bhip: behavioral health integration program at montefiore ......bhip: behavioral health integration...
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BHIP: Behavioral Health Integration Program at Montefiore- Across the Pediatric Lifespan
Rahil D. Briggs, PsyDAssociate Professor of Pediatrics, Albert Einstein College of Medicine
Director, Pediatric Behavioral Health Services, Montefiore Medical Group.
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Healthy Steps at Montefiore 2006-present
• Co-location and integration of mental health specialists in pediatric primary care
– Universal screening, assessment, treatment, and referral of infant mental health/development and caregiver mental health
– Adverse Childhood Experiences (ACES)
– Ages and Stages Questionnaires: Social Emotional (ASQ:SE)
– Patient Health Questionnaire ( PHQ-9)
– Provider education
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Healthy Steps at Montefiore
• First time mothers and their children and partners enrolled either prenatally or before the child is 2 months old
• Co-management of well child visits
• “Baby and Me” group
• Home visits
• Adult mental health services
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Healthy Steps Program Evaluation
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Design
• Quasi-experimental longitudinal follow up of children enrolled in a Healthy Steps (HS) program at their primary care pediatric setting and a comparison group (CG) from a matched clinic who met enrollment criteria, but did not receive the intervention
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Objective and Method
• Determine the relationship between maternal ACES and maternal report on the ASQ:SE at 36 months
• General linear model and logistic regression (LR) analyses
• Adjusted for baseline differences between HS and CG and between study completers and drop-outs
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Results – Impact of Intervention on 36 month ASQ:SE scores
90.4
28.3
44.5
28.2
0
10
20
30
40
50
60
70
80
90
100
ASQ:SE mean score p<.001
CG Children of motherswith 1 or more ACES
CG children of motherswith no ACES
HS Children of motherswith 1 or more ACES
HS Children of motherswith no ACES
Briggs, et al. (2014). Healthy Steps as a Moderator: The Impact of Maternal Trauma on Child Social-
Emotional Development. Clinical Practice in Pediatric Psychology (2, 2), 166–175
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Behavioral Health Integration Program
Behavioral Health
Pediatric Primary
Care
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Our model (present future)
• 300,000 patients (90,000 pediatric)
• 21 sites
• Healthy Steps 0-5, innovative Child and Adolescent programming (CAP), Collaborative Care Initiative model for adults
• Universal life span behavioral health screening
• Family assessments
• Integrated care at each site (hubs and satellites)
• Challenges
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CAP Study Objectives
• Understand the feasibility of implementing integrated behavioral health services on a large scale in pediatric clinics with a particularly vulnerable population
• Understand the effectiveness of CAP in improving the mental and physical health Montefiore’s pediatric patients
• Understand the effectiveness of CAP in reducing health care utilization and costs
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Outcome measures
• Primary outcomes: – Mental health symptoms – measured using PSC-17
• 4-month follow-up administered by research assistants
• Only among primary sample: patients at BOPS clinics with positive PSC-17
• Better Health
– Medical service utilization – sick visits and ED utilization• Lower Costs
– Steroid prescriptions for asthma – as a proxy for asthma control• Better Health
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Outcome measures
• Secondary outcomes:
– Patient satisfaction • two questions modified from the Strengths and Difficulties Questionnaire
– Provider satisfaction • Online survey (comfort with behavioral health issues and satisfaction with the
mental health care provided)
– Process measures – measuring success of implementation• % of patients referred to mental health providers
• % of patients referred who came to the first mental health visit
• number of days between referral and the first mental health visit
• number of mental health visits patients attended
• number of patients who successfully completed treatment
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BHIP Conclusions
• It is feasible and efficacious to integrate pediatric behavioral health into primary care pediatrics/family medicine settings
• HS as a moderator between ACES in parents and SE development in children
• Early data from CAP:
– Sept-Nov 2014: 19.6% of children presenting for HCM were referred to BHIP (N=833 referrals)
– at least 55% of those children came in for separate visits with the BHIP provider.
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Acknowledgements
• Andrew Racine
• Judy Aschner
• Peter Belamarich
• BHIP and Healthy Steps providers
• MMG provider and practice teams, MMC leadership
• Supporters (Altman Foundation, Center for Medicaid and Medicare
Innovation, Child Welfare Fund, Edith Glick Shoolman Children’s Foundation, Grinberg Family Foundation, Marks Family Foundation, NYC Children’s Mental Health under 5 Initiative, Price Family Foundation, Stavros Niarchos Foundation, Tiger Foundation)
Rahil Briggs, PsyDDirector, Pediatric Behavioral Health Services
Research Evaluation Team
Miguelina German, PhD
Director of Quality
Elizabeth Altschuler, PhD
Pediatric Psychologist
Diane Bloomfield, MD, FAAP
Medical Director, FCC
Nicole Brown, MD, MPH, MHS
Attending Physician, FCC
Silvie Colman, PhD
Health Economist
Lauren Haliczer, MA
Lab Manager
Teresa Hsu-Walklet, PhD
Senior Psychologist
Michael Rinke, MD, PhD
Assistant Medical Director
of Pediatric Quality
Clinical Team, Healthy Steps (Birth-5 years)
Rebecca Schrag Hershberg, PhD
Director of Training, Healthy Steps
Laura Krug, LCSW
Senior Healthy Steps Specialist
Polina Umylny, PhD
Senior Healthy Steps Specialist
Elizabeth Altschuler, PhD
Healthy Steps Specialist
Loring Bartlett, PsyD
Healthy Steps Specialist
Kate Cuno, PsyD
Healthy Steps Specialist
Elizabeth Ward, PhD
Healthy Steps Specialist
Carina Wind, LMSW
Healthy Steps Specialist
Miguelina German, PhD
Clinical Director, Parental Mental Health
Desiree Castillo, PhD
Parental Mental Health Specialist
Micheal Dowling, PhD
Parental Mental Health Specialist
Clinical Team, Child & Adolescent Psychiatry
Audrey Walker, MD
Division Chief, Child and Adolescent Psychiatry
Jason Herrick, MD
Pediatric Psychiatrist
Uchenwa Okoli, MD
Pediatric Psychiatrist
Darryl Smith, MD
Pediatric Psychiatrist
Susan Weinstein, MD
Pediatric Psychiatrist
Clinical Team, Child & Adolescent Psychology
Miguelina German, PhD
Director of Training, Child and Adolescent
Carla Cirilli, PsyD
Senior Psychologist
Dana Crawford, PhD
Senior Psychologist
Teresa Hsu-Walklet, PhD
Senior Psychologist
Elizabeth Merrill, PsyD
Senior Psychologist
Elizabeth Altschuler, PhD
Pediatric Psychologist
Martha Bennett, PsyD
Pediatric Psychologist
Desiree Castillo, PhD
Pediatric Psychologist
Kate Cuno, PsyD
Pediatric Psychologist
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