As part of the workshop, the planning committee issued a call for posters on studies on the connections between behavioral and physical health. Twenty-six projects were exhibited, including several discussed during workshop sessions. The abstracts were submitted by the presenters and edited only for consistency across entries. The titles, with abstracts to follow, are as follows:
- The Gap between Science and Practice in Behavioral Health Care: Implications for Workforce Training Based on a Regional Snapshot
- Promoting Mental Health Competency in Residency Training
- Building Mental Wellness: Outcomes of a Statewide Intervention to Implement Mental Health Services in Pediatric Primary Care
- Fostering Future Maternal and Child and Public Health Leaders: MCHC/RISE-UP Experience
- Preparing the Learners of Today for the Needs of Tomorrow: A Review of One Pediatric Psychology Postdoctoral Fellowship Program
- TEAM UP for Children: Transforming and Expanding Access to Mental Health in Urban Pediatrics for Children
- Preventing Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model
- Does Perceived Responsibility Lead to Practices in Caring for Mental Health Problems in Pediatric Trainees?
- Building the Pediatric Primary Care Mental Health Workforce: The Pediatric Mental Health Specialist (PMHS)
- Partnering Effectively with Schools: An Interdisciplinary Task
- Universal Promotion of Child Behavioral Health in Primary Care
- Interdisciplinary Training in Motivational Interviewing (MI) and SBIRT (Screening, Brief Intervention, Referral to Treatment)
- Transforming Children’s Mental Health Services by Training Pediatricians as “First-Responders”
- F.A.R.M C.A.M.P: Growing A Rural Behavioral Health Workforce
- Training and Credentialing the Family Peer Advocate Workforce in New York State
- Trauma and School-based Health Centers
- Mother-Daughter Sexual Communication: How Providers Can Help
- Implementation of Evidence-Based Practices in Urban Schools: Project ACCESS
- Interprofessional Training in Integrated Behavioral Health Urban Pediatric Primary Care
- Training Future Health Service Psychologists in Behavioral Health Practices for Children, Adolescents, and Families
- Integrated Wraparound: A Team-based Training Blueprint for Pediatric Residents and Social Service Staff to Optimize Pediatric Behavioral Health
- A Hybrid Implementation-Effectiveness Trial of Group CBT for Anxiety in Urban Schools—Training the Workforce in Community Settings
- Primary Care Behavioral Health Service Delivery: A Psychologist-Delivered Training Curricula for Pediatric Residency Programs
- Unleashing the Power of Prevention: Train and Enable a Workforce for Effective Prevention Practice
- One Model of Integrating Mental Health Care into a Pediatric Resident Group Practice
- Integrated Behavioral Health Care in the Pediatric Primary Care Setting
Title: THE GAP BETWEEN SCIENCE AND PRACTICE IN BEHAVIORAL HEALTH CARE: IMPLICATIONS FOR WORKFORCE TRAINING BASED ON A REGIONAL SNAPSHOT
Authors and Affiliations: Linda J. Alpert-Gillis, PhD, University of Rochester School of Medicine & Dentistry; Melanie Washington, LMSW, MPH, State University of New York at Buffalo; Kenya Malcolm, PhD, University of Rochester School of Medicine & Dentistry; Katelyn Taylor, PhD, University of Rochester School of Medicine & Dentistry; Michael Scharf, MD, University of Rochester School of Medicine & Dentistry
Background: U.S. data show that one of every five young people in the general population will suffer from at least one mental disorder in a given year and fewer than half of youth with mental health illnesses receive treatment. Although there has been a rapid increase in knowledge about what interventions work for the majority of youth, a gap exists between the science and practice of behavioral health treatment.
Aims: To examine workforce implications of the needs, resources, and implementation of behavioral health best practices for children and youth in a diverse nine-county region of Upstate New York.
Methods: The current study was completed as part of a larger project in the nine-county region in Upstate New York. Surveys were distributed to primary care providers (PCPs), mental health clinicians (psychiatrists, psychologists, social workers, and mental health counselors), and higher education training directors. Focus groups also were conducted that included urban, suburban, and rural settings.
Results: Findings included the following: 57 percent of mental health clinicians surveyed perceived “lack of providers that provide evidence-based services” as a significant or very significant barrier to care. PCPs report that they generally do not feel prepared to handle mental health concerns or psychopharmacological medications. For instance, 40 percent agree and 2 percent strongly agree they are prepared to handle most of the mental health concerns.
Funding Source: Greater Rochester Health Foundation
Poster Conclusions: Mental health professionals and PCPs vary in their preparedness to deal with the widespread mental health needs of children and families. The findings suggest that all mental health graduate programs and primary care residencies need to set evidence-based assessment and treat-
ment learning objectives, U.S. states need to require such learning for licensure and licensure renewal, and diverse organizations need to develop and evaluate easily accessible continuing education trainings for mental health clinicians, and PCPs on new advances in evidence-based mental health care.
Title: PROMOTING MENTAL HEALTH COMPETENCY IN RESIDENCY TRAINING
Authors and Affiliations: Nerissa S. Bauer, Paula D. Sullivan, Anna M. Hus, and Stephen M. Downs, all from Indiana University School of Medicine
Objective: To evaluate the effect our developmental-behavioral pediatrics curricular model had on residents’ comfort with handling mental health issues.
Methods: From August 2007 to January 2010, residents participating in the Indiana University DBP rotation completed a self-assessment questionnaire at baseline and at rotation end. Residents rated their comfort with the identification, treatment, and counseling of mental health problems using a 5-point scale.
Results: Ninety-four residents completed both self-assessments. At baseline, categorical pediatric residents possessed higher comfort levels toward identification (mean 2.8 vs. 2.3 for noncategorical pediatrics residents, p <0.05), treatment (2.6 vs. 2.2, p <0.05), and counseling of mental health issues (2.7 vs. 2.1, p <0.005). Residents who were parents were also more comfortable. At rotation end, all residents showed significant improvements in self-rated comfort (4.0 vs. 2.6 for identification, p ≤0.05; 4.0 vs. 2.4 for treatment, p ≤0.05; and 4.0 vs. 2.4 for counseling, p ≤0.05). This remained true regardless of being a categorical pediatric resident, a parent, or primary care–oriented.
Practice Implications: Increasing residents’ comfort may influence the frequency of active discussion of mental health issues during well-child visits and lead to earlier diagnosis and needed treatment.
Keywords: mental health; anticipatory guidance; primary care; child behavior; competency
Poster Conclusions: Our curricular model promotes residents’ comfort with handling common mental health issues in practice.
Title: BUILDING MENTAL WELLNESS: OUTCOMES OF A STATEWIDE INTERVENTION TO IMPLEMENT MENTAL HEALTH SERVICES IN PEDIATRIC PRIMARY CARE
Authors: Rebecca A. Baum, MD; Melissa A. King, PhD, MPAff; Heather Maciejewski; John Duby, MD; Lawrence S. Wissow, MD, MPH
Background: Mental health concerns are among the most frequent issues faced by pediatric primary care, yet providers report low comfort levels for managing common mental health conditions. Efforts to train primary care providers are under way, but research on interventions that address both individual and organizational determinants of mental health care are lacking.
Aim: To determine the effectiveness of the Building Mental Wellness (BMW) Learning Collaborative in improving mental health implementation outcomes in pediatric primary care.
Methods: Staff from 29 pediatric primary care practices completed four on-site trainings over 10 months. Training content included communication and management skills for common mental health problems and addressed organizational (inner organizational context) and individual (staff attitudes, provider confidence) factors. Practices measured change in five areas (resources, referral tracking, mental health promotion and screening, mental health integration, and practice-based interventions), earning a star for each category.
Results: Most practices earned ≥3 stars in the five-star recognition system, and all earned at least one. All aspects of inner organizational context improved, with most being significantly affected by practice. Improvements in staff attitudes were noted but did not reach statistical significance. Total confidence scores increased 20 percent (95% CI: 15 to 25%) from 2.92 to 3.55 points postintervention. Using Medicaid claims data, monthly rates of office visits for mental health concerns increased by 0.14 percentage points (95% CI: 0.05, 0.23; p = 0.003) per month, from 6 percent 1 year prior to 9 percent at the end of BMW.
