Teaching. Discovering. Caring. Presenter: Donita Lamarand, BSN, CPHRM Director of Risk Management, EVMS and Children s Specialty Group

Transcription

1 Teaching. Discovering. Caring Presenter: Donita Lamarand, BSN, CPHRM Director of Risk Management, EVMS and Children s Specialty Group

2 This speaker does not have any potential conflicts of interest to disclose

3 BRIEF OUTLINE 1. Why the push for Pediatric Primary Care providers to provide mental health treatment. 2. Is this within the PCP s scope of practice? 3. Who defines and monitors a provider s scope of practice 4. What are the added risks 5. How to reduce the risks and still put your best foot forward.

4 In 2009, the American Academy of Pediatrics published a Policy Statement The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care. 1 Numerous organizations, policy statements and white papers are promoting the integration of mental health into pediatric primary care American Academy of Child & Adolescent Psychiatry National Institute for Health Care Management Medical Economics

5 The Affordable Care Act (ACA) will give over 60 million Americans access to mental health and substance abuse benefits There is and will continue to be a shortage of child and adolescent psychiatrists The Primary Care physician is the single most important provider of the nation s health care system. PCP s represent access, stability, consistency, familiarity, and trust to their patients and families

6 The conclusion: The primary care provider is the best option to treat a number of children with mental health and substance abuse issues. This patient population will increase in volume and complexity PCP will need mental health competencies PCP will need to consider new models of collaboration which may include consultation via telepsychiatry, co-locations and establishing the Medical Home to include mental health

7 When broadening your scope of practice you should know; The definition of Scope of Practice Who defines it. Who regulates and monitors it. What are your added risk exposures. How do you reduce those risks. Teaching. Discovering. Caring.

8 Federation of State Medical Boards, FSMB, a nonprofit association of all medical licensing and disciplinary boards in the United States and who acts as a collective voice for member medical boards defined scope of practice in a 2005 report; 2 The activities that an individual health care practitioner is permitted to perform within a specific profession. The activities shall be based on appropriate education, training and experience. FSMB established a set of guidelines for State legislators and regulatory boards to use when considering requests for expansion of scopes of practice.

9 Further defined by each State s Board of Medicine Oversight is within the purview of State law and regulation. Changes must be made by legislative process BOM monitors and enforces the regulations Investigates complaints regarding individual and group scope of practice Collaborates with the Medical Society of Virginia when there are questions or concerns Closely monitors other disciplines who submit requests to amend their scope of practice, for example Nurse Practitioners Physician Assistants

10 Other factors that determine scope of practice Residency and Fellowship Training ACGME core competencies Specific Practice Associations American Academy of Pediatrics Geography availability of specialty care or lack there of Employer and group practice established scope of practice call group Individual physician s additional training and competency* Individual physician s desire to limit or broaden their scope of practice* New treatment modalities and/or procedures da Vinci robotic surgery *Has to be within BOM s definition of scope of practice

11 Broadening your scope of practice is different than practicing outside of it PCP has appropriate education and training; needs experience Increased risk to doing just a little of any type of treatment Need to decide to be all in or not at all Start with a defined set of mental health issues, such as ADHD, anxiety, depression and substance abuse disorders. 3

12 Physicians may be reluctant to broaden their scope of practice because it increases their chances of being sued Fact is, PCPs are seeing and treating patients with mental health issues already. Higher risk associated with not not assessing the mental health needs of your patients than there is in treating them. You are not expected to be a mental health professional

13 For any treatment a physician provides they are held to the standard of care. Standard of Care is defined as; The type and level of care an ordinary, prudent, health care professional, with the same training and experience, would provide under similar circumstances in the same community. When treating a patient, a physician takes on an obligation to use minimally sound medical judgment and render minimally competent care in the course of serves provided. 4

14 Be Proactive Assess your current patient demographics Common mental health diagnoses of current patients Cultural and ethnic diversity Payer mix Assess your practice Do you have the capacity for additional services Are your partners interested in broadening the practice s scope of practice What ancillary staff do you have; what is their skill set

15 Should discuss what types of mental health issues your group is competent and comfortable in treating and which patients should be referred be consistent What internal resources are available to support the physicians and the practice; Risk Management Clinical administrator Billing and Coding Mental Health Colleague(s) in same multispecialty group/organization

16 Assess current resources External Resources Community referrals for both children and adolescents Family Counseling services Communications with school counselors Community Service Board for your catchment area Internal mental health resources Does your group practice have mental health professionals What is their scope of practice and are they available to you

17 Consider screening all patients or at specific ages/well child check-up Use a reliable and validated assessment tool for patients with mental health issues Select screening tools that you are comfortable with and understand the results ask a mental health professional for recommendation Have a suicide assessment tool Have a substance abuse assessment tool Have a family assessment tool

18 Decide which service model(s) would best meet your patient s and your practice s needs 5 Consultation Formal Curbside be careful here Use of telepsychiatry viable option Co-locating mental health professionals in your practice Collaborative care models

19 Build a resource library starting with your toolkit from this conference Have your staff contact the mental health providers in your geographic location and expand outward. Ask what their scope of practice is Ask how to refer patients what is the average wait for a new appointment Do they take emergency referrals Get a contact name and number for each practice

20 Investigate and evaluate the use of video-based online mental health services (practice guideline is included in your toolkit) Contact your area s Community Service Board regarding what services they provide to children and adolescents How do you access those services or make a referral to the CSB Do all patients have to present to the ED Get a contact name and number

21 Additional resources to include; Inpatient treatment facilities for child and adolescents, both voluntary and involuntary admissions Outpatient treatment facilities and/or providers; Child Psychiatrist Child Psychologist Family Therapist Substance Abuse Treatment Counselors Gets names and contact numbers

22 Additional resources continued; Need educational information for families List of websites that you or your staff have vetted Names of organizations that offer information and support National Alliance on Mental Health NAMI NAMI for Parents, Caregivers and Youth Consumers Child Welfare Information Gateway U.S. Department of Health and Human Services

23 Pediatric Primary Care Physicians who treat patients with mental health issues will have a significant impact on the growing numbers of these children and adolescents. By taking the steps to increase their competencies and experience to treat mental health, develop collaborative consultative relationships with mental health professionals, and build a library of resources for referrals, the PCP will reduce their risk exposure when broadening their scope of practice.

24 1. Pediatric Symptom Checklists available to download from Mass General and scoring the PSC American Academy of Pediatrics Mental Health Concerns in Primary Care A Clinicians Toolkit Health/Pages/Addressing-Mental-Health-Concerns-in-Primary-Care-A-Clinicians- Toolkit.aspx 3. Resources for parents of children with mental illness 4. National Alliance of Mental Illness Resources and Support for Parents, Caregivers and Youth Consumers 5. American Academy of Child & Adolescent Psychiatry; A Guide to Building Collaborative Mental Health Care Partnerships In Pediatric Primary Care building_collaborative_mental_health_care_partnerships.pdf

25 1. American Academy of Pediatrics, Policy Statement The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care. Pediatrics. 2009; Volume 124, Number 1: Federation of State Medical Boards of the United States, Inc., Assessing Scope of Practice in Health Care Delivery: Critical Questions in Assuring Public Access and Safety, 2005 p American Academy of Pediatrics. Mental Health Initiatives: Primary Care Tools Report From the American Academy of Pediatrics Task Force on Mental Health. 4. Hall v. Hilburn, 466 So. 2d 856 (Miss. 1985) 5. National Institute for Health Care Management; Strategies to Support the Integration of Mental Health into Pediatric Primary Care : Issue Paper, August 2009