Innovative Solutions at CHOP Are Removing Barriers to Mental Health Care

Brooklyn, 5, receives behavioral health services right in her CHOP primary care office in South Philadelphia. Her pediatrician, Katie Lockwood, MD (at right), referred her to psychologist Jennifer Mautone, PhD (left), who works in the same office. Picture a child’s classroom. According to research, one out of every five of the kids sitting there has or will have a mental or behavioral health condition in any given year.

It may be aggressive behavior, attention deficit hyperactivity disorder, anxiety, an eating disorder, depression, autism spectrum disorder or one of a multitude of other problems. While these children would benefit from treatment from behavioral health specialists, getting that treatment can be difficult.

There’s a nationwide shortage of mental health care providers — about 20,000 too few — and some families still feel lingering stigma in seeking care, so they don’t always follow through on a referral to see a psychiatrist, psychologist or counselor. Children’s Hospital of Philadelphia is tackling those hurdles in a way that’s both revolutionary and profoundly simple: by bringing behavioral and mental health care into primary care offices in the CHOP Care Network.

Co-location convenience

“Kids should be able to get their healthcare all in one place — well care, sick visits and behavioral health,” says Tami Benton, MD, Chief of the Department of Child and Adolescent Psychiatry and Behavioral Sciences. “We’re creating models to make that happen.”

In the Healthy Minds, Healthy Kids (HMHK) program, when pediatricians hear about or see a behavioral health issue in a patient, they can connect the family to a behavioral health specialist who works as a member of the practice. Often, the behavioral health specialist can meet briefly with the family right then. Future appointments happen in the primary care office, which is convenient for families and reduces stigma.

Right now, HMHK is available in six CHOP Care Network primary care locations — South Philadelphia, Chadds Ford, HighPoint, Central Bucks, Haverford and Cobbs Creek — and more are slated to begin services this year.

Help where and when needed

Jennifer Mautone, PhD, an HMHK psychologist who sees patients in CHOP’s South Philadelphia primary care practice, has experienced numerous success stories.

• Reducing tantrums: Parents of a 6-year-old boy told their pediatrician that their son was frequently throwing temper tantrums. The doctor connected them with Mautone. In their first session, the parents mentioned their son had trouble sleeping. She arranged for a sleep study at CHOP that led to a diagnosis of obstructive sleep apnea. Exhaustion was exacerbating the child’s behavioral problems. The boy had his tonsils removed, improving his sleep. Mautone also taught the parents strategies to address his tantrums. Today — with his parents’ help — the boy’s behavior is much better.
• Easing anxiety: A mother brought her 8-year-old daughter to the pediatrician because the girl had been complaining of chest pain and a racing heart. The doctor found no physical cause of her symptoms but heard extreme anxiety in her voice. Mautone saw the family that day and worked with them to get an appointment with an outpatient provider for treatment for intense anxiety and mood disorder.
• Helping depression: A 17-year-old girl scored as at-risk on a depression questionnaire during her annual well visit. Concerned, her pediatrician recommended she see Mautone. The teen had been referred to a behavioral health provider in the past for low mood, but she wasn’t comfortable going to a community provider. Working with Mautone, however, the girl completed cognitive behavioral therapy and her mood, coping skills and relationships with family members improved significantly.

“It’s great to collaborate closely with pediatricians and meet children and families in an office that is familiar to them,” Mautone says. “They know that everyone in the office is part of their care team, and families have told me they feel more comfortable with behavioral health care as a result.” Early statistics of HMHK bear that out: Families are able to see a behavioral health specialist much more quickly, and the shorter gap between referral and first appointment has led to far fewer no-shows when compared to referrals to community providers.

A direct line

There are times when a primary care physician needs to consult with a psychiatrist right away. That’s when TiPS (Telephonic Psychiatric Consultation Service Program) can help.

The pediatrician calls the TiPS line and, within an hour, talks to a psychiatrist to get questions answered. “We get all types of calls,” says Taliba Foster, MD, a psychiatrist who is Medical Director for TiPS. “The primary care pediatricians are great partners because they know the child and family through a long-standing relationship. We’re there for them when they need help managing psychotropic medications or their patients have complex social and behavioral issues.”

If the child needs behavioral health services outside the scope of what the pediatrician can provide, the TiPS care coordinator helps the family access those services, such as specialty psychiatry or a neuro-psychological assessment. Right now, TiPS is available to physicians treating patients insured by Medicaid from the five-county Philadelphia region — a total of 400,000 children.

“Having quick access to someone who can guide you and help troubleshoot a psychiatric issue is a really wonderful service,” says Mary Fabio, MD, a pediatrician in the Nicholas and Athena Karabots Primary Care Center. “I’m seeing an increase in frequency and intensity of mental and behavioral issues, and more children are presenting at a younger age. It’s great to be able to pick up the phone and get answers in an hour or so.”

Bolstering knowledge

Other initiatives will help primary care providers feel more comfortable handling some behavioral health issues on their own. CHOP is rolling out a series of education sessions that will fill knowledge gaps so pediatricians can evaluate their patients’ emotional development along with their physical development. Equipping primary care pediatricians with additional behavioral health skills increases the opportunity for earlier diagnosis so treatment can begin before a problem escalates.

“When we accommodate the kids in the CHOP Care Network who need behavioral health services, we’re giving families what they need, where they need it,” Benton says. “We’ll continue to make changes that expand access to mental health care because we recognize the body and the mind do not separate.”