Acknowledgments and Funding Sources: We would like to thank the BMW participants for their time and insights. We would like to thank the Ohio Colleges of Medicine Government Resource Center for assistance with our Medicaid data request. BMW was supported by the Ohio Colleges of Medicine Government Resource Center with funding from the Ohio Department of Health and the Ohio Department of Medicaid. This research was additionally supported by National Institute of Mental Health grant
P20MH086048 (Center for Mental Health Services in Pediatric Primary Care).
Poster Conclusions: This study provides initial evidence that an intervention addressing individual and organizational factors may be effective in improving aspects of mental health service delivery in primary care. These factors may be important in driving and sustaining changes in care. Using a train-the-trainer model, BMW has been adapted for use in residency continuity clinics to address gaps in training.
Title: FOSTERING FUTURE MATERNAL AND CHILD AND PUBLIC HEALTH LEADERS: MCHC/RISE-UP EXPERIENCE
Authors and Affiliations: Harolyn M.E. Belcher, MD, MHS, Kennedy Krieger Institute and Johns Hopkins University; Jenese McFadden, DM, MS, MBA, Kennedy Krieger Institute; Jacqueline Stone, PhD, PT, Kennedy Krieger Institute; Yvonne Bronner, RDA, Morgan State University; Barbara Wheeler, RN, University of Southern California; Beth Hoffman, PhD, California State University; Tyler Hemmingson, BS, University of South Dakota; Ann Wilson, PhD, University of South Dakota; Eric Kurtz, PhD, University of South Dakota and Sanford School of Medicine
Background: Addressing projected shortages in the public health workforce, especially among African American, Latino/a, Native American, and select Asian American populations is a significant public health and educational challenge. The CDC is addressing this challenge through an innovative leadership program at the Kennedy Krieger Institute, the Maternal Child Health Careers/Research Initiatives Program for Student Enhancement-Undergraduate Program (MCHC/RISE-UP). MCHC/RISE-UP engages diverse undergraduate and postbaccalaureate scholars in experiential leadership tracks to introduce students to interdisciplinary approaches to the maternal and child health and public health fields.
National Consortium: The MCHC/RISE-UP created a national consortium among institutions, universities, and University Centers of Excellence in Developmental Disabilities (UCEDD), including (1) Kennedy Krieger Institute partnering with Historically Black Colleges and Universities and Johns Hopkins Medical Institutions, (2) University of South Dakota and Sanford School of Medicine and Research Institute partnering with Tribal Serving Institutions, and (3) University of Southern California and Children’s Hospital partnering with California State University Los Angeles, a feder-
ally designated Hispanic Serving Institution to provide geographically and culturally relevant learning opportunities and enroll diverse college junior, senior, and recent baccalaureate degree scholars.
Hypothesis: It was hypothesized that MCHC/RISE-UP leadership experiences would promote a diverse, skilled, and committed maternal and child and public health workforce.
Leadership Activities: Students participated in up to two of three public health leadership tracks: (1) clinical, (2) community engagement and advocacy, and/or (3) research. The consortium’s unifying distance-learning curriculum examined the CDC’s Winnable Battles using an epidemiological and evidence-based flipped classroom approach.
Scholars: During the 2012–2016 enrollment periods, 2,931 students applied for MCHC/RISE-UP. There were 197 accepted scholars for the MCHC/RISE-UP, 56 (28.4%) African American (non-Hispanic), 53 (26.9%) Hispanic/Latino, 34 (17.3%) Asian, 19 (9.6%) White (non-Hispanic), 16 (8.1%) American Indian/Alaskan Native, 4 (2.0%) Native Hawaiian/Pacific Islander, and 15 (7.6%) Biracial/Other.
Outcomes: The majority of students (n = 155; 78.7%) graduated from undergraduate institutions. Of the graduates, 83.8 percent (n = 130) of MCHC/RISE-UP scholars planned to enter public health or health care fields. Improvements were noted in eight maternal and child health core competencies, including knowledge, self-reflection, ethics, critical thinking, negotiation, family-centered care, teaching/mentoring, and community.
Poster Conclusions: Scholars enrolled in MCHC/RISE-UP demonstrated commitment to pursuing public health and health care careers. Increases were noted in maternal and child health core competencies.
Title: PREPARING THE LEARNERS OF TODAY FOR THE NEEDS OF TOMORROW: A REVIEW OF ONE PEDIATRIC PSYCHOLOGY POSTDOCTORAL FELLOWSHIP PROGRAM
Authors and Affiliations: Katherine M. Burrell, PsyD; Crystal Cederna-Meko, PsyD, both from Hurley Medical Center
Background: Today’s training programs must consider their impact on the direction of the profession as a whole, while adapting to the needs of patients in a changing climate. Individuals trained in clinical health psychol-
ogy are uniquely prepared to contribute to primary care medical homes, participate in biopsychosocial approaches to care, and answer calls for their services in medicine at large. Pediatric psychology, a subspecialty within clinical health psychology, targets children and adolescents specifically, and emphasizes health promotion, illness prevention, and adaptation.
Aim: One pediatric psychology training program will be reviewed in detail.
Methods: Michigan State University’s Consortium for Advanced Psychology Training offers 2-year, APA accredited, postdoctoral fellowship training in Clinical Health Psychology. Within the consortium, a position with a pediatric psychology emphasis is offered. Clinical activities span clinical and health psychology presentations, exclusively in the birth to young adult population. Pediatric psychology fellows train alongside pediatric medical residents, share faculty, and learn from them while simultaneously teaching the psychosocial aspects of health care. Activities shared with all fellows of the consortium include routine individual and group supervision; a longitudinal clinical health psychology curriculum; didactics in psychopharmacology, rehabilitation psychology, leadership and management, and pathophysiology; participation in a diversity and inclusion council with related experiential activities; teaching; and engagement in scholarly activity.
Results: Pediatric psychology fellows are exposed to extensive breadth and depth, owing to a reliance on evidence-based practices tailored to the unique sociocultural needs of the population served, scope of practice, educational climate, and many innovations employed. Consequently, knowledge and skill acquisition is considerable, and pertinent to the roles of clinician, supervisor, teacher, administrator, and scholar.
Poster Conclusions: Pediatric psychology fellows graduate with knowledge, skills, and attributes applicable to a variety of high-demand vocational pursuits, along with the capacity to both thrive in, and enrich, pediatric health care settings.
Title: TEAM UP FOR CHILDREN: TRANSFORMING AND EXPANDING ACCESS TO MENTAL HEALTH IN URBAN PEDIATRICS FOR CHILDREN
Authors and Affiliations: Genevieve Daftary, MD, MPH, Codman Square Health Center; Michael H. Tang, MD, Dimock Center; Rebecca A. Stoltz, MPH, Lowell Community Health Center; Karen Schoenherr, BA, Codman Square Health Center; Cathleen Bonacci, MD, Lowell Community Health
Center; Nandini Sengupta, MD, MPH, The Dimock Center; Colleen E. Canfield, LMHC, The Dimock Center; Connie B. Cohen, LICSW, Lowell Community Health Center; Sheila L. Och, MPH, CHW, Lowell Community Health Center; Emily Feinberg, ScD, CPNP, Boston Medical Center; Megan Bair-Merritt, MD, Boston Medical Center; and Shanna Shulman, PhD, Richard and Susan Smith Family Foundation
Background: TEAM UP for Children is a 4-year, $10 million initiative to co-create and test an innovative model of fully integrated pediatric health care in three Massachusetts federally qualified health centers: Codman Square Health Center, Dimock Health Center, and Lowell Community Health Center.
Aims: TEAM UP seeks to build integrated care capacity through therapeutic teams of primary care providers, clinicians, and community health workers within primary care sites. A learning community was created to support evidence-based identification, prevention, and management of child behavioral health disorders, and provides technical support for practice transformation.
Approach: TEAM UP is grounded in a stepped care model, utilizing evidence-based behavioral health screening and treatment strategies in an integrated care setting, and leveraging the collective experience of the collaborating health centers. TEAM UP uses a learning community approach to inform process and clinical models using best practices and adaptations to fit the cultural context of each community. The collaboration focuses on workforce development for all primary care team roles, practice transformation, strategies to maximize reimbursement, and evaluation metrics in support of continuous quality improvement.
