Massachusetts Child Psychiatry Access Project: MCPAP

MCPAP Announces Newly Designed Website

The newly designed Massachusetts Child Psychiatry Access Project (MCPAP) website is currently online.  You may find it at http://www.mcpap.com

For the debut of our newly designed website, we have an interesting article in the Spotlight section by Dr. Sara Brewer of the Baystate MCPAP.  The article discusses how a primary care clinician can tell if his/her patient is receiving cognitive behavioral therapy (CBT) as opposed to another type of therapy.

The Primary Care Behavioral Health Toolkit is available to download in PDF format on the new website.  This toolkit includes guidelines on implementing behavioral health screenings in primary care settings, guidance on clinical issues related to screening, and information on four screening tools: M-CHAT, PSC, PEDS, and PHQ-9.  The CRAFFT Toolkit which screens for substance abuse is available on the website as well.

In our "About Us" section, we provide general information about MCPAP including our history, goals, and vision; data; frequently asked questions, and contact information.

In our "Services" section, we explain what services MCPAP provides to primary care clinicians.  We also include informarion about our school pilot program and our screening tool consultation project.  The "Find a Provider" directory contains links to MassHealth and commercial insurers.  We also include a form which primary care clinicians can fill out if they want more information about enrolling with MCPAP.

Our "Clinical Reference" directory contains links to an extensive array of resources that a primary care clinician may need when treating children with behavioral health needs within the primary care setting.  These include medication guidelines, clinical practice guidelines, state agencies and more.

Our "Screening Tools" page contains resources and links for behavioral health screening within the primary care setting.

The "Diagnosis" section contains clinical guidelines, rating scales, and parent information and handouts for the following diagnoses: ADHD, anxiety, autism/PDD/ASD, bipolar, conduct disorder, depression, eating disorders, obsessive compulsive disorder, oppositional defiance disorder, post traumatic stress disorder, schizophrenia, and substance abuse.

The "Team Sites" section contains information and bios of all of our MCPAP staff members, the access and fax numbers, the cities and towns within each MCPAP region, and listings on currently enrolled practices in the given region.

The "Behavioral Health Events" page currently provides information about upcoming events.  For example, it lists the MassHealth PCC Plan forums titled How Primary Care Clinicians Can Help Patients Access Children's Behavioral Health Initiative Services.  These forums will be held on June 10th in West Springfield and on June 16th in Waltham.

Our website also contains a small section for parents.  The "What is MCPAP?" page explains what the Massachusetts Child Psychiatry Access Project is.  The "Your Child's Mental Health" can help parents recognize if their child has a behavioral health issue.  The "Parent Education Resources" page lists links to many general and diagnosis specific resources for families.  The "Behavioral Health Resources" page links to general behavioal health resources.  The "Advocacy Resources" page contains summaries and links to advocacy resources.

We hope that you find this new website helpful.  We value any comments or feedback you may have regarding the website.  Please send feedback to mcpap@valueoptions.com.

Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration

An April 2009 special article published in Pediatrics addresses administrative and financial barriers to achieving access to pediatric behavioral health care within the primary care setting.  Also discusses barriers to facilitating collaboration between behavioral health care providers and primary care clinicians.  The article outlines specific recommendations to insurance purchasers, payers, and managed behavioral health organizations to help improve the situation for integrated health care and access between primary care clinicians and behavioral health providers.  This article was co-authored by Barry Sarvet, MD, who is the statewide co-medical director for MCPAP and directs the Baystate MCPAP team.

Click here to link to the article.

Child Psychiatry in Primary Care Conference on May 27, 2009 in Holyoke

Baystate Children's Hospital and the Massachusetts Child Psychiatry Access Project ( MCPAP) will be presenting its fifth annual conference designed for primary care physicians and advanced practice nurses and the mental health professionals who collaborate with them.  This conference explores a wide variety of topics including services for children with acute mental health problems, a clinical update on pediatric bipolar disorder, the mental health/school interface, living with Asperger's syndrome, sorting out severe behavior problems in very young children, treatments for post-traumatic stress disorder, and ADHD in adolescents.  CME/CEUs will be offered.

