with private insurers can consider enhancing communication between mental health professionals and pediatricians as part of their agenda. Efforts to improve communication should also include public insurers; the education system; administrators of the state EI programs; and associations representing early childhood educators.
Identify the key barriers to sharing health information between pediatricians and the professionals who provide mental health and developmental services to children and adolescents. In addition to community-based mental health professionals, this may include school-based mental health personnel (eg, psychologists, social workers, guidance counselors), mental health professionals in the juvenile justice and social service systems, early intervention (EI) and Head Start providers, and early childhood educators.
In doing so, determine whether these barriers are the result of privacy laws, informed consent laws and policies, and/or the culture of mental health practice in the state and/or community. Family Educational Rights and Privacy Act (FERPA), as well as Health Insurance Portability and Accountability Act (HIPAA), regulations may cover exchange of information between school personnel and pediatricians. An important tool chapters can provide to their members is a synopsis of applicable federal and state privacy laws, including issues specific to adolescents.
HIPAA Privacy Rule and Provider to Provider Communication
HIPAA Privacy Rule and Sharing Information Related to Mental Health
Confidentiality Laws Tip Sheet
AAP Resources on HIPAA
Joint Guidance on the Application of the FERPA and HIPAA to Student Health Records
American Academy of Pediatrics