Expected outcomes: TEAM UP implementation began June 2016. Baseline data were collected and outcomes are being tracked via electronic health records, payer data, and stakeholder interviews. Success will be measured by an increase in the capacity of health centers to track and treat childhood mental illness, parental satisfaction, health and learning outcomes, pediatric clinical staff knowledge and confidence related to mental health, and achievement of a fully integrated pediatric behavioral health care model, as well as reduced burden of mental illness.
Acknowledgments and Funding Sources: Richard and Susan Smith Family Foundation, Robert Wood Johnson Foundation
Poster Conclusions: Findings from TEAM UP for Children are anticipated to provide a roadmap of pediatric integrated care for providers, payers, policy makers, and professional organizations.
Title: PREVENTING CHILD MALTREATMENT: THE SAFE ENVIRONMENT FOR EVERY KID (SEEK) MODEL
Authors: Howard Dubowitz, MD, MS, FAAP, and Christina Von Waldner, MS
Background: Pediatric primary care offers an excellent opportunity for addressing prevalent psychosocial problems. The infrastructure is in place and there are generally good relationships between providers and parents.
Aims: To help address prevalent psychosocial problems (e.g., parental depression, substance abuse, major stress, intimate partner violence, food insecurity and harsh discipline). This in turn should strengthen families; support parents and parenting; promote children’s health, development, and safety; and prevent child abuse and neglect.
Methods: Two federally funded randomized control trials (RCTs) were conducted, the first in a high-risk urban sample, the second in relatively low-risk suburban pediatric practices, with approximately half randomly assigned to implement the SEEK model, others to usual care. The SEEK model had five core ingredients: (1) training of health professionals, (2) use of the SEEK Parent Questionnaire, (3) brief assessment and initial management, incorporating principles of Motivational Interviewing, (4) ideally, good access to behavioral health, and (5) SEEK Parent Handouts. Health professionals and parents were recruited to help evaluate the study. They completed initial surveys and then periodically up to 36 months. Toward the end of the studies, we reviewed children’s medical records and obtained child welfare data on possible involvement. In one study, medical students observed checkup visits to see the extent to which psychosocial problems were being addressed.
Results: SEEK was associated with significantly improved provider thinking and practice behavior, and these were sustained for up to 36 months. Similarly, there was a reduced rate of child abuse and neglect and harsh discipline, measured in different ways.
Acknowledgments: U.S. Department of Health and Human Services, Administration on Children and Families, Centers for Disease Control and Prevention, Doris Duke Charitable Foundation
Poster Conclusions: SEEK appears to be a practical evidence-based model for enhancing pediatric primary care to help address psychosocial problems and help prevent child maltreatment.
Title: DOES PERCEIVED RESPONSIBILITY LEAD TO PRACTICES IN CARING FOR MENTAL HEALTH PROBLEMS IN PEDIATRIC TRAINEES?
Authors and Affiliations: Cori Green, MD, MS, and Elisa Hampton, MD, both from New York Presbyterian-Weill Cornell Medical College
Background: Training programs need to better prepare future pediatricians to provide care for children with mental health (MH) problems. There are limited data on how trainees see their role in MH care and whether this influences their practices.
Aims: (1) To assess pediatric trainees’ perceived role in providing MH care and whether these are associated with practices; (2) To assess factors that influence perceived role and practices.
Methods: Mixed methods study using a survey and focus groups. Perceived responsibility and self-reported practices in inquiring, treating, and referring common MHPs were collected. Other variables included provider and practice characteristics, educational experiences, perceived barriers, and psychosocial orientation measured by the Physician Belief Scale (PBS). Nonparametric correlations looked for associations between variables. Fourteen focus group questions asked about experiences with MH care.
Results: 45/60 residents completed the survey. Perceived role was associated with practices when inquiring about anxiety (rs = 0.37, p = 0.01), treating ADHD (rs = 0.3, p = 0.03) and behavioral problems (rs = 0.34, p = 0.02), and referring all conditions. Psychosocial orientation correlated with perceived responsibility. Learning from a general pediatrician correlated with practices. Three focus groups (n = 31) elucidated four main themes: provider factors, environmental factors, patient factors, and mental health itself. Within each theme there were rewards and barriers in providing MH care. Many accepted an active role in MH care and acknowledged the impact and satisfaction achieved with successful treatment. Knowledge, confidence, the structure of continuity clinic, and the paucity of role models prevented them from fulfilling their role and providing rewarding patient care experiences.
Acknowledgments and Funding Sources: Dr. Lawrence Wissow, MD, Janice Hanson, PhD, and Mary J. Ward, PhD. Funding provided by the American Academy of Pediatrics CATCH Program (Community Access for Children’s Health) and the Pilot Award program in the Department of Pediatrics at Weill Cornell.
Poster Conclusions: Perceived responsibility (intention) was not always associated with behaviors, which is contrary to many theories of behavior change. Future initiatives need to target resident attitudes to influence their acceptance of their role in MH care and provide more positive role models who provide MH care.
Title: BUILDING THE PEDIATRIC PRIMARY CARE MENTAL HEALTH WORKFORCE: THE PEDIATRIC MENTAL HEALTH SPECIALIST (PMHS)
Authors and Affiliations: Elizabeth Hawkins-Walsh PhD, CPNP, PMHS, Catholic University, and Adele Foerster, MSN, CPNP-PC/AC, Pediatric Nursing Certification Board
Background: It has been nearly two decades since the Surgeon General called upon pediatric primary care providers to expand their scope of practice to attend to the mental health needs of children and adolescents (U.S. Department of Health and Human Services, 1999). Since then, many providers have obtained increased training in mental health care. However wide variability continues to exist and inadequate access to mental health care for children remains a problem.
Purpose: The purpose of this study was to provide the basis for a new specialty certification examination for advanced practice nurses in pediatric primary mental health care: PMHS. The study sought to validate that advanced practice registered nurses (APRNs) in pediatric primary care had gained—by virtue of experience, interest, and ongoing training—the expertise to attend and respond to many of the mental health needs of children and adolescents in primary care.
Methodology: In 2009, the Pediatric Nursing Certification Board (PNCB) launched a national survey and role delineation study (practice analysis) to validate the importance and relevance to practice of broad content areas and tasks related to the delivery of pediatric mental health care within primary care (Hawkins-Walsh and Van Cleve, 2013). (A second national survey is currently in process that will examine whether any changes have occurred in this role in the past 6 years.)
Results: Three hundred providers widely dispersed across the country have now described the range, frequency, and scope of activities that have become the basis for the Pediatric Primary Care Mental Health Specialist role. The study validated that many APRNs caring for children in primary
care have added competencies worthy of added specialty recognition and certification. The research defined the scope of PMHS exam content and is used to develop the 150 questions on this exam that has been available to eligible APRNs since fall 2011.
Exemplars: Three distinct exemplars are shared that describe the PMHS in practice.
Poster Conclusions: The PMHS certification provides formal recognition of a post-advanced practice nursing certification specialty in child and adolescent mental and behavioral health and is consistent with the APRN Consensus Model. This new role strongly supports the early involvement of the primary health care provider in the promotion of mental health, as well as early intervention within the pediatric health care home. The PMHS certification of over 350 APRNs in this specialty marks a significant step in improving critical access to mental health for children in this country.
Hawkins-Walsh, E. and D. Van Cleve. (2013). The pediatric mental health specialist: Role delineation. Journal for Nurse Practitioners, 9(3):142–148.
Pediatric Nursing Certification Board. (n.d.). Pediatric Mental Health Specialist Certification Exam. Available: https://www.pncb.org/pmhs [September 2017].
U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Available: https://profiles.nlm.nih.gov/ps/access/NNBBHS.pdf [September 2017].
