Development of Integrated Mental Health Services within the primary clinics at the Penn State Hershey Medical Center
Objectives:
In the United States, the need for pediatric psychiatric care exceeds the availability, leading to long waitlists for appointments With the national shift towards population medicine, it will be even more imperative to develop efficient models of care that emphasize early detection and intervention in primary care settings.
In this changing healthcare environment, pediatricians will be expected more frequently to treat mental health disorders and to start psychiatric medications. Approximately half of the pediatric office visits in a primary setting involve emotional, behavioral, developmental, psychosocial,
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Outpatient pediatric clinics and outpatient child psychiatric clinics are often housed in separate buildings, so pediatricians and child psychiatrists rarely meet in the outpatient setting.
Method
The Division of Child and Adolescent Psychiatry at The Penn State Hershey in collaboration with the Department of Pediatrics developed a Collaborative Model for provision of pediatric behavioral health services at the Hershey Medical Center. The goal was to improve access to behavioral health services and to provide increase support to pediatric medical providers across the HMC campus. Additional goals are to speed the effectiveness of behavioral health treatments offered in pediatric medical settings.
Clinic embedded within the Departments of Psychiatry and Pediatrics’ efforts to establish a collaborative care model for child mental health issues across Penn State Milton S. Hershey Medical Center.
Outcome measures will include satisfaction ratings from referring pediatric staff and participating families, wait times for receipt of behavioral health services and the total number of behavioral health visits in medical
IDENTIFYING INFORMATION: Raven Wright is a 13-year-old eighth-grader who was initially scheduled to be seen at the Psychiatric Consultation clinic at the outpatient pediatrics. The clinic staff was contacted by patient 's the therapist, who brought up a number of concerns. Per review of the chart, Dr. Sandra Shocket was concerned that the child is having thoughts of harming self and others without a plan and that child hears a voice telling her to do things. Raven was described as, anxious and depressed. At the time of appointment
As a pediatric hospitalist, there are a wide range of duties that must be completed for the safety and well-being of one’s patients. A duty amongst all physicians is caring for a patient’s illnesses. As a pediatrician, one must be involved in the physical, mental, and emotional upbringing of adolescents throughout every stage of development in good health as well as in illness. A pediatrician takes care of a child from a few weeks after birth to the age of twenty-one when the patient transfers to a new physician. The duties designated to all pediatricians is to reduce infant and child mortality rates, control diseases, make sure patients lead well-maintained lifestyles, and make easier the lives of children and adolescents with chronic conditions. Becoming a pediatrician would improve the lives of many children.
According to the Academy of Pediatrics, the average length of a preventative care visit is under 30 minutes. During this visit, the pediatrician personally spends under 20 minutes with the child and his or her parents. (Hutchinson) It does not seem feasible that a pediatrician is able to fairly assess a child’s physical health, let alone assess him or her for psychological issues in such a short amount of time.
These children had the worst histories I have seen in mental health nursing. The opportunity to work with this population was the most difficult and honorable thing I have done in my life. Part of my goal as a nurse practitioner will be to work with the underserved and difficult populations that others are not willing to work with. The next four years I spent floating around seven different units at CenterPointe Hospital. Some of the units include adult detox unit, geriatrics, acute adult, chemical dependency residential programs, and adolescent units. Child and adolescents are my passion but working with dual diagnosis, acute adults and geriatric/dementia populations gave me a well-rounded experience. I have also worked the last 3 years PRN as an eating disorder nurse. This vast experience working with every psychiatric population has taught me much about psychiatric disorders and provided me with balanced work history. In addition, I have worked as charge nurse of these units and gained leadership skills. I intent to use the experience and knowledge from my nursing career to help me assess, diagnose and treat, as a nurse
The documentary “The Medicated Child” gave me a lot of insight into the lives of children diagnosed with bipolar disorder. When we hear and learn about bipolar disorder, we do not normally think of children. However, there are many children diagnosed with bipolar disorder ranging from all ages. As we saw in the documentary, bipolar disorder can be very hard on both the child and the family, so finding a cure that is effective and safe is important. The video also highlighted how little research there has been on the effectiveness of antidepressants on children.