Click below to download the brochure:

Download Child PsychiatryMay2009Conference

Click here to register online

USPSTF Recommends that Adolescents Aged 12 to 18 Be Screened for Depression

The US Preventative Services Task Force (USPSTF) has recommended that adolescents be screened for depression in primary care.  This recommendation is based on evidence on the benefits and harms of screening for depression in primary care.

Click here for the USPSTF recommendation published in the April 2009 issue of Pediatrics.

Click here for the USPSTF evidence review in Pediatrics.

Click here for the Associated Press story.

Click below to download a Primary Care Behavioral Health Screening Toolkit for the MassHealth  Children's Behavioral Health Initiative.  This toolkit includes guidelines on general implementation of behavioral health screenings in primary care settings and guidance on clinical issues related to screening and referral.  Implementation of four commonly used screening tools ---CHAT, PSC, PEDS and PHQ-9---is highlighted.  The PHQ-9 is recommended for adolescents aged 12 to 18.

Download PCCScreening Toolkit

CRAFFT Toolkit Now Available

The Massachusetts Department of Public Health, in conjunction with MBHP and the Center for Adolescent Substance Abuse Research (CeASAR), has published a toolkit for the CRAFFT( acronym for Car, Relax, Alone, Forget, Friends, Trouble) screen.  The CRAFFT screens for substance abuse in adolescents.

Click the download below for the CRAFFT screening toolkit:  ( The toolkit may take a few minutes to download.)

Download CRAFFT Screening Tool

The Parents' How-to Guide to Children's Mental Health Services in Massachusetts ( 2nd Edition, 2009)

The Boston Bar Association in collaboration with Children's Hospital Boston has published their second version of an easy-to-read how-to guide for parents seeking children's mental health services in Massachusetts.

This is an excellent comprehensive resource for parents of child and adolescent patients with behavioral health issues.  Topics include problems a child may have, steps for getting help, paying for services, navigating mental health networks, school services, and other state programs for mental health.  This revised guide contains a brand new section titled "Aging out of child services" that the first version of the guide (2004) did not contain.

Click here to download the 172-page guide.

Predicting Remission in Depressed Children Treated with Fluoxetine

The Journal of the American Academy of Child and Adolescent Psychiatry recently published a study ( Tao R et al, 2009 Jan; 48: 71-8 ) that attempts to identify early predictors of response to treatment in depressed children being treated with Fluoxetine.  This was a twelve (12) week open label study of 168 depressed youth ( ages 7-18 years).  One significant predictor of remission at twelve weeks was a positive first degree family member with a history of depression.  Also, a 50% or greater reduction of symptoms at four (4) weeks was the best predictor of remission at twelve weeks ( PPV=88.6%).

SPED Parent Basic Toolkit

The Concord Special Education Parent Advisory Committee ( Concord SPED PAC) has assembled a comprehensive parent toolkit that would be very helpful to parents of patients with behavioral health and other diagnoses.

This toolkit contains many parent education resources for behavioral health diagnoses including ADHD, anxiety disorders, autism, aspergers, reactive attachment disorder, bipolar disorder, depression, and PTSD.

The toolkit is divided into two sections.  One section helps parents learn about their child's disability.  The other section helps parents navigate the special education system.

Even though this website was created by the Concord SPED PAC, it would be helpful to parents of children diagnosed with disabilities from all over the state of Massachusetts.

To visit this parent toolkit, click the link below:

http://www.concordspedpac.org/toolkit.htm

FDA Mandates Suicidality Warning on All Epileptic Drugs

The FDA announced on December 16, 2008 that it will require the manufacturers of antiepileptic drugs to add a warning that the use of antiepileptic drugs increases suicide ideation.  Antiepileptic drugs are used to treat epilepsy, psychiatric disorders, migraine headaches, and other conditions.

"Patients being treated with antiepileptic drugs for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior, " said Russell Katz, MD, director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research."

