- Email: [email protected]
3.36 Ten Years of Telemental Health (TMH) Collaboration With Behavioral Health Organizations
NEW RESEARCH POSTERS 3.36 — 3.37
Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Kelsy Newton, MS, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Elizabeth Machado, MS, Case Western Reserve University School of Medicine and MetroHealth Medical Center, elizabethm.machado@gmail. com; Maixner W. Rae, MS, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Terry Stancin, PhD, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected] Objectives: Primary care pediatricians (PCPs) are often tasked with prescribing psychotropic medications without access to a psychologist (PSY) or child and adolescent psychiatrist. The purposes of this study were: 1) to determine the feasibility of adapting an integrated care model that already incorporates PSY residents in a pediatric continuity care clinic to include child and adolescent psychiatrist consultation; and 2) to enhance knowledge of pediatric residents in psychopharmacology. Methods: Subjective and objective assessments of knowledge and comfort with prescribing psychotropic medications were conducted with pediatric residents prior to program implementation and again four months later. PSY doctoral residents who are embedded in a pediatric continuity care clinic at an urban academic health center collaborated with pediatric residents to identify patients for child and adolescent psychiatrist consultation. PSY residents assessed patients and reviewed cases with the child and adolescent psychiatrist who then messaged recommendations to the pediatric resident and attending PCP through electronic health records. Monthly child and adolescent psychiatrist-led educational conferences were conducted with pediatric and PSY residents. Patient diagnosis, medications prescribed, and time spent on consults were tracked within the four month pilot feasibility phase. Results: Cases receiving consultation (17/19) were started on psychotropic medications. Mean time spent by the child and adolescent psychiatrist on consultations was 20 minutes. Most common diagnoses were ADHD (42%), MDD (26%) and anxiety disorders (21%). 52 percent were prescribed SSRIs; 35 percent were prescribed ADHD medications. Total resident objective knowledge score (possible range 0 - 10) improved from pre- (M ¼ 5.1, SD ¼ 1.55) to post-intervention (M ¼ 8.1, SD ¼ 1.04; t ¼ -8.70, p < 0.05). Resident subjective assessment of knowledge/comfort improved (p < 0.05) on 20/21 items. No patient would have had access to a child and adolescent psychiatrist without the intervention. Conclusions: Availability of child and adolescent psychiatric or developmental behavioral pediatric psychopharmacology consultation is feasible within an integrated care model when facilitated by an embedded collaborating mental health professional. This approach may increase access to care and offer interprofessional educational opportunities.
REST, CC, CON Supported by the MEDTAPP Healthcare Access Initiative and the Ohio Department of Medicaid http://dx.doi.org/10.1016/j.jaac.2017.09.183
3.36 TEN YEARS OF TELEMENTAL HEALTH (TMH) COLLABORATION WITH BEHAVIORAL HEALTH ORGANIZATIONS L. Lee Carlisle, MD, Child Study and Treatment Center, [email protected]; William P. French, MD, University of Washington and Seattle Children’s Hospital, william.french@ seattlechildrens.org; Ian Kodish, MD, PhD, University of Washington and Seattle Children’s Hospital, ian.kodish@ seattlechildrens.org; Katherine Lo, ARNP, Seattle Children’s Hospital, [email protected]; Lisa Chui, ARNP, Seattle Children’s Hospital, [email protected]; Erin Dillon-Naftolin, MD, University of Washington and
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Seattle Children’s Hospital, erin.dillon-naftolin@ seattlechildrens.org; Kathleen Myers, MD, DFAACAP, MPH, MS, University of Washington and Seattle Children’s Hospital, [email protected] Objectives: We describe the experience of seven telemental health (TMH) providers in collaborating with 11 behavioral health organizations (BHOs) in Washington and Alaska in the context of the newly published Practice Guidelines for Telemental Health with Children and Adolescents. Methods: We obtained utilization statistics, demographics, and clinical characteristics of patients treated at the BHOs from 2007 to 2017. We surveyed BHO therapists, administration, and families regarding their satisfaction. TMH providers summarized their experiences and outlined approaches for providing “best practices” for collaboration with BHOs. Results: The TMH providers collaborated in the care of over 3,000 youth (ages 4–21 years) across diagnoses with over 9,000 sessions. Most patients were prescribed medication. Parents reported high satisfaction (36 of 40 points). Therapists and administrative staff were also highly satisfied and wanted more time from the TMH providers for direct services and patient discussion. TMH providers appreciated working with underserved and vulnerable youth. Technology did not impede their delivery of evidencebased treatment. They noted facilitation of treatment by inclusion in sessions of a therapist or case manager (“telepresenter”). The lack of a shared electronic health record impeded efficiency and precluded understanding the therapists’ expertise and patients’ progress. Therapists’ turnover was frustrating. TMH providers noted the need for assistance in obtaining rating scales to establish measurement-based practice and to coordinate youths’ system of care (e.g., TMH providers, primary care physicians, and teachers). Conclusions: This presentation delineates best practices for meeting the challenges of collaborating with BHOs through TMH. Five top best practices include the following: 1) a telepresenter; 2) shared electronic records and tracking methods to document progress; 3) integration across the youth’s system of care; 4) time for interdisciplinary conferences, not just direct service; and 5) establishing criteria for discharge back to primary care. Our findings will guide aspiring TMH providers in collaborating with BHOs and establishing an enjoyable career in TMH.