Title: PARTNERING EFFECTIVELY WITH SCHOOLS: AN INTERDISCIPLINARY TASK
Authors and Affiliations: Melissa C. Heatly, PhD, Fabienne Bain, PhD, and Linda Alpert-Gillis, PhD, all from University of Rochester School of Medicine & Dentistry
Background: Each day, millions of youth attend school with significant behavioral health concerns that negatively impact their school performance. Consequently, psychologists are increasingly coordinating evidence-based mental health services and programming with school staff and across educational systems. However, achieving integration and collaboration is fraught with challenges, including differences in language, culture, expectations, and even goals. To overcome these barriers, education and behavioral health professionals must be trained to negotiate the needs of multiple systems while delivering effective services.
Aims: (1) Enhance educators’ ability to address complex behavioral health difficulties through consultation and interdisciplinary training in behavioral health; and (2) provide behavioral health staff and trainees with interdisciplinary training and experience in educational systems, school consultation, and school-based services.
Methods: Mentored experiences were delivered within the context of a school-community behavioral health partnership, which delivers an array of tiered services including educator training and workshops (Tier 1), behavioral health consultation (Tier 2), and a school-based clinic (Tier 3). Training and weekly supervision in school partnerships were offered to behavioral health staff and trainees, and changes in interdisciplinary skills were assessed via a cross-walk of standards for effective school–mental health service delivery.
Results: Educators’ consultation requests were concerned with students’ classroom functioning (89%), mental health (82%), and comorbidities (71%). Interdisciplinary training was also requested to help educators better understand students’ emotional regulation and crisis response.
Analyze Interventions Provided: Future analyses will assess the extent to which behavioral health trainees reported growth in skill needed for interdisciplinary collaboration, as well as perceived barriers in collaboration between educators and behavioral health psychologists.
Poster Conclusions: To facilitate success for children with complex behavioral health needs, professionals from traditionally disparate behavioral health and education systems must make proactive efforts at effective collaboration. Opportunities to link training to standards in interdisciplinary collaboration between schools and behavioral health will be discussed.
Title: UNIVERSAL PROMOTION OF CHILD BEHAVIORAL HEALTH IN PRIMARY CARE
Authors and Affiliations: Rachel Becker Herbst, PhD, Mary Carol Burkhardt, MD, and Jessica McClure, PsyD, all from Cincinnati Children’s Hospital Medical Center
Background: Primary care (PC) offers a unique setting for health promotion, as greater than 90 percent of children visit a health care provider each year (Child Trends Databank, 2014) and visits are frequent in the early
years. Therefore, PC represents an opportunity to provide nonstigmatizing, integrated health services to underserved populations.
Aims: We present learnings from 9 months of an innovative universal PC intervention focused on positive parenting and child behavioral health (BH) for families with children 0 to 5 years during routine well-child checks (WCC).
Methods: Using process and outcome data from the electronic health record (EHR), we capture information regarding the implementation and impact of BH screening and clinical services provided by a pediatric psychologist. Observational and qualitative data illustrate the impact on professional development and practice transformation.
Results: Greater than 50 percent of eligible patient visits included BH services, and 100 percent of those families agreed to participate in the integrated program. Eighty percent of families seen in this clinic have completed the Ages and Stages Questionnaire, Social-Emotional and the Strengths and Difficulties Questionnaire, both used as future outcome measures. We are currently obtaining EHR data regarding penetration of BH services at the patient level. Future data will assess the program’s impact on WCC adherence. Observational and qualitative feedback indicates early practice transformation and health professionals’ satisfaction. Pediatric and psychology trainees, as well as medical students, participate in office-based BH care.
Funding Source: Cincinnati Children’s Hospital Medical Center
Poster Conclusions: Universal BH promotion services offer the potential to transform patient- and systems-level outcomes. We are exploring costs and sources of sustaining revenue streams. Our intent is to expand this BH promotion model to other urban PC sites.
Child Trends Databank. (2014). Well-Child Visits. Available: https://www.childtrends.org/?indicators=well-child-visits [September 2017].
Title: INTERDISCIPLINARY TRAINING IN MOTIVATIONAL INTERVIEWING (MI) AND SBIRT (SCREENING, BRIEF INTERVENTION, REFERRAL TO TREATMENT)
Authors and Affiliations: Paul J. Hershberger, PhD, Dean A. Bricker, MD, John C. Duby, MD, Angela K. Castle, MA, all from Wright State University Boonshoft School of Medicine
Background: In spite of extensive medical and social comorbidities associated with unhealthy levels of alcohol use, recreational drug use, and/or inappropriate use of prescription medications, substance use is often not addressed by health professionals. Lack of confidence and inadequate skill development contribute to this omission in health care.
Aims: Our interdisciplinary training module aims to develop the skills of health professions students and residents in effectively screening for and addressing substance use problems in their adolescent and adult patients.
Methods: The training module includes residents in family medicine, internal medicine, and pediatrics, as well as pharmacy students, nurse practitioner students, and dental residents. The module consists of four 2.5-hour sessions that meet once per week during a 4-week residency block. The module emphasizes skill development through practice. The focus of each session is as follows:
Week One: Review of motivational interviewing as an approach to patient behavior, including video examples.
Week Two: Review of Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a recommended approach to universal screening and appropriate treatment of adolescent and adult patients regarding alcohol and drug use. Video examples are utilized.
Week Three: Role-play practice of MI and SBIRT with a myriad of cases that contain various co-morbidities.
Week Four: Practice of MI and SBIRT with a trained simulated patient.
Results: Ninety percent of participants (n = 70) report satisfaction with the training. More importantly, nearly 93 percent of participants report that the training is useful to them in addressing substance use in their patients.
Funding Source: Substance Abuse and Mental Health Services Administration (SAMHSA) Grant #1H79T1025981-01
Poster Conclusions: Health professions students can learn useful MI and SBIRT skills for addressing substance abuse problems in their patients in an interdisciplinary educational module.
Title: TRANSFORMING CHILDREN’S MENTAL HEALTH SERVICES BY TRAINING PEDIATRICIANS AS “FIRST-RESPONDERS”
Authors: Peter S. Jensen, MD, REACH Institute and University of Arkansas for Medical Sciences; Elena Man, MD (Pediatrics); Lisa Hunter Romanelli, PhD, REACH Institute; Ruth E.K. Stein, MD, Albert Einstein College of Medicine; Mark Wolraich, MD, University of Oklahoma; Rachel Lynch, MD, Mayo Clinic; Lawrence Amsel, MD, Columbia University; Diane Bloomfield, MD, Montefiore; Elizabeth Wallis, MD, MUSC; Rachel Zuckerbrot, MD, Columbia University; Cathryn Galanter, MD, SUNY Downstate; Laurence Greenhill, MD, Columbia; Danielle Laraque, MD, SUNY Upstate; Christopher Kratochvil, MD, U Nebraska MC; Harlan Gephart, MD, Group Health, Seattle; Lynn Wegner, MD, UNC Chapel Hill; Robert Kowatch, MD, Nationwide Children’s; Mark Riddle, MD, Johns Hopkins; James Jaccard, PhD, New York University; Peter Gollwitzer, PhD, New York University; Gabrielle Oettingen, PhD, New York University; Marisa Domino, PhD, University of North Carolina at Chapel Hill
Background: Given urgent workforce shortages of child mental health specialists, the U.S. Surgeon General issued a call for primary care providers (PCPs) to become “first responders” for pediatric mental health disorders. Unfortunately, pediatric residencies do not prepare graduates for this role, and continuing medical educational (CME) efforts use teaching methods that do not produce PCP practice changes (e.g., passive learning/lectures). Ironically, decades of research have identified effective methods for behavior change in diverse populations, yet these proven methods have rarely been used to help PCPs meet the growing needs for child mental health services.
Aims: To apply proven behavior-change strategies within a PCP-focused curriculum to teach E-B diagnostic/treatment methods for common childhood mental disorders.
Methods: Since 2006, the nonprofit REACH Institute (www.TheReachInstitute.org) has convened child/adolescent psychiatrists, pediatric leaders, education experts, and behavior scientists to develop/apply basic science-guided methods to help PCPs provide E-B child mental health care.
Results: To date, over 2,200 PCPs have completed REACH’s 6-month “mini-fellowship” in pediatric mental health. As a result, over these PCPs’ careers, more than 1 million children who ordinarily would not have received mental health services will receive them, often in areas of the country where no other care is available. Multiple studies, including an NIMH-funded RCT, have demonstrated the impact of REACH’s training methods
on PCPs’ application of E-B procedures, as well as cost-savings and reduced use of medications.
