PARTNERS IN CHILD PARTNERS IN CHILD PSYCHIATRYPSYCHIATRY

John E. Dunne, MDJohn E. Dunne, MD1400 Talbot Road South, #2031400 Talbot Road South, #203Renton, WA 98055Renton, WA 98055425-235-7383425-235-7383

PremisesPremises

There is a chronic shortage of Child There is a chronic shortage of Child and Adolescent Psychiatristsand Adolescent Psychiatrists– US Average: 8.67 C+A Pyschiatrists/100,000 US Average: 8.67 C+A Pyschiatrists/100,000

youths (2001)youths (2001)– High – Massachusetts: 21.3/100,000 youthsHigh – Massachusetts: 21.3/100,000 youths– Low – Alaska: 3.1/100,000 youthsLow – Alaska: 3.1/100,000 youths– Washington: 6.6/100,000 youthsWashington: 6.6/100,000 youths

Thomas and Holzer, The Continuing Shortage of Child and Thomas and Holzer, The Continuing Shortage of Child and Adolescent Psychiatrists, J Am Acad Child Adolesc Psychiatry, Adolescent Psychiatrists, J Am Acad Child Adolesc Psychiatry, 45:9, 1023-1031, Sept 2006 45:9, 1023-1031, Sept 2006

GoalsGoals

1. To provide training for PCP’s in 1. To provide training for PCP’s in principles of assessing, diagnosing and principles of assessing, diagnosing and treating C + A with a wide range of MH treating C + A with a wide range of MH problemsproblems

2. To improve the quality of MH 2. To improve the quality of MH treatment received by C + A in WAtreatment received by C + A in WA

3. To change the working relationship 3. To change the working relationship between C + A psychiatrists and PCP’s between C + A psychiatrists and PCP’s from consultation to collaborationfrom consultation to collaboration

TrainingTraining

1. Assessment process in a 1. Assessment process in a primary care settingprimary care setting

2. Interviewing children and 2. Interviewing children and adolescentsadolescents

3. Assessment tools, use and 3. Assessment tools, use and interpretationinterpretation

4. Evidence based treatments 4. Evidence based treatments and best practicesand best practices

ImplementationImplementation

1. Provide assessment tools1. Provide assessment tools 2. Provide standard text “Child 2. Provide standard text “Child

and Adolescent Psychiatry, The and Adolescent Psychiatry, The Essentials,” Keith Cheng, MD, and Essentials,” Keith Cheng, MD, and Kathleen Myers, MD, ed., Lippincott Kathleen Myers, MD, ed., Lippincott Williams and Wilkins, 2005Williams and Wilkins, 2005

3. Assist with practice 3. Assist with practice implementation implementation

On-line Discussion On-line Discussion GroupsGroups 1. Secure bulletin board format1. Secure bulletin board format 2. Ten PCP’s per group with a child 2. Ten PCP’s per group with a child

psychiatric moderator/consultantpsychiatric moderator/consultant 3. Oversight by a child psychiatrist 3. Oversight by a child psychiatrist

program administratorprogram administrator 4. Discussion group for the child 4. Discussion group for the child

psychiatristspsychiatrists 5. Access to UW clinical experts by the 5. Access to UW clinical experts by the

child psychiatristschild psychiatrists 6. Duration of 12 months with 6. Duration of 12 months with

debriefing debriefing

Washington State Child Washington State Child Psychiatry Access Psychiatry Access ProgramProgram 1. Robert Hilt, MD, CHRMC1. Robert Hilt, MD, CHRMC 2. Provide one-time assessment 2. Provide one-time assessment

and consultation and report for and consultation and report for Medicaid and Medicare children Medicaid and Medicare children and potentially for those with and potentially for those with private payprivate pay

3. Not currently funded 3. Not currently funded