Promising Practices: Imagine Pediatrics – Georgia

Identifying Mental Health and Psychosocial Needs

From the time a child enrolls in the practice, Imagine Pediatrics conducts screening and gathers family history in very direct, straightforward ways to understand a family’ needs. Prenatal visits include questions about expectant parents’ mental health history. The Edinburgh Postpartum Depression Scale (EPDS) is used in the first newborn appointments. In addition to the anxiety and depression screening, Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) is used during teenage visits. The pediatrician and her staff prepare families for perinatal mental health questions, providing clear reasons for the information collection and sharing confidentiality policies so that families understand that their information will be protected and used only to promote their family’s health and safety. Imagine Pediatrics staff’s honesty and directness are critical to building trusting relationships with families from the time of a child’s birth. Additionally, the clinic staff within the practice can provide consistency for families, further supporting relationship building needed to gather accurate information about a family.

Staff understand the complexity of gathering accurate information due to stigma and fears families may experience, particularly if accompanied by other family members during health supervision visits. Therefore, all staff, from the waiting room to the examination room, focus on identifying possible needs families of infants and young children may be unwilling or unable to share. Conversations focus on strengths, removing stigma and praising successes while encouraging families to seek support when needed. This ongoing reminder that each family is welcome and respected as human beings makes Imagine Pediatrics a safe place to come for help and support.

Family-Centered Approaches

Families served by Imagine Pediatrics often have complex needs that make services more challenging to offer. Some of Imagine Pediatrics’ families experience substance use issues, domestic violence, trauma and involvement with the child welfare system. Increasing numbers of families are newly arrived immigrants and experience the challenges of learning a new language and culture. Some expectant people may have received little or no prenatal services, limiting the amount of support and intervention they accessed in the pre- and peri-natal periods. As a relationship-driven practice, staff meet families where they are. Conversations in health supervision visits connect families to educational and social service supports, building each adult’s capacity to support the children in their family.

Staff stress the importance of attending health supervision visits, with a practice policy around attendance and reminder calls offered three days, one day and same day of the appointment. When families experience barriers to attending appointments (lack of transportation, child care or time off from work), staff uses motivation techniques such as immunizations required for school or free/reduced price services. Imagine Pediatrics also includes multi-lingual and multi-cultural staff who can accommodate the diversity of the population they serve. For those families who have significant barriers to in-person attendance, telehealth is offered as an option. Ultimately, Imagine Pediatrics staff constantly work to connect with and engage families in the practice and build a medical home that adapts to and addresses family needs.

The Role of Collaboration

Imagine Pediatrics’ pediatrician values a holistic approach of education and prevention. The practice has strong relationships with partners who work with families to promote mental wellness and respond to psychosocial needs. They have worked to form connections with school health, adult providers, mental health supports and other social services to build a multi-disciplinary model of health services delivery. Strong collaborative relationships with parents support consent for information sharing between partners to ensure that each partner is aware of family well-being, needed services and additional concerns. Additionally, referrals are multi-directional so that needs can be addressed by Imagine Pediatric staff and their partners as promptly as possible.

Once a need is identified, staff use a database of community resources to identify the appropriate referral and enter it into the electronic medical record (EMR) while also alerting the staff member responsible for referrals. Perinatal mental health resources include Georgia HOPE (a community-based mental health, substance use and family preservation services program), therapists, counselors, positive parenting programs and breastfeeding supports. The staff person designated to manage referrals utilizes the EMR and a print-version of referrals in a notebook to ensure that follow up occurs on each referral. As referrals are completed, the data is entered in the EMR, and the paper copy of the referral is removed from the notebook so that it only includes referrals needing follow up. Using both the EMR and notebook for tracking referrals creates a closed-loop system with checks and balances. Additionally, all staff at Imagine Pediatrics support the process, offering families reminders and support in accessing additional resources as needed.

Challenges and Lessons Learned

As mentioned, Imagine Pediatrics relies on relationships within the community to deliver quality mental health and psychosocial services to families. Building those relationships requires time, effort and systemic supports. As a sole practitioner, Imagine Pediatrics’ pediatrician built a community of support from the beginning of her career. This connection to the community and to other providers offers professional and personal support as staff respond to significant family needs.

Ongoing learning opportunities regarding practice management, including billing and coding for services, have been critical to Imagine Pediatrics’ success. The practice accesses professional development supports from the American Academy of Pediatrics and the Georgia Chapter of the American Academy of Pediatrics, particularly focusing on ways to code and bill for perinatal mental health services. In addition, the primary pediatrician participates in ongoing credential and certification programs to improve support and services for perinatal mental health. She has training in perinatal mental health received while working within the child welfare system and is seeking credentials as a lactation consultant. Her ongoing pursuit of educational programs to improve her skills and knowledge broaden her services to not just the child but the whole family.

Imagine Pediatrics understands the stressors new parents face. Modeling and encouraging open conversations about all topics from a child’s birth offers families an opportunity to access needed supports. Staff also work with families to teach their children the values and traditions they value most, a key component to self-advocacy and mental wellness. Supporting families’ access to books and literature feeds these conversations. Imagine Pediatrics uses all these strategies to support safe, healthy lives for children by empowering the adults in their lives to create better futures through ongoing mental wellness.