Latest / Pediatrics in Practice: A CME Podcast / Bringing Behavioral Health Into the Pediatric Clinic

Transcript

Bringing Behavioral Health Into the Pediatric Clinic · Pediatrics in Practice: A CME Podcast

• 0:03
  Dr. Bob Underwood (Host):
• 0:03
  Welcome to Pediatrics in Practice, a CME podcast.
• 0:07
  I'm Dr.
• 0:07
  Bob Underwood.
• 0:08
  And with us today is licensed clinical social worker Rebekah O'Donnell, who is
• 0:15
  an integrated behavioral health provider from Children's Mercy Kansas City.
• 0:21
  And today, we will talk about integrated behavioral health and how this model
• 0:26
  can transform care for children and families in the primary care setting.
• 0:31
  So, Rebekah is going to help us understand that a little bit better.
• 0:34
  Rebekah, welcome to Pediatrics in Practice.
• 0:38
  Rebekah O'Donnell: Thank you for having me.
• 0:40
  Host: Absolutely.
• 0:41
  So just to start us out, to level set for all of our listeners, how do you
• 0:47
  define integrated behavioral health in a primary care pediatrician's setting?
• 0:53
  And what does a good integration look like in a day-to-day practice?
• 0:59
  Rebekah O'Donnell: Yeah.
• 0:59
  So, integrated behavioral healthcare is integration, bringing in
• 1:04
  mental healthcare into what would traditionally be medically focused.
• 1:10
  I am in our primary care clinic working with psychologists and
• 1:14
  our medical providers to meet the everyday needs of our families.
• 1:19
  There are different types and levels of integration.
• 1:23
  So, the highest form of integration is our behavioral health clinicians being
• 1:27
  able to go in to the medical appointments, participate in warm handoffs, and meet
• 1:33
  directly with the families while they're here for their medical appointments.
• 1:37
  There are also different levels of integration like co-located services,
• 1:42
  where mental health providers are located potentially in the same building.
• 1:46
  And then, there are also lower levels of integration where it's more
• 1:50
  community relations, being able to refer families to community-based care.
• 1:55
  I think we have a bit of a mix of all of that here at Children's
• 1:58
  Mercy, where we have our integrated providers, we have our specialists
• 2:02
  or the therapists and other clinics.
• 2:04
  And then, we also still coordinate with community providers as well.
• 2:08
  Host: Sure.
• 2:08
  So, there's an array of these.
• 2:12
  Rebekah O'Donnell: Kind of like thinking about like a taco
• 2:14
  even is an example we'll use.
• 2:16
  Like, you have your taco completely put together, all your toppings, everything
• 2:20
  in there, versus a taco bar where you have the choice to pick and choose what
• 2:24
  to put together, but it's accessible, versus going to get takeout, I suppose.
• 2:29
  Host: Yeah, I love it.
• 2:30
  It's a great analogy.
• 2:32
  And the idea is to kind of make this a little bit more seamless in
• 2:35
  terms of getting behavioral health services, integrating them in
• 2:39
  with the pediatrician's practice.
• 2:41
  Rebekah O'Donnell: Exactly, yeah.
• 2:43
  Host: So, some pediatricians might feel a little overwhelmed
• 2:46
  by the volume of behavioral health needs that they actually see.
• 2:51
  So, how does an integrated model change what happens in a typical,
• 2:55
  say, 15 or 20-minute visit?
• 2:58
  Rebekah O'Donnell: I think it just adds to.
• 3:01
  I don't think it changes much for the medical provider.
• 3:04
  That they are there, they're doing their job, they're ruling out medical concerns.
• 3:08
  And this is just a bonus add-on.
• 3:10
  We get a little more depth.
• 3:12
  We get to figure out kind of seeing a more holistic picture of what's influencing a
• 3:18
  potential behavior or medical condition.
• 3:22
  So when we talk about mental health care, talk about behavioral mental health
• 3:27
  needs, but also health behaviors as well, how do we improve sleep, nutrition?
• 3:31
  I used to work in a clinic that was lifespan of integrated care.
• 3:35
  So, that's a few more topics we would cover there.
• 3:38
  But in pediatrics, I think, it just adds a little more depth.
• 3:41
  And then, it kind of takes that weight off of some of that diagnostics.
• 3:46
  How do we get a clear diagnosis?
• 3:48
  What kind of treatment is more specified to what that family needs?
• 3:53
  And how do we kind of take that load off the medical provider for us to be
• 3:56
  able to take care of that connection
• 3:58
  Host: And that's amazing and got to be, you know, a benefit to the pediatrician,
• 4:02
  but also to the patient and the families to be able to integrate like that.
• 4:08
  So, what types of concerns are best suited for integrated behavioral health within
• 4:14
  the medical home versus referral out to a specialty behavioral health service?