Acknowledgments: NIMH-MH088922-01, 2009-2012, PIs: P.S. Jensen; L. Hunter-Romanelli: Enhancing Pediatric Psychopharmacology in the Medical Home
Poster Conclusions: Basic-science and adult-education-guided training methods are effective in producing major practice changes among PCPs. If broadly deployed, these methods can address workforce shortages and facilitate application of E-B practices for children with mental illnesses. REACH has now developed a successful “train-the-trainers” program, creating regional training teams to assist local PCPs in applying E-B child mental health practices.
Title: F.A.R.M C.A.M.P: GROWING A RURAL BEHAVIORAL HEALTH WORKFORCE
Authors and Affiliations: Catherine Jones-Hazledine, PhD, and Ryan Asherin, MA, both from Western Nebraska Behavioral Health and University of Nebraska Medical Center
Background: Nebraska is a highly rural state. Only 9 of 93 counties in the state are considered metropolitan, 49 are classified as rural, and 35 are deemed frontier counties (≤6 persons per square mile) (Nguyen et al., 2016). However, 71.2 percent of behavioral health (BH) providers in the state are clustered in metropolitan areas. As a result, 88 of 93 counties are identified as BH shortage areas. Research suggests that financial incentives are not sufficient for the recruitment and retention of rural BH providers, but one good predictor of rural practice choice is having grown up in a rural setting (Watanabe-Galloway et al., 2015).
Aims: F.A.R.M C.A.M.P (Frontier Area Rural Mental Health Camp and Mentorship Program) aims to improve recruitment and retention in two particularly rural and underserved areas of Nebraska by identifying local high school students interested in BH careers and providing education, support, and mentoring.
Methods: Since 2011, high school students interested in BH careers are invited to participate in a weeklong summer camp designed to introduce BH careers. The camp includes a college credit-eligible introductory course in BH, presentations by current rural BH providers, and additional educa-
tional activities. Following camp, rural BH providers mentor these students through high school and into college.
Results: To date, four cycles have participated in F.A.R.M C.A.M.P (n = 39; 9 males, 30 females). Of the total, 49 percent of participants were Native American, and 51 percent were Caucasian. Follow-up surveys indicated high rates of participant satisfaction, and increased knowledge about BH careers. Results include that 84 percent of respondents had ongoing interest in BH careers, and 95 percent of respondents indicated ongoing communication with an assigned mentor, and this contact was rated as helpful by participants.
Poster Conclusions: Although F.A.R.M C.A.M.P has not been in existence long enough to determine long-term improvements in recruitment and retention of BH providers in rural communities, student response to this innovative program has been promising for developing future rural BH providers.
Nguyen, A.T., K.E. Trout, L. Chen, L. Madison, K.L. Watkins, and S. Watanabe-Galloway. (2016). Nebraska’s rural behavioral healthcare workforce distribution and relationship between supply and county characteristics. Rural and Remote Health, 16:3645.
Watanabe-Galloway, S., L. Madison, K.L. Watkins, A.T. Nguyen, and L. Chen. (2015). Recruitment and retention of mental health care providers in rural Nebraska: Perceptions of providers and administrators. Rural and Remote Health, 15:3392.
Title: TRAINING AND CREDENTIALING THE FAMILY PEER ADVOCATE WORKFORCE IN NEW YORK STATE
Authors and Affiliations: Anne Kuppinger, New York University; Susan Burger, Families Together in New York State, Inc.; Geraldine Burton, New York University; Priscilla Shorter, New York University; Serene Olin, New York University; and Kimberly Hoagwood, New York University
Background: Family Peer Advocates (FPAs) are increasingly being used to assist parents to navigate multiple child-serving systems, improve engagement, promote family-centered decision making, and support effective parenting for children and youth with complex health, behavioral health, and developmental needs. FPAs are trained, “veteran” parents with lived-experience. The use of Family Peer Support Services (FPSS) is expected to increase significantly as the service is being added to New York’s Medicaid State Plan.
Aims: This poster will describe training and credentialing for the FPA.
Methods: A standardized approach to training this paraprofessional workforce, the Parent Empowerment Program (PEP), was developed in 2005. As this service has matured and expanded to new settings, a consensus service definition was developed (New York State Office of Mental Health and Families Together in New York State, 2014) and a formal credentialing process was initiated in 2011.
Results: To date, 750 FPAs have been trained and over 435 have been credentialed. FPA competencies have been updated and training will soon include 20+ online modules, in-person training, and follow-up coaching. This work is taking place in the context of a commitment to understand the impact of this service through an expanded research agenda (Hoagwood and Burns, 2014).
Acknowledgments and Funding Sources: This work is supported through a partnership between the New York State Office of Mental Health, the IDEAS Center, the Community Technical Assistance Center, and Families Together in New York State, Inc.
Poster Conclusions: The augmentation of the health care workforce with trained and credentialed FPAs will be critical to improving access, integration, and quality of care.
Hoagwood, K.E., and B.J. Burns. (2014). Vectoring for true north: Building a research base for family support. Administration and Policy in Mental Health and Mental Health Services Research, 41(1):1–6. doi:10.1007/s10488-013-0516-2.
New York State Office of Mental Health and Families Together in New York State. (2014). New York State Family Peer Support Services Definition. Albany: New York State Office of Mental Health.
Title: TRAUMA AND SCHOOL-BASED HEALTH CENTERS
Authors and Affiliations: Satu Larson, PhD, RN, CPNP, San José State University; Susan A. Chapman, PhD, RN, FAAN, University of California San Francisco; Claire D. Brindis, DrPH, University of California San Francisco and National Adolescent Health Information and Innovation Center; and Joanne Spetz, PhD, FAAN, University of California San Francisco
Background: Approximately 71 percent of children and adolescents in the United States have experienced childhood trauma in the form of victimizing and nonvictimizing events. Minority racial/ethnic populations and those living in poverty are at greater risk of exposure to trauma, development of mental health disorders, and school failure, yet are less likely to have access to mental health services. School-based health centers (SBHCs) staffed with mental health providers may be one strategy to decrease health care disparities.
Aims: The aim of this study was to describe factors associated with SBHCs in the United States that are staffed with mental health providers as compared to those that are not, to aid policy creation that promotes access to and funding of mental health services in SBHCs.
Methods: Secondary analysis of cross-sectional School-based Health Alliance Census School Year 2010–2011 Report. Descriptive statistics and Chi-square analysis used to describe differences between SBHCs with and without onsite mental health services (MHS).
Results: Seventy percent of SBHCs offer MHS. SBHCs with more resources, larger student bodies, longer history, and state funding had significantly more MHS services. Mental health providers were more commonly found within SBHCs that served upper grade levels, 9–12. Nurse practitioners (NPs) were found in 79 percent of SBHCs, yet only 3 percent employed NPs specializing in mental health. The full-time equivalent (FTE) mean for NP services was 0.77, followed by physicians (0.32 FTE) and physician assistants (0.78 FTE). Among SBHCs with a mental health provider, 85 percent employed a licensed social worker/counselor/therapist with a mean of 0.82 FTE.
Acknowledgments: Unfunded dissertation research. Article submitted to Journal of Pediatric Health Care
Poster Conclusions: SBHCs are in a position to ameliorate the impacts of exposure to chronic childhood trauma since a large proportion provides primary preventive health and mental health care. Further evidence is needed to assess whether the mental health services currently available in SBHCs are adequate in number and properly trained to mitigate childhood exposure to trauma.
Title: MOTHER-DAUGHTER SEXUAL COMMUNICATION: HOW PROVIDERS CAN HELP
Author and Affiliation: Randee L. Masciola, DNP, CNP, Ohio State University
Background: Parent-adolescent sexual communication (PASC) has been shown to decrease adolescents’ sexual risk-taking behaviors, delay their sexual debut, and decrease teenage pregnancies.
Aims: This study reports on the attitudes, beliefs, and knowledge mothers perceive as barriers and facilitators of sexual communication with their 11- to 14-year-old daughters. By identifying barriers and facilitators, interventions and implement strategies can be created to optimize PASC and improve sexual health outcomes for female adolescents.
