BEHAVIORAL HEALTH SERVICES FOR KIDS
Easier Than Ever to Access

ONLINE APPOINTMENT REQUESTS
An Added Convenience for Parents

HOWARD W. HANNA III NEW FOUNDATION BOARD CHAIRMAN

PEDIATRIC ANESTHESIOLOGY
Peter J. Davis, MD, On What Makes It Special

AMERICA’S BEST CHILDREN’S HOSPITALS
Children’s Ranks Among the Top Again

H1N1
Is a Third Wave Coming?

WMWC SEES TEENS WITH PCOS

NEWS BRIEFS

PHYSICIAN LIAISONS

PAST ISSUES

Partners With a Purpose

Working Together To Provide Behavioral
Health Care to Pediatric Patients

Pediatric behavioral health care is changing. Until
recently a referral to a behavioral health specialist 
required special trips, most likely into Oakland, for
the child and family — and often a loss of control
over the child’s care for the referring physician.

Now, thanks to a unique, new model of care
developed in a collaborative effort among
the Child and Family Counseling Center
(CFCC), at Children’s Hospital of Pittsburgh
of UPMC, Children’s Community Pediatrics
(CCP), and Western Psychiatric Institute
and Clinic of UPMC (WPIC), kids who need
behavioral health care can access it much
more easily — sometimes right down the hall
from their doctor’s office.

Begun as a pilot project at one CCP practice in the
summer of 2007, the project put pediatric behavioral 
health specialists directly in those offices. Due to the
success of this initial site, two additional practices 
added behavioral health specialists in the fall of 2008.
Each of the three pilot practices — CCP–South Hills
Pediatric Associates (SHPA) in Brentwood, CCP–Mt.
Lebanon, and CCP–Pittsburgh Pediatrics — put its own
resources into developing dedicated spaces for behavioral
health, which include child-friendly items like puppets and
paints for therapeutic play, softer lighting, and comfortable
furniture.

Now, eight therapists see patients. Twenty practices have therapists on-site, and children from seven others are seen at Pine Center, Wexford. About 80 percent of the diagnoses are for anxiety, depression, or ADHD.

“We know that patients’ care is better with a ‘home base,’ where the other aspects of care revolve around the PCP, who helps coordinate care,” says Mark Diamond, MD, CCP–SHPA. “The PCP is the hub, and all other aspects of care are the spokes to that hub.”

“One of the most unique characteristics of this program is the ability for a child to see a therapist conveniently, in the office of a pediatrician the family knows and trusts,” says Michael Drnach, executive director, Ambulatory Administration at Children’s Hospital. “This has been a successful way to start breaking down the barriers that surround behavioral health.”

The results are telling. At the Brentwood practice, both the days and hours the therapists were available had to be increased. Now, two therapists — Barb Minnich, LPC, and Tiffany Tipton, LCSW— and psychiatrist Abigail Schlesinger, MD, cover the Brentwood practice eight hours a day, five days a week.

For families who don’t use those eight CCP practices, their children can be seen at the program’s hub, located at Pine Center in Wexford.

A Focus on the Child's Needs

Pediatric behavioral care has long been an underserved and misunderstood market. For years, the CFCC at Children's Hospital was a referral resource for community pediatricians looking for behavioral health care for their patients, assisting with assessment, diagnosis, and treatment recommendations.

Also for years, behavioral health systems were not set up to interface smoothly or easily with pediatric systems. Pediatric patients were "handed off" to behavioral health specialists by the pediatrician, health records were set up differently, and the systems even had different regulations.

There was a need for a new model of care, one that kept the focus on the child's needs and the pediatrician intimately involved.

Now, with this new collaboration in place, the hand-off is gone: In most cases, unless the child requires specialty care at WPIC, he or she is seen at the pediatrician's office. "The key is, the pediatrician is managing the child's condition with the support of the therapist," says Gretchen Crum, LCSW, clinical manager of the Child and Family Counseling Center. "They're working together."

Child and adolescent psychiatry services have played a significant role in developing this collaborative approach to care. Currently, Dr. Schlesinger, a faculty member at WPIC, sees patients two days each week as part of CCP's behavioral health care services. Jill McCulloch, MD, another child psychiatrist from WPIC, recently joined the team.

"What Do Pediatricians Want?"

The program began with a question — “What do pediatricians want?” when they are considering behavioral health care options for their young patients.

The answers included improving communication between the pediatrician and therapist, easing the way for children and their families to access behavioral health services, and enhancing the child’s care by keeping as much of it as possible in his or her pediatrician’s office — the “medical home.”

Each spoke of the “wheel”— mental health therapists, families, psychologists, and child and adolescent psychiatrists — brings its individual voice and expertise to bear in order to collaborate on the best treatment plan for each child. Judging from the patient satisfaction surveys conducted relative to the project, patients and their families agree. Survey results have been overwhelmingly positive.

Because behavioral care — and to some extent the patients receiving it — bears a certain stigma, a major goal was to make the therapists and the care they provide a part of the practice, says Ms. Crum. Dr. Diamond echoes this thought. “We think of it as another service our practice provides; it’s another benefit for our patients and families,” he says.

The program averages 600 visits a month; 1500 patients have been seen since August 2008.

This collaborative care model would have been impossible had it not been of critical importance to Children’s, CCP, and WPIC — and to the leaders at each organization. “Our Executive Steering Committee worked collaboratively, which had rarely been seen before on a clinical service,” says Ms. Crum. “This also wouldn’t have been possible without all of the leadership and physicians at CCP going above and beyond to develop the program with us.”

David Wolfson, MD, medical director of CCP, says “Parents often don’t realize how helpful a brief intervention can be in dealing with very common childhood and family issues. Often, they can be identified during a routine visit or phone conversation with the doctor. Families now can have access to the appropriate level of care, in an environment that is familiar and comfortable.”