• 4:21
  So, kind of a combination question of what are really good
• 4:26
  integrated behavioral health.
• 4:28
  Rebekah O'Donnell: I think that's the beauty of integrated care is
• 4:32
  it can be a bit of everything.
• 4:34
  I think it really depends on the clinic and what their needs are.
• 4:38
  So, being able to do at their own needs assessment, getting to
• 4:41
  know your different providers.
• 4:43
  Some may feel very confident in addressing ADHD, but some not so much, and so that's
• 4:48
  why they need a behavioral provider.
• 4:50
  So, I think it depends on the program.
• 4:53
  I'd say particularly here at Children's Mercy and our psychology team, Dr.
• 4:58
  Belzer and all of them have done a fantastic job really addressing
• 5:02
  neurodevelopmental concerns such as autism screenings and things like that.
• 5:07
  So, I think it depends on your medical providers, what they need support in,
• 5:13
  what our community is coming in and expressing, and where there might be
• 5:17
  barriers for access in community care and how can we create accessibility
• 5:21
  within a space they're already coming to.
• 5:24
  In social work, we say meeting people where they're at
• 5:26
  and in their environments.
• 5:28
  So, I think typically a lot of integration really started with a focus on like
• 5:32
  depression, anxiety, things like that.
• 5:35
  But we also have families coming in with universal human experiences
• 5:39
  like grief or figuring out parenting at different developmental stages.
• 5:44
  So, I think it really just depends on the program.
• 5:46
  But that's the beauty of it, is being able to tailor it to your
• 5:49
  providers and your community needs.
• 5:52
  Host: I absolutely agree with that.
• 5:55
  And, you know, often, I think, many people may try to view behavioral
• 6:00
  health and medical care as separate, but they are so intertwined.
• 6:04
  And this gives us the opportunity to make sure that we're
• 6:07
  addressing both simultaneously.
• 6:09
  Rebekah O'Donnell: Yeah.
• 6:09
  So actually, when I introduce myself, I always am like, "I'm Rebekah.
• 6:13
  I'm a behavioral health consultant, which is just a big fancy way of saying
• 6:17
  I talk to kiddos about their mind and their body and how those are connected."
• 6:22
  So, we all have a mind, we all have a body, they influence one another.
• 6:26
  And there's all the research to show how we take care of our mental health impacts
• 6:31
  how our health outcomes go in long term.
• 6:35
  Host: Yeah, absolutely.
• 6:36
  So, from your experience, what are some barriers practices might face when
• 6:42
  they are trying to implement integrated behavioral health, and how have successful
• 6:49
  teams worked through those challenges?
• 6:52
  Rebekah O'Donnell: Yeah, I think first barrier is getting
• 6:55
  integration up and running.
• 6:58
  I think people fear, "Oh, we're going to have to pay another salary.
• 7:01
  It's going to be expensive."
• 7:03
  But research actually shows us that it's cost-effective and the benefits.
• 7:07
  And on a macro level, we're seeing payer sources change to more value-based
• 7:11
  payer sources, things like that.
• 7:13
  That's a whole different conversation.
• 7:14
  But I think that financial barrier really scares a lot of programs, or I think
• 7:21
  there's sometimes some outdated "mental health is separate," but we know it's not.
• 7:26
  Barriers can look different depending on what community.
• 7:28
  Are we in a rural community where we have less access to community-based resources?
• 7:34
  And how can we get flexible with that of programs doing a lot more
• 7:38
  virtual services to the rural communities or connections to
• 7:43
  psychiatry or things like that?
• 7:45
  I think the overwhelm we mentioned earlier can be a big barrier in itself.
• 7:50
  Providers are like, "I don't have time.
• 7:53
  I already have so many other things I need to address."
• 7:56
  So I think there's a couple different barriers there of
• 7:58
  financial kind of attitudes and just that overwhelm for sure.
• 8:04
  Host: Speaking of which, this may be part of the answer to the next
• 8:07
  question, which is how does integrated behavioral health support pediatricians
• 8:11
  themselves, particularly around burnout, decision-making, managing complex
• 8:18
  family dynamics, those types of things?
• 8:21
  Where does integrated behavioral health fall into that mix?
• 8:26
  Rebekah O'Donnell: Oh, I think that's one of my favorite things about it.
• 8:29
  That sigh of relief when you walk in a room or, "Thank God you're here."
• 8:37
  I wish I would start tallying how many times I hear that in a day.
• 8:41
  I think the beautiful relationship we have is such a privilege
• 8:44
  with our medical providers.
• 8:46
  I have one who jokingly calls me her Swiss Army knife.
• 8:50
  Another calls me Miss Congeniality.
• 8:53
  We're really here for them as much as we are our patients, because that is what's
• 8:58
  going to give our communities better care, allowing them to focus on the medical.
