Integrated health care: How can it help my child?

Jamir is a bouncy, restless 6-year-old who arrives at the pediatrician's office with his mother and 3-year-old sister.  The mother, who has taken a day off from work for the appointment, explains that the teacher feels Jamir is hyperactive. She then expresses concerns about using any medications.  In the past six months, the family has moved, the father just started a new job after being laid off, the 3-year-old has been sick, and Jamir has had problems with bouts of asthma. .

With all these changes, the pediatrician thinks Jamir and his mom should meet with a psychologist to talk about what's been going on, but she also knows that it would be difficult for the mother to take another day off of work. Fortunately, for Jamir and his mom, they can see a psychologist in the office that same day. The psychologist gathers some initial information, reviews the chart, and sets up a follow up on a day when there is already another appointment scheduled to see the pediatrician.  This model is part of the future of health care: integrated care.

The idea dates back to 1964 when the president of the American Academy of Pediatrics, in his presidential address, suggested that all pediatric offices should have a child psychologist. Research has shown that over half of the questions from parents to pediatricians involve development and behavior. Thus, the blending of psychology and pediatrics should be a natural combination and we are now starting to see it develop here in the Delaware Valley.

Tom Power, PhD, directs a program through the Children's Hospital of Philadelphia, funded by a federal grant, to train psychology residents to provide a wide range of services in an inner city clinic, including making contact with many families during well child visits. Out in central Pennsylvania, Paul Kettlewell, PhD, at Geisinger has developed a more extensive program providing a full range of psychological services at three rural clinics, including helping with some children who have severe depression problems.  In Delaware is a program first developed in 2001 at Nemours Pediatrics. The program, under the supervision of Meghan Lines, PhD, now provides training for psychology residents, and services at nine clinics in medically underserved areas of the state.

Rural, urban, suburban, servicing a range of families from various backgrounds, these clinics have been uniformly successful.  Integrated care makes mental health services accessible to families in their familiar doctor's office, and makes it more acceptable because it is comfortable setting.  In addition, these providers can use the same effective means of counseling and guidance that they would use in a mental health clinic.  Accessible, acceptable and effective are the key words for integrated care.   Not only here in the Delaware Valley, these programs have arisen in Nebraska, Michigan, Ohio, Florida and Massachusetts.

Helping it along are models of greater cooperation between pediatricians and psychologists and the use of a common electronic health record to efficiently share information.  Also, under the Affordable Care Act, all insurance policies must cover mental health benefits and primary care providers are supposed to be screening for emotional and behavioral problems, so they are more aware of the need more than ever.  Over 20 percent of children have some type of diagnosable mental health problem in the first 18 years of their life, and most of them never receive services. Access to those services has always been one of the major obstacles.

With integrated care, access is much easier, and if the successes seen in Philadelphia, Danville and Wilmington are any example, we will see more of this in the future.

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