Pediatric Community Intervention Paper

Background: In or order to improve quality of care , address need of the physically ill children in one setting and improve integration between specialties our institution developed models of care with the various levels of integration between pediatricians and child and adolescent psychiatrist .Our goal is to meet the need of the children in general pediatric practice and children with the chronic medical illness
Method: This report describes levels of integration in each model using proposed levels of integrated Healthcare models (Heath, B., Wise Romero, P., & Reynolds, K. A. 2013). We surveyed pediatric and psychiatric providers related to the existing models of care they use at our institution. We asked about the organization of the integrated models at their clinical site and
providers experience and challenges with the behavioral health/ pediatrics collaboration models.
Results: At the Penn State College of Medicine, the adolescent Medicine model represents a full collaboration and integration where all systems are shared including medical record scheduling and billing and staff meets on the regular basis.
Pediatric Behavioral Health Collaborative Care Program represents the model of Close collaboration at the outpatient general pediatric clinic. Children are referred by general pediatricians and remain in the care of the pediatrician after the consultation unless children need more intense care. Wait lists are shorter than in the classis system where children are referred to the psychiatric clinic. Anxiety & Cognitive Behavioral Consultation Clinic utilizes a model of Co-location at the outpatient specialty pediatric site. Specialists including neurologist, gastroenterologists and cardiologist refere patients to behavioral health specialist. Pediatric specialists except neurologist in majority of the cases do not choose to prescribe psychotropic medication and prefer follow up for medication at the psychiatric clinic. Child continues to see a therapist at the pediatric specialty clinics so all systems except billing is
shared.
We continue to use at the outpatient psychiatric site traditional model of care with the separate systems where only medical records are shared, but billing and scheduling are done by the separate services and wait list are longer. Children referred by specialist are seen in the chronic illness clinic for medication management and individual and group Cognitive behavioral therapy.
Discussion: Integrating behavioral medicine and pediatrics is developing field. Ongoing feedback from patient and providers will be needed to access benefit of each model for patient care and ensure financial sustainability.
Conclusion: Establishing models of care where child needs will be met at one setting are at this time tested and expanding a model to other specialty sites will depend on the feedback from the patients and providers.
References:
Heath, B., Wise Romero, P., & Reynolds, K. A. (2013). A standard framework for levels of integrated healthcare. Washington DC: SAMHSA–HRSA Center for Integrated Health Solutions.