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| Adolescent Behavioral Health (ABH) project | |
|---|---|
| Investigator (PI): | Tai-Seale, Ming |
| Performing Organization (PO): |
(Current): Palo Alto Medical Foundation, Research Institute / (650) 853-4779 |
| Supporting Agency (SA): | Palo Alto Medical Foundation |
| Initial Year: | 2013 |
| Final Year: | 2018 |
| Award Type: | Intramural |
| Abstract: | The Problem: The Big Picture. Within the private health care sector in the United States, mental health services are often disconnected from the routine medical care of the patient, even within well-functioning health care systems that offer a wide variety of medical specialties. This disconnect is detrimental to all, but it is especially problematic for adolescents, since many adult psychiatric disorders have their onset during teen years, and since these conditions contribute to suicide, the third leading cause of death in adolescents. The lack of integrated behavioral and medical health services is due to two major factors: insurance models that "carve out" behavioral health from general medical coverage, and cultural stigmatization. As a result of the carve-out model, behavioral health practitioners often work outside primary health care settings and primary care providers (PCPs) are not reimbursed for offering mental health care. In addition, adolescents are particularly sensitive to the stigmatization engendered by mental health diagnoses and, therefore, they may have difficulty accessing mental health providers; and if they do access such providers, the PCP is typically uninformed. The Problem: The Local Picture. The Sutter Health Peninsula Coast Region (PCR) which includes Palo Alto Medical Foundation and Mills-Peninsula Health Services provides outpatient and hospital-based health care services to more than 70,000 adolescents (ages 12-18). Despite a reputation for providing high-quality care, including well-developed and well-respected psychiatric services and PCPs who are highly motivated to improve systems of care, the PCR has yet to develop a truly integrated system of behavioral health care delivery based on close collaboration with primary care. The barriers noted above at the national level pertain locally as well: the carve-out insurance model that separates medical and mental health networks inhibits collaboration. Our solution. Within the Sutter Health Peninsula Coast Region we seek $3M to support a 5-year program to implement and evaluate integration of behavioral health into our primary care settings. The program will focus on our adolescents, for the reasons described above and also because of the recent teen suicide cluster that has galvanized our local communities. Integration of behavioral health into our primary care settings will improve screening and treatment of psychiatric disorders in adolescents and will save lives. We propose a three-arm study, each arm being conducted at one or more clinic sites: 1) treatment as usual, but with education of PCPs; 2) PCP education plus resource navigation; and 3) PCP education, resource navigation, and enhanced case management by trained staff who will facilitate management of mental health disorders within primary care settings. Throughout the program, data will be analyzed to determine the clinical effectiveness and costs of our interventions. The resource navigator's main role will be to facilitate behavioral health referrals from PCPs and communication between PCPs and behavioral health practitioners. The navigator will help train PCPs to: 1) use screening instruments, 2) identify psychiatric disorders, 3) manage psychiatric disorders when appropriate, 4) refer patients to behavioral health practitioners, and 5) co-manage the disorders with specialists as appropriate. In addition, the navigator will develop systems to track behavioral health disorders among our adolescents and their responses to interventions. The navigator will also work with local experts to provide links to behavioral health resources. In summary, through this adolescent behavioral health program, our region will assess the impact of integrating behavioral health services into primary care, starting with adolescents, a particularly vulnerable population. The systems developed and outcomes tracked will inform decisions about long-term investment and expansion to other patient groups. Finally, our program may guide other health care systems as the nation moves toward systemic change. |
| MeSH Terms: |
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| Country: | United States |
| State: | California |
| Zip Code: | 94301 |
| UI: | 20151002 |
| Project Status: | Completed |