• 9:02
  Let's make this decision together.
• 9:05
  Let's talk about options.
• 9:08
  And so, I think it helps reduce burnout because it reduces that overwhelm.
• 9:13
  I think when we allow our providers to be human and they don't have to
• 9:16
  know everything, and we can take away some of that decision fatigue.
• 9:20
  I think it just takes so much off their plate.
• 9:23
  And they can then trust that we're providing quality care as well,
• 9:26
  because that can be a barrier too of, "Can I trust you with my patients?"
• 9:31
  Because these are my patients, first and foremost, and especially with
• 9:34
  complex family dynamics, being able to have kind of multiple eyes on
• 9:39
  the situation, being able to spend a little more time with the family to
• 9:44
  tease apart some of the particular factors influencing maybe why are we
• 9:49
  not adhering to medication management, or is there some social determinant of
• 9:53
  health barriers that we need to address?
• 9:56
  So, allowing providers to know they don't have to do it all and that we're here
• 10:00
  for them just as much as those patients, I think is one of the most beautiful
• 10:03
  parts of integrated care for sure.
• 10:06
  And particularly being in a teaching hospital, our residents don't always get
• 10:10
  the most robust behavioral healthcare.
• 10:11
  So, how can we educate them as we go along?
• 10:15
  And I think it teaches them to not be afraid of behavioral health.
• 10:19
  Just because a kid's got autism, we don't have to be scared to go in that room.
• 10:22
  So yeah, I think it just humanizes them, takes some of those barriers and
• 10:26
  those burdens away and, just long-term, provides better care for everyone.
• 10:31
  Host: Okay.
• 10:32
  For pediatricians listening who don't currently have access to integrated
• 10:37
  behavioral health, what are one or two concrete steps that they could take now to
• 10:43
  move their practice closer to this model?
• 10:46
  Rebekah O'Donnell: First always, this might be my social work
• 10:48
  background, a needs assessment.
• 10:51
  What are we seeing?
• 10:52
  What's going on?
• 10:53
  Where are there maybe some gaps in our care, in our education?
• 10:57
  So, first, identifying what could we do, and then advocacy with leadership about
• 11:04
  the benefits and also connecting with what resources are already out there.
• 11:09
  I think all the time I hear that with referers, they're like, "I
• 11:11
  just didn't know or I would've been telling everybody about this."
• 11:14
  I'm like, "Well, that's my job to know."
• 11:15
  So, first, identifying what the needs are, and I think that goes to like barriers.
• 11:21
  We can't do everything.
• 11:22
  So, what could we target to do and do well if that means creating
• 11:27
  particular clinical pathways and then trialing that in the clinic?
• 11:30
  What does it look like to have a psychiatrist we can refer to?
• 11:35
  What does that look like to create a referral liaison between a community
• 11:38
  mental health provider and ourselves?
• 11:41
  How do we educate ourselves about the best therapy models and medication management?
• 11:48
  Because things are constantly changing.
• 11:49
  So first identifying needs, advocating for these programs, understanding
• 11:54
  the benefit of them, and then on that personal note of how do I provide
• 11:59
  quality care with what I have access to?
• 12:03
  Host: And that's awesome.
• 12:04
  To be able to provide that and to guide clinicians, again, patients, family
• 12:10
  members all along through those things that they may not have even heard
• 12:14
  of or been integrated with before.
• 12:16
  So, as we conclude, is there anything else you'd like to add?
• 12:20
  Rebekah O'Donnell: I think it's such a privilege to get to do this
• 12:22
  work and to meet with our families.
• 12:24
  We're seeing on a macro level that primary care is the touchstone.
• 12:30
  Like, we are that linchpin for families of where do they go to first.
• 12:35
  And so, being able to be here to receive their needs and for them to leave with
• 12:40
  a little more support and a little bit of relief that we have a plan, I
• 12:43
  think that's worth it, worth any of the financial cost, which research
• 12:48
  does say balances out in the long run.
• 12:50
  So, I would just encourage everyone to advocate to have
• 12:53
  some level of integration.
• 12:56
  Host: All right.
• 12:56
  Rebekah, thank you for being on today.
• 12:59
  Rebekah O'Donnell: Thank you for having me.
• 13:00
  I appreciate it
• 13:01
  Host: Absolutely.
• 13:02
  And as a reminder to our audience, claim your CME credits after listening
• 13:06
  to this informative episode today.
• 13:09
  You can do so by visiting cmkc.link/cmepodcast.
• 13:16
  And then, click the Claim CME button.
• 13:19
  If you enjoyed this podcast, please share it on your social channels
• 13:22
  and check out the entire podcast library for topics of interest to you.
• 13:27
  I'm Dr.
• 13:28
  Bob Underwood.
• 13:28
  And this has been Pediatrics in Practice, a CME podcast.