Methods: Mothers of adolescents’ females were recruited via convenience sample and participated in semistructured, one-on-one interviews. Transcripts were analyzed for themes and categories using Data Analysis and Interpretation by Hesse-Biber and Levy.
Results: Mothers perceived their role as a primary resource of sexual health information and education. Data revealed the mothers felt confident in their content knowledge and ability to answer questions. Perceived barriers were lack of initiation of PASC by the adolescents and the mothers’ fear of causing embarrassment to their daughters. Mothers perceived puberty and scheduled school-based health talks as facilitators to PASC.
Poster Conclusions: Finding of this study will educate providers on facilitators and barriers of PASC, as well as develop strategies and interventions that promote mother-daughter sexual communication.
Khurana, A., and E.C. Cooksey. (2012). Examining the effect of maternal sexual communication and adolescents’ perceptions of maternal disapproval on adolescent risky sexual involvement. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 51(6):557–565.
Noone, J., and H.M. Young. (2010). Rural mothers’ experiences and perceptions of their role in pregnancy prevention for their adolescent daughters. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN / NAACOG, 39(1):27–36.
Wilson, E.K., B.T. Dalberth, H.P. Koo, and J.C. Gard. (2010). Parents’ perspectives on talking to preteenage children about sex. Perspectives on Sexual and Reproductive Health, 42(1):56–63.
Title: IMPLEMENTATION OF EVIDENCE-BASED PRACTICES IN URBAN SCHOOLS: PROJECT ACCESS
Authors and Affiliations: Jennifer A. Mautone, Children’s Hospital of Philadelphia/Perelman School of Medicine at University of Pennsylvania; Billie S. Schwartz, Children’s Hospital of Philadelphia; Barry McCurdy, Devereux Center for Effective Schools; Andrew Orapallo, Children’s Hospital of Philadelphia; Beatriz Cabello, Children’s Hospital of Philadelphia; Muniya Khanna, Children’s Hospital of Philadelphia; Ricardo B. Eiraldi, Children’s Hospital of Philadelphia/Perelman School of Medicine at University of Pennsylvania
Background: Unmet need for behavioral health services is extraordinarily high among urban children of diverse racial/ethnic backgrounds. As overall unmet need for services continues to grow, schools are fast becoming the main source of behavioral health services for children. There is a need for implementation research to better understand methods to disseminate evidence-based practices (EBPs) to school mental health providers to meet the unmet needs of students in urban schools.
Aims: The purpose of this presentation is to provide an overview of Project ACCESS (Advancing Collaboration for Children’s Emotional and School Success; Eiraldi et al., 2014), a clinical trial focused on enhancing urban schools’ internal capacity for implementation of school-wide positive behavior interventions and supports (SWPBIS) with integrated small group EBPs at the Tier 2 level. The main aim of the project is to determine whether school staff can implement EBPs with fidelity and clinical effectiveness whether they receive consultation and coaching with performance feedback (C + C) or just receive consultation (C) alone.
Method: Six large urban schools in the Northeast were randomized to C + C or C only. C + C was provided by trained research staff supervised by licensed psychologists. Fidelity of implementation was evaluated based on direct observation in the school (for schoolwide interventions) and by coding videos of small group intervention sessions.
Results: Preliminary results suggest that schools can successfully implement EBPs and that fidelity is higher for schools receiving C + C.
Poster Conclusions: SWPBIS with integrated evidence-based mental health interventions can be employed as a vehicle for addressing mental health problems in under-resourced urban schools, and school personnel can be trained to maintain high levels of implementation fidelity.
Eiraldi, R., B. McCurdy, K. Khanna, J. Mautone, A.F. Jawad, T.Power, Z. Cidav, J. Cacia, and G.A. Sugai. (2014). Cluster randomized trial to evaluate external support for the implementation of positive behavioral interventions and supports by school personnel. Implementation Science, 9(12). doi:10.1186/1748-5908-9-12.
Title: INTERPROFESSIONAL TRAINING IN INTEGRATED BEHAVIORAL HEALTH URBAN PEDIATRIC PRIMARY CARE
Authors and Affiliations: Jennifer A. Mautone, PhD, Children’s Hospital of Philadelphia and University of Pennsylvania; Billie S. Schwartz, PhD, Children’s Hospital of Philadelphia; Wanjiku Njoroge, MD, Children’s Hospital of Philadelphia and University of Pennsylvania; Paul Robins, PhD, Children’s Hospital of Philadelphia and University of Pennsylvania; Thomas Power, PhD, Children’s Hospital of Philadelphia and University of Pennsylvania
Background: Access to quality behavioral health (BH) care for children is an unmet need in the United States. Pediatric primary care (PPC) has emerged as a major de facto venue for the delivery of BH services; however, primary care providers (PCPs) are typically unable to provide the necessary range of BH services due to multiple constraints. Therefore, BH providers based in PPC can help improve the quality of preventative health care in these settings.
Aims: The purpose of this presentation is to describe a program designed to train child psychology, child and adolescent psychiatry, and general pediatrics trainees to address the BH needs of youth, specifically children and adolescents residing in low-income, urban settings.
Methods: Training in collaborative BH services in urban PPC at Children’s Hospital of Philadelphia (CHOP) has evolved in response to current unmet needs and national priorities. Our model includes BH trainees working with PCPs, social workers, and residents. Experiential training occurs through the provision of direct consultation with the PCP and/or family and brief follow up interventions. Interdisciplinary training includes practice-based psychosocial rounds, individual and group supervision, and a series of seminars and case conferences focusing on population-based care, engagement, trauma-focused care, and consultation with schools.
Results: Trainees have attained clinical competency required to provide effective primary care BH services. Trainee feedback has been positive, and
a number of program graduates have entered careers in integrated PPC. Additionally, pilot findings indicate increased patient access to behavioral health care and overall satisfaction with the model and service.
Acknowledgments and Funding Sources: HRSA (D40HP25714), Department of Child & Adolescent Psychiatry & Behavioral Sciences and CHOP Care Network, Children’s Hospital of Philadelphia
Poster Conclusions: Given that integrated behavioral health approaches require different clinical competencies than traditional outpatient practices, it is important that interdisciplinary, experiential, and didactic training experiences are available.
Title: TRAINING FUTURE HEALTH SERVICE PSYCHOLOGISTS IN BEHAVIORAL HEALTH PRACTICES FOR CHILDREN, ADOLESCENTS, AND FAMILIES
Authors and Affiliations: Erin T. O’Callaghan, PhD, Alliant International University; Denise Rockwell, PhD; Jessie R. Lowell, Psy; Cristina Magalhaes, PhD; Peter S. Theodore, Ph.; Jennifer Hsia, PhD; Kristin Conover, PhD; and Ron E. Duran, PhD
Background: The American Psychological Association-Accredited Ph.D. and Psy.D. Clinical Psychology doctoral programs at the California School of Professional Psychology at Alliant International University in Los Angeles share a Clinical Health Psychology Emphasis area for students interested in becoming clinical health psychologists. This emphasis area uses a biopsychosocial approach to train students in best practices for assessment and treatment of individuals across the lifespan. Students receive comprehensive and multidisciplinary training in behavioral health practices through coursework, field training placements, and dissertation/research mentorship opportunities with Clinical Health Psychology faculty members. Most of these faculty members are licensed psychologists, and all provide distinct expertise in clinical, behavioral, developmental, and pediatric psychology. It is through the training the university provides that students gain the knowledge and skills necessary to implement evidence-based practices with children and families in community, school, and clinic-based settings.
Aim: This poster outlines the Clinical Health Psychology Emphasis area’s coursework, field training, and dissertation/research requirements and opportunities for future health service psychologists pursuing training in behavioral health for children and families.
Methods: This poster describes the Emphasis area’s mission, aims, and expected competencies for all students. Curriculum development and expectations for students pursuing training with an emphasis in the treatment of behavioral health in children, adolescents, and families is reviewed. Second, this poster describes required courses and advanced clinical electives for students, which focus on training in evidence-based behavioral health practices across the lifespan from biopsychosocial and developmental conceptualization models. Descriptions and examples of behavioral health field training placements and dissertation/research mentorship are also provided.