Goldstein (1995, as cited in Gol & Jarus, 2005) and Cantwell (1996, as cited in Gol & Jarus, 2005) explain referral to mental health services is prevalent for children with this chronic behavioural problem. For parents needing guidance in addressing concerns, a first point of contact may be a General Practitioner where symptoms can be discussed and referral to an appropriate service considered. As Laver-Bradbury (2013) states, clinicians within a children’s mental health service or paediatric setting are recommended, although McGonnell, Corkum, McKinnon, MacPherson, Williams, Davidson, Jones, and Stephenson (2007) suggest waiting lists for services can be detrimental. Child, Adolescent and Family Services (CAFS) is a mental health service specifically aimed at targeting the needs of children 0-19 years of age. Medical and health professionals wi...
New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America: Final report (DHHS Pub. No. SMA-03-3832). Rockville, MD: Author.
Stroul, B. A., Pires, S. A., Armstrong, M. I., & Meyers, J. C. (1998). The impact of managed care on mental health services for children and their families. Future of Children, 8, 119-133.
Rather than preparing graduates in education or consulting as previous graduate nursing programs had done, this program educated psychiatric-mental health nurses as therapists with the ability to assess and diagnose mental health issues as well as psychiatric disorders and treat them via individual, group, and family therapy (ANA, 2014). Thus, the Psychiatric Mental Health Clinical Nurse Specialist (PMH-CNS), one of the initial advanced practice nursing roles (Schmidt, 2013), was born. After Community Mental Health Centers Act of 1963 led to deinstitutionalization of individuals with mental illness, PMH-CNSs played a crucial role in reintegrating formerly institutionalized individuals back into community life (ANA, 2014). PMH-CNSs have been providing care in a wide range of setting and obtaining third-party reimbursement since the late 1960’s. In 1974 a national certification for PMH-CNSs was created (APNA, 2010). Subsequently, PMH-CNSs began to be granted prescriptive privileges in the Pacific Northwest in the late 1970s, that practice has now spread to 37 states and the District of Columbia (APNA,
...(as discussed previously), attentiveness for the need of such an intervention is a step in the right direction. Furthermore, Wotherspoon, Laberge, and Pirie (2008) indicate that the “… rapid increase in the number of requests for a consultation from our child welfare partners…” (p. 391) demonstrates the positive benefits of their CMHC program. This program has built a relationship with Child Welfare and included opportunities for those workers to enhance their knowledge (Wotherspoon, Laberge, & Pirie, 2008) on child development, mental health and trauma implications. As highlighted in Bass’s et al. (2004) report, the policies and practices for child welfare agencies are varied between different states, hence their contribution towards alleviating and preventing mental health problems in young foster children is unbalanced and hard to measure in terms of success.
States obtain many services that fall under mental health care, and that treat the mentally ill population. These range from acute and long-term hospital treatment, to supportive housing. Other effective services utilized include crisis intervention teams, case management, Assertive Community Treatment programs, clinic services, and access to psychiatric medications (Honberg at al. 6). These services support the growing population of people living in the...
I believe that it is very important that psychologists and psychiatrists start looking into a long term therapy for depression in children as opposed to choppy short term therapies that might prove to be less effective than those with a more longitudinal effect.
In 1984 Congress began to appropriate funding to aid in the children’s mental health initiative. The present initiative that is in place is guided by the Substance Abuse and Mental Services Administration’s Center for Mental Health Services (CMHS). The need for reform and interventi...
A physician can test and diagnose the child, however, specialists suggest having the patient be seen by a phycologist. A psychologist is not a medical doctor and cannot prescribe medicine. They will consider giftedness, temperaments, family problems, social problems, and discipline strategies. In this manner the child or adult le...
National Institute of Mental Health. Transforming the understanding and treatment of mental illnesses. Depression in Children and Adolescents (Fact Sheet). Retrieved March 6, 2014, from http://www.nimh.nih.gov/health/publications/index.shtml