Patient Tracking Portal
HIPAA compliant Tracking
Mental Health Scales
Electronic Administration & Scoring
24/7 Access
Connect via any mobile/web device

Trained or not, family doctors and pediatricians are on the front lines of mental health care

, Nashville Tennessean


Here are some tips to help recognize a mental health crisis and how to help. Ayrika L Whitney, The Tennessean

When a sick kid steps into the pediatrician’s office, it could be for just about anything: an ear infection, a twisted ankle or an upset stomach. And sometimes, behind all those outward symptoms, there is something deeper that needs attention.

Pediatricians and family doctors have long served a crucial but largely undefined role in American mental health care, diagnosing and treating depression and anxiety in addition to everyday physical injuries and common diseases.

But amid rising concern about mental health and gun violence in America, experts say these primary care doctors could do more to spot red flags among their patients.

Dr. Nathaniel Clark, chief medical officer at Vanderbilt Behavioral Health, described the task of primary care doctors as challenging: They are the Swiss army knives of medicine, expected to do a little of everything, but also a front-line defense in a growing mental health crisis.

“As health care has become more complicated, the pressure on family care providers to do it all has increased exponentially,” Clark said.

“But what’s also happened is there is a growing awareness of how common behavior health disorders are. And the challenge for family practitioners and pediatricians is partly that, while they have excellent training, it’s not necessarily focused on behavioral health.”

Psychiatrists are in short supply throughout Tennessee and nationwide, so the vast majority of mental health disorders are diagnosed and treated by primary care doctors. Nearly all these doctors studied mental health at one point because a psychiatry rotation is mandatory in most medical schools. But once school is done, the amount of continuing education they get in the field of mental health varies broadly.

More: Clergy not prepared to meet congregations’ mental health needs

More: When we have mental health crises, are our schools, churches or doctors offices prepared?

But now a relentless drumbeat of deadly mass shootings — including Nashville’s own Waffle House shooting — has spurred a nationwide desire to prioritize mental health and expanding training options for primary care doctors.

In Tennessee, the governor’s office has led an initiative called “Building Strong Brains,” funded with $1.25 million from state lawmakers the past two years, including grant funding for mental health education for pediatricians and other doctors.

Training primarily focuses on the link between early-age childhood trauma, officially known as “adverse childhood experiences,” and teenagers with behavioral and physical health problems.

In addition to the Building Strong Brains program, the Tennessee Chapter of the American Academy of Pediatrics has launched the Behavioral Healthcare in Pediatrics training program, or BeHIP, in which doctors learn from real cases of children with complex mental health diagnoses.

The program started small, uniting about five pediatricians in the state’s northeast corner, but is now expanding into Knoxville. Organizers hope to expand it statewide, said Dr. Michelle Fiscus, BeHIP medical director.

Participating doctors discuss challenging mental health cases within Tennessee’s children protective services system, Fiscus said. That experience should make the doctors’ interaction with other patients with depression or attention deficit disorders “much less intimidating.”

“It makes perfect sense that a pediatrician could be a great resource and manager of behavioral health concerns for our patients,” Fiscus said.

Fiscus, a Franklin pediatrician, said she envisioned the BeHIP training program in part because of an uncertainty she felt when treating mental health patients years ago. Too many other doctors, she said, still feel the same way.

“Across the state, it’s not the biggest topic that pediatricians want to treat,” Fiscus said. “Because it’s so large and so broad, sometimes they don’t know where to start when it comes to mental health.”

Jessica Bliss contributed to this report.

What’s Driving ‘Whole Health’ For Children?

By Monica E. Oss


A couple weeks ago, I hosted our first annual OPEN MINDS Children’s Services Executive Summit. In the opening session, The 5 Key Trends Driving Change In Children’s Services, I discussed how the push for “integrated care” is changing the financing and delivery for children’s services—much like it is with health care overall. But, the issues for children are unique, and the “integration” is spanning not just health care and services for children with disabilities, but also child welfare and special education services.

This market shift is illustrated by the launch of the Whole Child Model Program in California, which integrated most services in the California Children Services (CCS) program with the health plans in select areas of the state. The CCS program, which provides services to children with special needs and disabilities, previously delivered and financed services fee-for-service. The program also requires health plans to report on a series of quality measures including emergency room utilization, family satisfaction, mental health visits, and inpatient stays (see California Medicaid Launches Whole Child Model Program).