EBP, CC, TVM http://dx.doi.org/10.1016/j.jaac.2017.09.184
3.37 ASSOCIATION OF RECENT CYBERBULLYING WITH OTHER FORMS OF MALTREATMENT, ANXIETY, AND DEPRESSION AMONG ADOLESCENTS IN AN OUTPATIENT SETTING Samantha B. Saltz, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, samantha.saltz@ jhsmiami.org; Nils C. Westfall, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, nils. [email protected]; Gabrielle E. Hodgins, University of Miami Miller School of Medicine, [email protected]; Rolando Gonzalez, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, rolando. [email protected]; Piotr Pelc, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, [email protected]; Alodia Diaz de Villegas, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, [email protected]; Nicole Mavrides, MD, University of Miami Miller School of Medicine, [email protected]; Philip D. Harvey, PhD, University of Miami Miller School of Medicine, pharvey@med. miami.edu Objectives: Cyberbullying is a major public health threat associated with increased psychiatric morbidity and mortality in youths. We have previously shown that adolescent inpatients with psychiatric disorders who endorsed recent cyberbullying victimhood reported higher levels of
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Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Kelsy Newton, MS, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Elizabeth Machado, MS, Case Western Reserve University School of Medicine and MetroHealth Medical Center, elizabethm.machado@gmail. com; Maixner W. Rae, MS, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected]; Terry Stancin, PhD, Case Western Reserve University School of Medicine and MetroHealth Medical Center, [email protected] Objectives: Primary care pediatricians (PCPs) are often tasked with prescribing psychotropic medications without access to a psychologist (PSY) or child and adolescent psychiatrist. The purposes of this study were: 1) to determine the feasibility of adapting an integrated care model that already incorporates PSY residents in a pediatric continuity care clinic to include child and adolescent psychiatrist consultation; and 2) to enhance knowledge of pediatric residents in psychopharmacology. Methods: Subjective and objective assessments of knowledge and comfort with prescribing psychotropic medications were conducted with pediatric residents prior to program implementation and again four months later. PSY doctoral residents who are embedded in a pediatric continuity care clinic at an urban academic health center collaborated with pediatric residents to identify patients for child and adolescent psychiatrist consultation. PSY residents assessed patients and reviewed cases with the child and adolescent psychiatrist who then messaged recommendations to the pediatric resident and attending PCP through electronic health records. Monthly child and adolescent psychiatrist-led educational conferences were conducted with pediatric and PSY residents. Patient diagnosis, medications prescribed, and time spent on consults were tracked within the four month pilot feasibility phase. Results: Cases receiving consultation (17/19) were started on psychotropic medications. Mean time spent by the child and adolescent psychiatrist on consultations was 20 minutes. Most common diagnoses were ADHD (42%), MDD (26%) and anxiety disorders (21%). 52 percent were prescribed SSRIs; 35 percent were prescribed ADHD medications. Total resident objective knowledge score (possible range 0 - 10) improved from pre- (M ¼ 5.1, SD ¼ 1.55) to post-intervention (M ¼ 8.1, SD ¼ 1.04; t ¼ -8.70, p < 0.05). Resident subjective assessment of knowledge/comfort improved (p < 0.05) on 20/21 items. No patient would have had access to a child and adolescent psychiatrist without the intervention. Conclusions: Availability of child and adolescent psychiatric or developmental behavioral pediatric psychopharmacology consultation is feasible within an integrated care model when facilitated by an embedded collaborating mental health professional. This approach may increase access to care and offer interprofessional educational opportunities.
