137 - Integration of Mental and Behavioral Health Services in Complex Care Programs

Poster Number: 137
Publication Number: 137.304

Kristina Malik, University of Colorado/Children's Hospital Colorado, Denver, CO, United States; CHARLENE SHELTON, UNIVERSITY OF COLORADO, ANSCHUTZ MEDICAL CAMPUS, Aurora, CO, United States; Verenea J. Serrano, University of Colorado School of Medicine, Denver, CO, United States; Carlos Lerner, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Ricardo Mosquera, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Edward L. Schor, Edward L. Schor, Menlo Park, CA, United States; Christopher J. Stille, University of Colorado School of Medicine, Aurora, CO, United States

Background: Recent literature has noted an increasing unmet need for mental and behavioral health (MBH) services among children with medical complexity (CMC). No data exist on MBH resources within complex care programs (CCP) for CMC.

Objective: To assess need for MBH care, MBH screening and services, and integration between MBH and medical complex care among a national sample of pediatric outpatient CCP in the US.

Design/Methods: A 72 question email survey was sent to outpatient CCP within the US. The sample comprised all 12 members in CYSHCNet, a national research network based primarily at large children’s hospitals, and known outpatient programs that are part of the APA complex care SIG listserv. Questions covered MBH need, MBH screening, and a series of questions about the availability of MBH services by location. Data was analyzed to describe program characteristics, screening patterns, and levels of integration using previously-published categories of primary care-MBH integration.

Results: All CYSHCNet programs (n=13, one member has two CCP) and 14 additional programs responded. Only 32% of programs screen for MBH concerns in patients and 36% screen for MBH concerns in caregivers/families. Most programs (64%) reported between 10-25% of their patients received MBH services. The most common MBH concerns were disruptive behaviors (i.e. tantrums), self-injurious behaviors (i.e. head banging), and family MBH in response to caregiving needs.41% of CCP reported having a MBH provider located in the same space as the CCP, most likely a social worker, with 64% of those having a MBH provider able to join medical appointments. Psychiatrists and psychologists were more likely available in the community setting, but MBH providers in the community were less likely to have direct or frequent communication with the CMC provider.  Conclusion(s): Integration of MBH services within CCP is uncommon, despite high levels of need. MBH needs are different from those described in routine primary care. Recognition of these needs and allocation of appropriate resources to address them are critical.