Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC.

OBJECTIVE: Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. PROGRAM DESCRIPTION: CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. METHODS: The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. RESULTS: CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CONCLUSIONS: CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.

Teaching child psychiatric assessment skills: Using pediatric mental health screening tools.

This article describes the workshop "Teaching Child Psychiatric Assessment Skills: Using Mental Health Screening Instruments," presented at the 35th Forum for Behavioral Sciences in Family Medicine on 20 September 2014. The goals of the presentation were (1) to teach family medicine behavioral health educators to use both general and problem-specific mental health screening tools (MHSTs) in their work with trainees to help satisfy the Accreditation Council for Graduate Medical Education (ACGME) mandate for behavioral and mental health experience during family medicine residency, (2) to reflect on how MHSTs might be integrated into the flow of family medicine teaching practices, and (3) to exemplify how evidence-based methods of adult education might be used in teaching such content. One general MHST, the Pediatric Symptom Checklist-17 and one problem-specific MHST for each of the four commonest pediatric mental health issues: for attention-deficit hyperactivity disorder, the Vanderbilt; for Anxiety, the Screen for Childhood Anxiety-Related Emotional Disorders; for Depression, the Patient Health Questionnaire-9 for teens; and for Aggression, the Retrospective-Modified Overt Aggression Scale, were practiced at least twice in the context of a clinical vignette. All of the selected MHSTs are free in the public domain and available for download from the website: www.CAPPCNY.org. Participants were asked to reflect on their own office practice characteristics and consider how MHSTs might be integrated into their systems of care. This workshop could be replicated by others wishing to teach the use of MHSTs in primary care settings or teaching programs.

The development of a forgiveness scale.

This paper reports on the development, validity, and reliability of a self-report instrument designed to assess a respondent's perspective of pain resulting from relational violations and work toward relational forgiveness based on a framework proposed by Hargrave (1994a). Presented here is the five-stage procedure used in the development of the Interpersonal Relationship Resolution Scale. Construct validity and reliability were determined from an initial sample of 164 subjects. Concurrent validity of the scale was supported by another sample of 35 respondents who took the Interpersonal Relationship Resolution Scale, the Personal Authority in the Family System Questionnaire, the Relational Ethics Scale, the Fundamental Interpersonal Relations Orientation-Behavior scale, and the Burns Depression Checklist. Finally, a predictive validity study of the scale was performed with a clinical and nonclinical sample of 98 volunteers. Data are presented that support the validity and reliability of the instrument, as well as the final version of the scale.

Deleading dilemma: pitfall in the management of childhood lead poisoning.

Deleading is a dangerous process which, if improperly done, can result in acute lead intoxication. The following case report illustrates what happened to an already-lead-poisoned child's lead level when he was not excluded from his apartment during deleading. Supportive evidence is provided from 12 additional cases recently seen by the same pediatric practice. The issues behind the failure of these families to vacate their apartments during deleading are discussed, and the need for lead-poisoning prevention programs to address these issues, particularly that of providing alternative shelter during deleading, is stressed. Society should adequately fund such programs so that they become a reality.