REST, CC, CON Supported by the MEDTAPP Healthcare Access Initiative and the Ohio Department of Medicaid http://dx.doi.org/10.1016/j.jaac.2017.09.183
3.36 TEN YEARS OF TELEMENTAL HEALTH (TMH) COLLABORATION WITH BEHAVIORAL HEALTH ORGANIZATIONS L. Lee Carlisle, MD, Child Study and Treatment Center, [email protected]; William P. French, MD, University of Washington and Seattle Children’s Hospital, william.french@ seattlechildrens.org; Ian Kodish, MD, PhD, University of Washington and Seattle Children’s Hospital, ian.kodish@ seattlechildrens.org; Katherine Lo, ARNP, Seattle Children’s Hospital, [email protected]; Lisa Chui, ARNP, Seattle Children’s Hospital, [email protected]; Erin Dillon-Naftolin, MD, University of Washington and
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Seattle Children’s Hospital, erin.dillon-naftolin@ seattlechildrens.org; Kathleen Myers, MD, DFAACAP, MPH, MS, University of Washington and Seattle Children’s Hospital, [email protected] Objectives: We describe the experience of seven telemental health (TMH) providers in collaborating with 11 behavioral health organizations (BHOs) in Washington and Alaska in the context of the newly published Practice Guidelines for Telemental Health with Children and Adolescents. Methods: We obtained utilization statistics, demographics, and clinical characteristics of patients treated at the BHOs from 2007 to 2017. We surveyed BHO therapists, administration, and families regarding their satisfaction. TMH providers summarized their experiences and outlined approaches for providing “best practices” for collaboration with BHOs. Results: The TMH providers collaborated in the care of over 3,000 youth (ages 4–21 years) across diagnoses with over 9,000 sessions. Most patients were prescribed medication. Parents reported high satisfaction (36 of 40 points). Therapists and administrative staff were also highly satisfied and wanted more time from the TMH providers for direct services and patient discussion. TMH providers appreciated working with underserved and vulnerable youth. Technology did not impede their delivery of evidencebased treatment. They noted facilitation of treatment by inclusion in sessions of a therapist or case manager (“telepresenter”). The lack of a shared electronic health record impeded efficiency and precluded understanding the therapists’ expertise and patients’ progress. Therapists’ turnover was frustrating. TMH providers noted the need for assistance in obtaining rating scales to establish measurement-based practice and to coordinate youths’ system of care (e.g., TMH providers, primary care physicians, and teachers). Conclusions: This presentation delineates best practices for meeting the challenges of collaborating with BHOs through TMH. Five top best practices include the following: 1) a telepresenter; 2) shared electronic records and tracking methods to document progress; 3) integration across the youth’s system of care; 4) time for interdisciplinary conferences, not just direct service; and 5) establishing criteria for discharge back to primary care. Our findings will guide aspiring TMH providers in collaborating with BHOs and establishing an enjoyable career in TMH.
EBP, CC, TVM http://dx.doi.org/10.1016/j.jaac.2017.09.184
3.37 ASSOCIATION OF RECENT CYBERBULLYING WITH OTHER FORMS OF MALTREATMENT, ANXIETY, AND DEPRESSION AMONG ADOLESCENTS IN AN OUTPATIENT SETTING Samantha B. Saltz, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, samantha.saltz@ jhsmiami.org; Nils C. Westfall, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, nils. [email protected]; Gabrielle E. Hodgins, University of Miami Miller School of Medicine, [email protected]; Rolando Gonzalez, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, rolando. [email protected]; Piotr Pelc, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, [email protected]; Alodia Diaz de Villegas, MD, University of Miami Miller School of Medicine and Jackson Memorial Hospital, [email protected]; Nicole Mavrides, MD, University of Miami Miller School of Medicine, [email protected]; Philip D. Harvey, PhD, University of Miami Miller School of Medicine, pharvey@med. miami.edu Objectives: Cyberbullying is a major public health threat associated with increased psychiatric morbidity and mortality in youths. We have previously shown that adolescent inpatients with psychiatric disorders who endorsed recent cyberbullying victimhood reported higher levels of
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