Poster Conclusions: Training future health service psychologists to provide evidence-based treatments to children, adolescents, and families is critical in furthering research, advancing applied practice, and promoting best practices in behavioral health treatment for these populations. The diverse academic training, mentorship, and clinical experience provided by members of the Clinical Health Psychology Emphasis area faculty aim to serve as a model for other clinical psychology doctoral programs in training future health service psychologists.
Title: INTEGRATED WRAPAROUND: A TEAM-BASED TRAINING BLUEPRINT FOR PEDIATRIC RESIDENTS AND SOCIAL SERVICE STAFF TO OPTIMIZE PEDIATRIC BEHAVIORAL HEALTH
Authors and Affiliations: Jan Schlaier, EdD, FNP-BC, and Kathy Werheim, MA, MPA, both from Bergen’s Promise
Background: Bergen’s Promise is a Care Management Organization within New Jersey’s Children’s System of Care serving children ages 5–21 with mental, behavioral, and substance use concerns, and intellectual/developmental disabilities. Bergen’s Promise provides integrated care coordination using the theoretical model of Wraparound. Advancing integrated care coordination fostered the creation of an experiential learning collaborative to strengthen the Child Family Team process within the Wraparound Model of Care. To this end, curricula have been designed to meet the need for pediatric residents to understand social determinants of child/family health and for social service staff to understand the influence of holistic health determinants on sustainable well-being.
Aim: To demonstrate the utility of the Wraparound Theoretical Model of Care as an interdisciplinary, team-based, experiential learning platform for pediatric residents and social service workforce members.
Methods: The Community Pediatrics and Child Advocacy Rotation Elective meets competency-based goals and objectives of the Accreditation Council for Graduate Medical Education (ACGME). Pediatric Behavioral Health Home team members will train the Care Management staff in basic medical/health knowledge to effectively identify health/wellness needs impacting children and families.
Results: (1) A pre/posttest measuring confidence in ability to foster integrated care within scope of practice. (2) Demonstration of learned skills through advocacy, presentation, and research opportunities. (3) Qualitative review of child wellness goals.
Poster Conclusions: Innovative, interdisciplinary curricular development is crucial toward the promotion of pediatric behavioral health. Integrated Wraparound Child and Family Teams provide a rich research opportunity to validate clinical and cost outcomes associated with effective transitions of care.
Accreditation Council for Graduate Medical Education. (2016). ACGME Program Requirements for Graduate Medical Education in the Subspecialties of Pediatrics. Available: http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320S_pediatric_subs_2016.pdf [September 2017].
Bruns, E.J., and J.S. Walker (Eds.). (2008–2015). The Resource Guide to Wraparound. Portland, OR: National Wraparound Initiative.
Title: A HYBRID IMPLEMENTATION-EFFECTIVENESS TRIAL OF GROUP CBT FOR ANXIETY IN URBAN SCHOOLS—TRAINING THE WORKFORCE IN COMMUNITY SETTINGS
Authors and Affiliations: Billie S. Schwartz, Children’s Hospital of Philadelphia; Muniya Khanna, Children’s Hospital of Philadelphia and The Child and Adult Center for Anxiety and OCD; Jaclyn Cacia, Child and Adult Center for Anxiety and OCD; Shannon Bressler, Children’s Hospital of Philadelphia; Rebecca Kanine, Children’s Hospital of Philadelphia; Lauren Swift, Children’s Hospital of Philadelphia; Andrew Orapallo, Children’s Hospital of Philadelphia; and Ricardo Eiraldi, Children’s Hospital of Philadelphia and University of Pennsylvania
Background: Anxiety disorders are highly prevalent in youth and can lead to problems with social interactions, academic achievement, and adjustment. Community mental health (CMH) agencies are frontline agents for
psychosocial treatment, but often lack knowledge and resources for proper adherence of evidence-based practices (EBP).
Aims: The need to focus on training mental health professionals in nontraditional settings on EBPs has increased in recent years (Herschell et al., 2010; Southam-Gerow et al., 2010). However, traditional training methods (e.g., workshops, seminars) have not resulted in broad uptake or improved practice quality (Cartreine et al., 2010). Few studies exist comparing training methods making it difficult to establish best practices. This study seeks to address this gap to improve quality of CMH interventions.
Methods: This study is a NIMH-funded three-arm parallel group, Type 2 hybrid effectiveness, and implementation RCT evaluating implementation of CBT for child anxiety in schools. The first aim compares the effectiveness of a brief (8-session) group CBT for anxious youth (CATS) to an existing (12-session) GCBT protocol (FRIENDS) in public schools. Simultaneously, our team is testing the effectiveness of two implementation training approaches: (1) train-the-trainer and (2) train-the-trainer plus expert consultation. Implementation outcomes are implementation fidelity and cost-effectiveness.
Results: As this is the first year of the study, outcome data are not yet available. We will describe the startup process (e.g., building community partnerships, training workshops) and the use of technology. The key components of the EBPs will be outlined. Finally, we will discuss challenges and limitations and directions for future research in clinical training in community settings.
Acknowledgments and Funding Sources: National Institutes of Health (1R01MH108555-01)
Poster Conclusions: This study aims to demonstrate that (a) CMH therapists and supervisors can implement an anxiety treatment with fidelity; and (b) use of a briefer, culturally sensitive group CBT treatment (CATS) can lead to improved outcomes for children with anxiety similar to other evidenced-based treatments (FRIENDS). Results concerning the use of technology to provide remote support could also contribute to the dissemination and implementation of EBPs in schools and CMHs, therefore increasing the training of the nontraditional workforce.
Cartreine, J.A., D.K. Ahern, and S.E. Locke. (2010). A roadmap to computer-based psychotherapy in the United States. Harvard Review of Psychiatry, 18(2):80–95. http://dx.doi.org/10.3109/10673221003707702.
Herschell, A.D., D.J. Kolko, B.L. Baumann, and A.C. Davis (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30(4):448–466. doi: 10.1016/j. cpr.2010.02.005.
Southam-Gerow, M. A., J.R. Weisz, B.C. Chu, B.D. McLeod, E.B. Gordis, and J.K. Connor-Smith. (2010). Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. Journal of the American Academy of Child and Adolescent Psychiatry, 49:1043–1052. doi:10.1016/j.jaac.2010.06.009.
Title: PRIMARY CARE BEHAVIORAL HEALTH SERVICE DELIVERY: A PSYCHOLOGIST-DELIVERED TRAINING CURRICULA FOR PEDIATRIC RESIDENCY PROGRAMS
Authors and Affiliations: Jeffrey Shahidullah, Rutgers University; Paul Kettlewell, Geisinger Health System; Kathryn DeHart, Geisinger Health System; Ilene Ladd, Geisinger Health System; Tyler Bogaczyk, Geisinger Health System; Kris Rooney, Lehigh Valley Health Network; Amy Signore, Geisinger Health System; and Sharon Larson, Geisinger Health System
Background: Pediatricians are positioned to serve increasing numbers of youth with behavioral health (BH) concerns in primary care (PC). However, a common barrier to providing effective care is the lack of BH training that primary care pediatricians (PCPs) receive. In fact, most pediatric residency training directors acknowledge that training on the topic is minimal/suboptimal (Leigh et al., 2006). The American Academy of Pediatrics in a 2009 policy statement cited aspirational BH competencies for all pediatricians in the areas of ADHD, anxiety, depression, and suicide among others.
Aims: This study empirically evaluated an innovative behavioral health training curricula delivered by pediatric psychologists as part of pediatric residency training. The training curricula consisted of two components: (1) service-delivery exposure consisting of “warm hand-offs,” “curbside consults,” and in-vivo performance feedback in residents’ continuity clinic; and (2) didactic exposure consisting of a BH lecture series, readings/quizzes, and case vignettes.
Methods: Thirty-six residents across two pediatric residency programs in a northeastern state participated in the study by completing a survey. The instrument included 18 items assessing knowledge in managing com-
monly occurring BH conditions in PC. Surveys were administered at each site at the beginning and end of the training year to demonstrate response to training at each site. One site received the enhanced behavioral health training curricula described above, while the other site received “training as usual” (ACGME-mandated 1-month developmental-behavioral pediatrics rotation).