Click here to link to the FDA press release.

Click here to link to the Associated Press article on the FDA mandate regarding anti-epileptic medication.

Click here for the February 12, 2008 MCPAP post on this issue.

Two New Blogs Seek Your Input on Child Mental Health Services

The REACH ( The Resource for Advancing Children's Health) Institute has set up two new children's mental health blogs.  The first blog explores the time delay between when proven interventions are found and when children and families in need actually receive these proven interventions.  This blog can be found at:

http://thereachinstitute.wordpress.com

The second blog discusses the children's mental health system as it is today, and how the system cannot serve the nation's children without some drastic reorganizational changes.  This blog can be found at:

http://catchservices.wordpress.com

Cognitive Behavioral Therapy plus Sertraline (Zoloft) Helps Kids with Anxiety

According to a recent study published in the New England Journal of Medicine, both cognitive behavioral therapy (CBT) and sertraline (Zoloft) reduce the severity of anxiety in children with anxiety disorders. However, a combination of the two therapies has a superior response.

Click here to view the New England Journal of Medicine article.

Click here to view an MSNBC article summarizing the NEJM findings.

Pediatric Mental Health Care: Strategies to Integrate Early Identification and Treatment into Primary Care - Webinar on December 4, 2008

This webinar sponsored by the National Institute for Health Care Management (NIHCM) Foundation will explore the current state of mental health services delivered to children during primary care, including a discussion of how mental health parity legislation will affect the future delivery of services in primary care. It will also discuss the current guidelines and training opportunities for primary care providers on mental health screening and treatment, including the recently updated Bright Futures guidelines. The session will highlight current health plan and health plan foundation efforts to support the integration of mental health services into primary care.

 

Speakers will include:

• James M. Perrin, MD, Professor of Pediatrics, Harvard Medical School; Director, Division of General Pediatrics, MassGeneral Hospital for Children; Associate Chair for Research, MGHfC; Director, MGH Center for Child and Adolescent Health Policy
• Joseph F. Hagan, Jr., MD, FAAP, Co-editor of The Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, Third Edition, Clinical Professor In Pediatrics at the University of Vermont College of Medicine
• Julie A. Kozlowski, RN, Corporate Program Coordinator, Medical Services - Case/Disease Management, BlueCross BlueShield of

  Western New York

• Matt McGarvey, Director, Wellmark Foundation

For registration information and or to download the presentations for download prior to the event, please visit the below link:

 

http://www.nihcm.org/maternal_adolescent_and_child_health1/conferences_and_webinars

 

 

Behavioral Health Screening in Primary Care and Then What?: Forums

As of December 2007, MassHealth primary care providers have been required to offer to administer MassHealth approved behavioral health screens.

The MassHealth PCC plan,the Massachusetts Behavioral Health Partnership, and the University of Massachusetts Medical School Office of Continuing Education are jointly sponsoring forums to help primary care physicians learn more about the "after the screen" process for those patients who present with positive behavioral health screens.

One dinner/forum will take place on Thursday, October 30th from 6PM to 8PM at the Sheraton Ferncroft in Danvers.  Another dinner/forum will be held at the Beechwood Hotel in Worcester on November 6th from 6PM to 8PM.

Michele Reardon, MD will be presenting at the October 30th forum.  Dr. Reardon is the medical director of the Partial Hospital Program at the North Shore Medical Center (NSMC), and is a child psychiatrist on call for the Northeast regional Massachusetts Child Psychiatry Access Project ( MCPAP) hub at NSMC.

Matthieu Bermingham, MS will be presenting at the November 6th forum.  Dr. Bermingham is a staff psychiatrist for our Central Massachusetts MCPAP hub at the UMass Medical Center.  He is also a consulting psychiatrist for Coordinated Family Focused Care (CFFC), the medical director of Valley Human Services in Ware, and the founder and medical director of the Center for Well Being.

CME credit will be offered.

