A Phone Consultation Call Line to Support SBIRT in Pediatric Primary Care.

Background: Screening Brief Intervention Referral to Treatment (SBIRT) is recommended as a routine part of pediatric primary care, though managing patients with positive screens is challenging. To address this problem, the state of Massachusetts created a call line staffed by pediatric Addiction Medicine specialists to provide consultations to primary care providers and access to a behavioral health provider specially trained in managing adolescent substance use.

Objective: To describe the uptake and outcomes of a consultation call line and virtual counseling for managing substance use disorders (SUD) in pediatric primary care.

Comparison of Use of the Massachusetts Child Psychiatry Access Program and Patient Characteristics Before vs During the COVID-19 Pandemic.

This cross-sectional study compares the number of encounters at the Massachusetts Child Psychiatry Access Program, patient characteristics, and mental health diagnoses before vs during the COVID-19 pandemic.

Depressive symptom screening and endorsement of psychosis risk-related experiences in a diverse adolescent and young adult outpatient clinic in the US.

Background: Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations.

Adolescent SBIRT Practices Among Pediatricians in Massachusetts.

Objectives: Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care is a key strategy to prevent, identify, and respond to substance use problems and disorders, including opioid and other drug addictions. Despite substantial investment in recent years to increase its implementation, few studies have reported on recent levels of SBIRT implementation among pediatricians. We aimed to assess self-reported use of the SBIRT framework with adolescent patients among Massachusetts pediatricians, and describe trends since an earlier survey.

Massachusetts Child Psychiatry Access Project 2.0: A Case Study in Child Psychiatry Access Program Redesign.

The Massachusetts Child Psychiatry Access Program is a statewide public mental health initiative designed to provide consultation, care navigation, and education to assist pediatric primary care providers in addressing mental health problems for children and families. To improve program performance, adapt to changes in the environment of pediatric primary care services, and ensure the program's long-term sustainability, program leadership in consultation with the Massachusetts Department of Mental Health embarked on a process of redesign. The redesign process is described, moving from an initial strategic assessment of program and the planning of structural and functional changes, through transition and implementation.

Screening Adolescents for Alcohol Use: Tracking Practice Trends of Massachusetts Pediatricians.

Objectives: Substance use screening is a recommended component of routine healthcare for adolescents. A 2008 survey of Massachusetts primary care physicians found high rates of screening, but low rates of validated tool use, leading to the concern that physicians may be missing substance use-related problems and disorders. In an effort to improve practice, a cross-disciplinary group developed and distributed an adolescent screening, brief intervention, and referral to treatment toolkit in 2009.

Behavioral health care for children: the massachusetts child psychiatry access project.

Access to behavioral health care for children is essential to achieving good health care outcomes. Pediatric primary care providers have an essential role to play in identifying and treating behavioral health problems in children. However, they lack adequate training and resources and thus have generally been unable to meet children's need for behavioral health care.

Clinicians' utilization of child mental health telephone consultation in primary care: findings from Massachusetts.

Objective: The authors examined utilization of the Massachusetts Child Psychiatry Access Project, a mental health telephone consultation service for primary care, hypothesizing that greater use would be related to severe psychiatric diagnoses and polypharmacy.

Methods: The authors examined the association between utilization, defined as the mean number of contacts per patient during the 180 days following the initial contact (July 2008-June 2009), and characteristics of the initial contact, including consultation question, the child's primary mental health problem, psychotropic medication regimen, insurance status, and time of year.

Results: Utilization (N=4,436 initial contacts, mean=3.

Medico-legal risk associated with pediatric mental health telephone consultation programs.

Clinicians providing consultation through mental health telephone consultation programs express concern about the potential legal risk of the practice. In this survey of six state mental health telephone consultation program directors, we report the annual number of children referred for consultation and the number of lawsuits against consultant clinicians. Between 2004 and 2010, 3,652 children per year were referred nationally, and there were no medical malpractice lawsuits against clinicians related to telephone consultation program activity.

Bridging the divide between child psychiatry and primary care: the use of telephone consultation within a population-based collaborative system.

The Massachusetts Child Psychiatry Access Project is a public system for improving access to care for children with mental health problems in which the provision of telephone consultation by child psychiatry teams to pediatric primary care providers (PCPs) plays a central role. In this article, the practice of telephone consultation within this system is explored through the examination of case studies, demonstrating its use in common clinical scenarios. The telephone consultations provide immediate case-based clinical education, and also serve as a gateway for the provision of as-needed direct child psychiatry evaluation and care coordination services.

Improving access to mental health care for children: the Massachusetts Child Psychiatry Access Project.

Background: Inadequate access to care for mentally ill children and their families is a persistent problem in the United States. Although promotion of pediatric primary care clinicians (PCCs) in detection, management, and coordination of child mental health care is a strategy for improving access, limitations in training, time, and specialist availability represent substantial barriers. The Massachusetts Child Psychiatry Access Project (MCPAP), publicly funded with 6 regional consultation teams, provides Massachusetts PCCs with rapid access to child psychiatry expertise, education, and referral assistance.

The interdependence of behavioral and somatic health: implications for conceptualizing health and measuring treatment outcomes.

Purpose: The interdependence of behavioral and somatic aspects of various health conditions warrants greater emphasis on an integrated care approach.

Theory: We propose that integrated approaches to health and wellness require comprehensive and empirically-valid outcome measures to assess quality of care.

Method: We discuss the transition from independent to integrated treatment approaches and provide examples of new systems for integrated assessment of treatment outcome.

Implementation of a consumer-directed approach in behavioral health care: problems and prospects.

Consumer-directed care, a payment system designed to make patients aware of the costs of care, requires treatment seekers to be active participants in their health care. Core components of consumer-directed care, such as higher deductibles and increased decision-making responsibilities, might preclude its easy translation from medical to behavioral health care. Aspects of behavioral disorders will force providers, insurers, and patients to compensate for unique barriers to increasing self-care, such as stigma, neuropsychological complications, and poor self-efficacy.