AAP News TODAY 2016 - Sunday, October 23, 2016 - 4
4 | AAPexperience.org
Integrating Mental Health Services
Feasible for Primary Care Offices
Early in his career, Jay Rabinowitz, MD,
FAAP, saw his share of ear infections and
colds. As time went on, however, he began
seeing more and more patients with mental
illness and behavioral problems.
He and his partners did their best to
refer patients to mental health providers in
insurance network, but the
"So we decided to take
the bull by the
horn and say
'let's try to do
Let's do it in our own office,'" said Dr.
Rabinowitz, senior pediatrician at Parker
Pediatrics and Adolescents in Parker, Colo.
"This is something that would benefit our
patients, would benefit our providers and
would benefit our practice."
Dr. Rabinowitz will talk about his
practice's experience and offer some advice
during a session titled "Integrating Mental
Health Services in the Primary Care
Office." The session will be held from 9:3010:15 am today (F2079) in Room 3022 of
Moscone West and again from 7:30-8:15
am Monday (F3008) in Room 303 of
Parker Pediatrics and Adolescents now
has three licensed child psychologists on
staff. Communication between providers
happens naturally since they see patients in
adjoining exam rooms and run into each
other in the hall, Dr. Rabinowitz said. The
psychologists also scan their notes into
patients' electronic health records, and
pediatricians make a point to stop in and
say hello to patients during their visits with
While his office isn't unique, hiring mental health professionals still is uncommon,
said Dr. Rabinowitz, a member of the AAP
Section on Administration and Practice
"When you talk to some family doctors
and other pediatricians, there are people
doing this but it's quiet," he said. "The
reason it's quiet is nobody knows quite how
to deal with the reimbursement part, and
so they don't want to talk about it."
Dr. Rabinowitz hopes to reassure attendees that adding mental health staff to
a primary care practice is feasible financially.
"You're not going to make enormous
profit, and you're not going to make as
much as your well visits and your acute
Moscone West, Room 3022
Repeats as F3008, 7:30-8:15 am
Monday, Moscone South,
care, but you won't necessarily lose money,"
The benefits go beyond the bottom line,
"You're doing a lot of good for patients,"
he said. "It brings patients to the practice.
It brings reputation to the practice. ... It
rounds out the practice, and it's hard to put
a dollar sign on that."
During the session, Dr. Rabinowitz plans
to share some of the procedures and forms
that his office uses. However, those interested in an integration model need to research
state rules and regulations as well as their
insurance contracts to see what's allowable.
If they find it's feasible to hire mental
health staff, they need to make a commitment.
"There will be some errors, and you have
to learn from your errors," Dr. Rabinowitz
said. "... It's OK to fail a little bit while
you're doing this process to make it work
continued from page 1
was promoted to acting director for six
months. During that period, he led the
CDC's response to the H1N1 influenza
pandemic, which focused intensely on
communicating and educating the public
- often in the media - for which he
received the Surgeon General's Medallion.
In addition to his traditional media
presence, Dr. Besser is active on Facebook
and Twitter. Each week, he hosts a Twitter
chat #abcDrBchat. In last week's chat, he
and others from national health agencies
discussed issues surrounding the flu. Over
the course of an hour, he said there were
868 active participants and 2,600 tweets
that reached a potential of 49 million
people with flu information.
"I am a big fan of social media and the
reason for that is that you need to reach
people where they are, where they get
their information. If you are looking to
reach the younger generation, they are
not watching our shows. Our (television)
demographic is much older," he said. "A
lot of people are getting their information
on social media."
Dr. Besser said his goal isn't to make
TV doctors, but he wants pediatricians
to consider offering their opinion to the
media the next time they call. "And you
think that 'Wow! This is a way that I
could actually get out a message to the
community that could make a difference.'
You are pediatricians, and people want to
know what you have to say."
How to Make Sure Your Patients Are Ready to Leave the Practice Nest
Can you imagine having a wedding without planning? Or going to college without
Yet many teens and young adults leave
their pediatricians without any guidance on
how to navigate the adult system of care.
"Is it fair to throw a young adult into
a new game without knowing the rules?"
asked Patience White, MD, MA, FAAP,
co-director of Got Transition: Center for
Health Care Transition Improvement. "No,
it's not really fair."
Dr. White will share tools and resources
to help pediatricians prepare their patients
for the move to an adult provider during a
session titled "Transition Strategies: Pediatric to Adult Care (F2033)" from 8:30-9:15
am today in Room 3020 of Moscone West.
While transition historically has focused
on youths with special needs, it is important for all patients, said Dr. White, a member of the AAP Section on Rheumatology.
Moscone West, Room 3020
tend to drop off
in high school,
and many teens
leave their pediatrician without
being connected to an adult
provider. As a
result, they use
more, costs increase and their health suffers,
Dr. White said.
Furthermore, there are 9 million teens
with chronic conditions who would benefit
from transition planning, she said.
"It's important for any life change to do
planning, particularly if you have a chronic
illness," she added.
Among the resources Dr. White will share
are the 2011 clinical report Supporting the
Health Care Transition From Adolescence to
Adulthood in the Medical Home from the
AAP, American Academy of Family Physicians and American College of Physicians
content/128/1/182) and the Six Core Elements of Health Care Transition 2.0 (http://
The Six Core Elements include 1) developing a transition policy, 2) tracking and
monitoring youths' progress, 3) assessing
transition readiness, 4) planning for the
transition, 5) transferring care and 6) completing the transfer.
Pediatricians often say they don't have
time to implement a transition system.
"You don't want to say you have to do
soup to nuts here. But if you could do a few
(of the steps), that would really be helpful
for everybody in the process," she said.
For example, practices could devote one
of their regularly scheduled staff meetings
to discuss at what age they would like
patients to transition to an adult provider.
Once a consensus has been reached, the
policy is posted on the practice website so
patients know what to expect and all physicians are consistent.
Practices also can administer assessments
to identify patients' needs and goals for
Dr. White said she gives her patients a
readiness assessment starting at age 12 to
14 years. Then at each visit, she tackles one
skill they need to work on such as how to
make an appointment or how to summarize their disease, allergies and medications
at the beginning of a medical appointment.
Practices also can enlist their office staff
to find adult providers, and they can use
their electronic health record system to
develop medical summaries for patients to
take to their new doctor.
"So many people are looking for a
process," Dr. White said. "I think we have a
pretty good one that is adaptable, customizable, which people need."
From Our Membership...
"I have such respect for what
the Academy does. What sets it
apart is that it really advocates
for kids. Being able to influence
the state of the art of pediatrics
-Scott Needle MD, FAAP
General Pediatrician, Naples, Fla.