Understanding Child Health Gaps to Forge Integration

Beth Friedman-Darner, LASW
Director, Kitsap Mental Health Services
Behavioral Health Champion, Pediatric Transforming Clinical Practice Initiative

As part of the Pediatric Transforming Clinical Practice Initiative (P-TCPI), Kitsap Mental Health Services (KMHS) recently met with primary care physicians at local pediatric clinics to ascertain needs and perceived barriers to serving children with behavioral health needs. In meeting with these two clinics, we utilized a written survey to collect the following information: 1) perceived comfort level in prescribing medications for KMHS clients, 2) barriers to working with KMHS clients, and 3) perceived comfort in collaborating with KMHS providers. The survey also assessed the diagnosis and medication groupings that primary care providers are most and least comfortable prescribing.

Findings from these meeting differed between the two practices. “Clinic A” shared that the pediatricians had knowledge of mental health diagnosis and were comfortable in prescribing behavioral health medications and specific classifications of medications.  They did indicate that they are struggling with receiving notes from our KMHS psychiatric medical providers when a referral occurs.

Our meeting with “Clinic B” revealed that the they did not perceive any barriers to taking KMHS clients.  They identified diagnosis groupings (psychosis, schizophrenia and bi-polar disorder) which gave providers pause and medication groupings (antipsychotics, some antidepressants, some mood stabilizers and benzodiazepines) which providers were uncomfortable prescribing. The clinic indicated that they would appreciate training opportunities and discussed benefiting from a “mentorship” which would consist of ongoing consultation and support from KMHS.

As a result of our findings from these meetings, KMHS entered into memorandums of understanding (MOUs) to 1) revise KMHS policies to ensure that appropriate and timely documentation and communication with PCP offices occurs when a client is transferred for medication management, and 2) provide training and mentorship to PCP offices when appropriate and needed.

During these two meetings, we also discussed a project around assessing the needs of KMHS clients with uncontrolled asthma. Data gathered during our Race to Heath 2012-2015 integration award showed some KMHS outpatient children experienced uncontrolled asthma which negatively impacted their ability to attend school and live a normal, healthy life.  These children frequently utilized the ED and urgent care when their asthma destabilized.

We know that asthma is associated with poorer school learning outcomes, depression, and increased risk of suicide, especially where multiple co-morbidities exist. Low income/poverty is also a risk factor.  Children with co-morbid asthma can benefit from enhanced care coordination between their PCP and their KMHS team.  We signed MOUs for working collaboratively on a project to identify joint clients with uncontrolled asthma and to develop a plan of enhanced care coordination to better serve these clients.  As a first step, KMHS staff will meet with the primary care clinics this month to begin identifying joint clients with this diagnosis.