Results: Data yielded three major findings: (1) at baseline, there were no significant differences in knowledge between residents at the two sites, making them appropriate for comparison, (2) at baseline, there were no significant differences between scores of interns and upper-level residents, demonstrating a lack of growth during matriculation through residency, despite low baseline scores, and (3) the residents who participated in the enhanced BH training demonstrated more statistically significant improvements in their clinical competencies compared to the “training as usual” group.
Poster Conclusions: Findings underscore AAP’s initiative to improve BH competencies for PCPs. The BH training curricula described in this study shows promise as a means to improve these competencies. Future dismantling studies of the enhanced BH curricula should analyze which components of the intervention are the most “active” ingredients. This will be important if other programs elect to adapt the curricula for implementation in their own residency programs.
Leigh, H., D. Stewart, and R. Mallios. (2006). Mental health and psychiatry training in primary care residency programs: Who teaches, where, when, and how satisfied? General Hospital Psychiatry, 28:189–194.
Title: UNLEASHING THE POWER OF PREVENTION: TRAIN AND ENABLE A WORKFORCE FOR EFFECTIVE PREVENTION PRACTICE
Authors and Affiliations: Valerie B. Shapiro, University of California Berkeley; Kimberly Bender, University of Denver; J. David Hawkins, University of Washington; and Jeffrey M. Jenson, University of Denver
Background: Behavioral health problems in youth have significant impacts on rates of economic independence, morbidity, and mortality. The U.S. behavioral health workforce has focused on treating these problems only after they have been identified—at a high cost to young people, families,
communities, and the nation. Evidence now suggests that many behavioral health problems can be prevented (Jenson and Bender, 2014).
Aims: The Grand Challenge to “Unleash the Power of Prevention” seeks to reduce the prevalence of behavioral health problems among young people by 20 percent over the next decade (Hawkins et al., 2015). Achieving this goal is predicated on training and enabling a workforce for effective prevention practice. A well-trained workforce comprised of social workers, nurses, physicians, psychologists, teachers, and others is needed to coordinate and deliver effective prevention programs.
Methods: The Coalition for the Promotion of Behavioral Health was created to develop and implement an action plan aimed at implementing effective preventive interventions for a range of behavioral health problems. The Coalition is a 90-member, interdisciplinary group of researchers, practitioners, and policy makers. A subgroup within the coalition has focused on preparing prevention practitioners.
Results: Actions of the subgroup include coordinating with accreditation bodies of professional degree programs (e.g., Council for Social Work Education), creating standardized learning objectives for prevention practice (e.g., “Advanced Social Work Practice Standards for the Prevention of Substance Use Disorders”), identifying existing prevention training programs (e.g., University of Oklahoma, Harvard, Colorado State), collating a repository of prevention course syllabi (e.g., “School, Family, & Community Prevention” at the University of Denver), and undertaking a systematic study of the integration of prevention content into broader programs of study (e.g., Integrated Behavioral Healthcare).
Acknowledgments and Funding Sources: The authors would like to (1) acknowledge the American Academy of Social Work and Social Welfare for coordinating the Grand Challenges Initiative (http://www.aaswsw.org/grand-challenges-initiative/ [September 2017]), which served as the impetus for this work, and (2) direct readers to the Discussion Paper published by the National Academy of Medicine for more information on Unleashing the Power of Prevention: http://www.nam.edu/perspectives-2015-unleashing-the-power-of-prevention/ [September 2017].
Poster Conclusions: Creating a prevention workforce will require interdisciplinary collaboration, infrastructure development, and changing policies that shape training, licensure, and funding across service sectors.
Hawkins, J.D., J.M. Jenson, R. Catalano, M.W. Fraser, G.J. Botvin, V. Shapiro, C.H. Brown, W. Beardslee, D. Brent, L.K. Leslie, M.J. Rotheram-Borus, P. Shea, A. Shih, E. Anthony, K.P. Haggerty, K. Bender, D. Gorman-Smith, E. Casey, and S. Stone. (2015). Unleashing the Power of Prevention. Discussion paper. Washington, DC: Institute of Medicine and National Research Council. Available: http://aaswsw.org/wp-content/uploads/2015/12/Unleashing-Nat-Academy-of-Medicine_Discussion-Paper-2015.pdf [October 2017].
Jenson, J.M., and K.A. Bender. (2014). Preventing Child and Adolescent Problem Behavior. Evidence-based Strategies in Schools, Families, and Communities. New York: Oxford University Press.
Title: ONE MODEL OF INTEGRATING MENTAL HEALTH CARE INTO A PEDIATRIC RESIDENT GROUP PRACTICE
Authors and Affiliations: Matthew Tirelli, PMHNP, Maura Frank, MD, Elisa Hampton, MD, Allison Gorman, MD, MS, Kathryne Adams, BA, and Cori Green, MD, MS, all from New York Presbyterian/Weill Cornell Medical College
Background: One in five youth are afflicted with a mental health (MH) disorder and MH problems are the leading cause of impairments in children, yet the majority of children do not receive appropriate treatment. MH care needs to be integrated into pediatric primary care, yet pediatricians are not prepared to do so. Increased collaboration between primary care pediatricians (PCPs) and MH professionals is needed to better prepare the future workforce
Aims: Describe a resident continuity clinic that uses an integrated MH model of care.
Methods: The continuity clinic at the main academic center at an urban institute developed an integrated model of MH care using an interdisciplinary team. There are 40 pediatric residents, 10 faculty members, a social worker, a psychiatric nurse practitioner (PNP), a care coordinator, and community health workers. This practice screens for trauma, psychosocial risk factors, and emotional and behavioral health problems at every well-child visit. The PNP’s role is to: advise on evaluation and management of MH problems, model difficult conversations with families, provide short-term treatment for children within the practice, and comanage patients with PCPs. He is also involved in formal and informal teaching for residents and faculty members.
Results: Over 150 children were evaluated since the inception of the program and approximately 50 percent of patients have been screened. Rigorous evaluation of this program is in the beginning stages. It will look at resident behaviors, rates of recognition, and family satisfaction with care.
Acknowledgments and Funding Sources: DSRIP
Poster Conclusions: It is feasible to create an integrated MH program in a resident training continuity clinic, and caring for children with MH problems collaboratively has increased patient engagement and completion of referrals. It has begun to change culture among providers making MH an integral part of well-child visits.
Title: INTEGRATED BEHAVIORAL HEALTH CARE IN THE PEDIATRIC PRIMARY CARE SETTING
Authors and Affiliations: Michael Yogman, MD, Harvard Medical School, Mt. Auburn Hospital; Susan Betjemann, LICSW, Yogman Pediatrics Associates; Anna Sagaser, BS, Tufts University School of Medicine; and Liza Brecher, MS, Tufts University School of Medicine
Background: The top five reasons for pediatric office visits in the United States today are behavioral health concerns, a departure from the physical concerns that were once the most prominent chronic illnesses of the nation’s youth. Yet children and families face multiple barriers to accessing behavioral health care. This paper describes a Quality Improvement project that utilizes a colocated behavioral health and care coordination integration model in a private pediatric primary care office that is a Patient Centered Medical Home. The project was designed to align with the IHI goals of the Triple Aim, targeting improved patient and provider experience, population health quality, and health care costs.
Methods: A licensed clinical social worker (LICSW) was colocated into the practice along with a parent partner/care coordinator. Children with behavioral health disorders were provided interventions involving consultation with the primary care physician, short-term treatment or referral for treatment of more complex cases, and care coordination by the parent partner/care coordinator. Outcomes measuring improvement in patient and provider experience, population health quality, and cost savings were examined.
Results: The LICSW had 1,573 encounters with over 366 patients in the practice over a 2-year period. Improvements in all aspects of the triple aim resulted. Cost savings averaged $336 per member per month (pmpm) for the total patient population and $716 pmpm for patients with behavioral health disorders.
Poster Conclusions: Behavioral Health Integration improved patient and provider experience, population health quality, and lowered overall cost.