And, a recent assessment of the New Hampshire child welfare system by Public Consulting Group (PCG) called for more integration of mental health, addiction treatment, and preventive services to better support youth and families. It even included a recommendation to contract with Medicaid managed care organizations to create and support a continuum of community-based services for youth with complex needs. PCG also called for “continuous accountability, quality improvement, and data mechanisms to track, monitor and manage the achievement of system of care goals, fidelity to the system of care philosophy, and quality and effectiveness at the geographic, agency, system, and individual level” (see New Hampshire Child Welfare Assessment Recommends Integrating Behavioral Health & Preventive Services).

There is good reason for this push for better coordination of services for children—there are wide variances in state performance on measures related to child health. My colleague, Athena Mandros, recently took a look at the Child Medicaid Core Set for behavioral health and found that the median state score on 30 day follow-up after a mental health hospitalization was 44.7% and the median state score on 30 day follow-up after an ADHD medication was newly prescribed was 48.8%. And state scores on these measures ranged by 82.5 percentage points and 72.9 percentage points, respectively (see Are The Kids All Right?).

And other recent research results illustrate the “gaps” in serving children in the U.S. health and human service system.

Only one-third of children receive the developmental screening and surveillance that is recommended during early childhood, meaning that of the estimated nine million children aged 9 through 35 months, only 30.4% received developmental screening and only 37.1% were reported to have received developmental surveillance (see A Third Of Children Receive Recommended Early Childhood Developmental Screening & Surveillance).

A 2018 lawsuit filed against the California Department of Health Care Services (DHCS) alleges that the state Medicaid program (called Medi-Cal) fails to provide adequate in-home nursing care for children with disabilities, with at least 29% of authorized Medi-Cal nursing hours going unstaffed (see Lawsuit Alleges California Medicaid Fails To Provide Adequate In-Home Nursing Care For Children With Disabilities).

Children who experience a traumatic brain injury (TBI) commonly have unmet treatment needs during the two years after the injury—over 25% of children with “complicated mild TBI” had unmet service need for speech therapy, mental health, services, educational services, and psychiatry services (see Unmet Therapy Needs Common In Children With Traumatic Brain Injury). And, about 20% of children hospitalized for TBI never return for outpatient follow-up treatment. Of those that do return for outpatient follow-up, 27% miss appointments (see Many Hospitalized Children With TBI Do Not Return For Follow-Up Care).

While each of these stories represents a narrow view of the market, I think they are pieces of a long-running trend where the need for services is misaligned with the services actually received. This arises from the siloed funding and service mentality that defines most of the market. For more on the children’s services market, check out these resources:

  1. Los Angeles County Contracts With A Second Chance, Inc. To Address Foster Family Approval Process Backlog
  2. Texas DFPS Selects Family Tapestry For Bexar County Foster Care Management Contract
  3. New Integrated Child Health System Goes Live In Wales
  4. Homelessness During Infancy: Associations With Infant & Maternal Health & Hardship Outcomes
  5. Apricot Case Management Software Receives $59 Million Investment
  6. ACF Launching EBP Clearinghouse For Family First Prevention Services Act
  7. Parents With Adverse Childhood Experiences More Likely To Have Children With Behavioral Health Problems
  8. Iowa Agrees To Change Special Education Requirements
  9. Maine Medicaid To Cover Youth Psychiatric Residential Treatment Facility Setting
  10. Settlement In Kentucky Lawsuit About Faith-Based Foster Homes Ruled Unenforceable

Want to keep up on all the latest news about the children’s service market? With one click, you can customize the market intelligence that comes to your inbox and receive our monthly market intelligence report on children’s services. Update your email preferences today to receive this monthly report—a summary of all of OPEN MINDS’coverage of the children’s service market.

Need a refresher on the metrics that are driving all improvement in health care service delivery? Join us at The 2018 OPEN MINDS Technology & Innovation Institute on October 23 in Philadelphia for the session: “Mapping Performance To Manage Value: The Clinical Data You Need To Manage The Risk Of Value-Based Reimbursement”, featuring OPEN MINDS Senior Associate Joseph P. Naughton-Travers; Vinfen President & Chief Executive Officer, Bruce L. Bird, Ph.D.; and Project Transition Chief Executive Officer, Luke Crabtree, J.D., MBA.