Click the below link to download the brochure which contains registration information:

Download behavioralhealthscreeningthenwhat.pdf

FDA's New Drug Safety Resources Web Page

The FDA has announced a new web page that provides a wide variety of safety information about prescription drugs.  The web page includes information about drug labeling, risk evaluation and mitigation strategies, studies and clinical trials, safety information, warnings and recalls, and more.  It also includes a list of drugs for whick medication guides are available.   This web page is a good resource for information on prescription drugs including those drugs used to treat behavioral health issues.

Click here to visit the new "Postmarket Drug Safety Information for Patients and Providers" web page.

CDC Findings on Use of Mental Health Services:Children Aged 4-17

In September 2008, the Centers for Disease Control (CDC) released key findings from the National Health Interview Study ( NHIS) regarding the use of mental health services in the past 12 months by children aged 4-17 years in the United States, 2005-2006.

Key findings include:

• In 2005-2006, 15% of US children aged 4-17 had parents who talked to a health care provider or school staff about their child's emotional or behavioral difficulties.  This included 18% of boys and 11% of girls.
• Approximately 5% of children were prescribed medication for difficulties with emotions or behavior.  A large majority of these children (89%) were prescribed medications for difficulties with concentration, hyperactivity, or impulsivity, which are symptoms of attention deficit-hyperactivity disorder (ADHD).
• Approximately 5% of children received "treatment other than medication" for emotional or behavioral difficulties.  Most of these children - 60% -received this treatment from a mental health private practice, clinic, or center.

To view the entire report, click here.

Depression in the United States Household Population, 2005-2006

In September 2008, the Center for Disease Control (CDC) released key findings from the National Health Interview Study (NHIS) regarding depression in the US household population, 2005-2006.

Key findings include:

• In any 2-week period, 5.4% of Americans 12 years of age and older experienced depression.
• Rates of depression were higher among poor persons than among those with higher incomes.
• Approximately 80% of persons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life.
• Only 29% of all persons with depression reported contacting a mental health professional in the past year, and among the subset with severe depression, only 39% reported contact.

To view the entire report, please click here.

Research Article Confirms Lack of Association between Measles Virus Vaccine and Autism

A September 2008 research article based on a case-control study confirms a lack of association between the measles virus vaccine and autism with enteropathy.

Click here to link to the PLoS One research article.

Dr. W. Ian Lipkin of Columbia University College of Physicians and Surgeons, who led the work on this article, was interviewed for a related Associated Press article.  Dr. Lipkin stated that no one knows just how many autism patients suffer from gastrointestinal disorders and the associated pain that they might not be able to communicate.  Dr. Lipkin went on to say that by some estimates, up to a quarter may be affected.

Click here to link to the Associated Press story on the MMR/autism study.

New M-CHAT Website

A new M-CHAT website at http://www2.gsu.edu/~psydlr includes downloads, instructions, translations, and articles related to the M-CHAT.  In addition to the English M-CHAT, you may download the M-CHAT in Arabic, Chinese, Dutch, German, Gujarati, Icelandic, Japanese, Portuguese, Sinhala, Spanish, Tamil, and Turkish.

Online Information re Oppositional Defiant Disorder from AACAP

The American Academy of Child and Adolescent Psychiatry has just published an online Oppositional Defiant Disorder Resource Center, the first in a series designed to gather together information regarding common children's mental health problems.   The site appears to be designed especially for parents, but also contains links to practice guidelines and other information which would be very helpful for primary care providers.  As an AACAP resource, the information is carefully vetted and computer literate parents of children with ODD may very much appreciate being directed to the site by their primary care clinician.  BDS

MassHealth Screening Initiative: Updated EOHHS Website

EOHHS has recently posted updated information regarding the mental health screening initiative on its site.  It appears to be a quite user-friendly resource which should be useful for getting answers and clarification regarding many aspects of this initiative including: 1) information regarding the screening instruments, 2) billing guidelines, 3) resources for helping to figure out what do after behavioral health needs are identified (including MCPAP!).  It also has some interesting discussion regarding why screening is important, and strategies for overcoming barriers to implementation.  Definitely worth taking a look and bookmarking the site.  BDS