Medical Homes for Children and Adolescents with Mental, Developmental and Substance Abuse Disorders
Mental health care is a key component of an effective Medical Home1. The American Academy of Child and Adolescent Psychiatry supports policies that promote the integration of mental health care within context of comprehensive care provided by the Medical Home. The Medical Home is an approach to providing comprehensive primary care in which a care team partners with a child and his/her family to assure that all of the medical and psychosocial needs of the patient are met. To meet these needs, a Medical Home must be "accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective to all children and youth, including those with special health care needs2."
The Medical Home must be responsive to and inclusive of the needs of children and adolescents with mental, developmental and substance use disorders, including the need for access to timely care by child and adolescent psychiatrists. Child and adolescent psychiatrists are critical to include in the Medical Home as they enhance the capability of pediatric primary providers, medical specialists, and other care providers to respond optimally to mental health needs of children and adolescents at the earliest stages. Child and adolescent psychiatrists may need to assume primary responsibility of the management of mental health care delivery when patients experience severe mental illnesses and comorbid psychiatric disorders. In order to achieve effective integration of mental health care, the Medical Home must allow for:
- Enhanced access to early mental health intervention, screening, prevention, youth and family peer support, and advocacy services as well as responsive mental health diagnostic and evidence based treatment services.
- Patient care decisions and recommendations that include direct input, active participation, and full endorsement from the parents and youth (as appropriate).
- Support for the provision of mental health care education and training by child and adolescent psychiatrists to primary care providers, medical specialists, and other care providers.
- Efficient collaborative support between child and adolescent psychiatrist and primary care providers, medical specialists, and other care providers through regular in person contact or telephone discussions, letters, faxes, secured electronic communication, or review of a shared medical record.
- Provision of direct psychiatric assessments and timely access to consultation by child and adolescent psychiatrists to meet the biological, psychological and social needs of children and adolescents.
- Access to ongoing evidence based mental health treatments by child and adolescent psychiatrists for children and adolescents with complex psychiatric disorders where the need extends beyond the capabilities of the primary care providers, medical specialists, and other care providers.
- Collaboration with child servicing community based agencies for those children and adolescents with the most challenging mental, developmental, and substance abuse disorders.
- Adequate reimbursement for non face-to-face aspects of care (such as consultation, case management and telemedicine\telepsychiatry) for child and adolescent psychiatrists as well as primary care providers, medical specialists, and other care providers), and the removal of billing barriers (i.e. "incident to" and nonpayment without patient present3).
1Federal Expert Work Group on Pediatric Subspecialty Capacity, "Promising Approaches for Strengthening the Interface Between Primary and Specialty Pediatric Care." Maternal Child Health Bureau, DHHS March 2006, 18 pages. Accessed at: http://www.mchpolicy.org/documents/InterfacePromisingPracticesReport.pdf.
2National Center for Medical Home, American Academy of Pediatrics statements from http://www.medicalhomeinfo.org/.
3American Academy of Child and Adolescent Psychiatry and American Academy of Pediatrics Task Force on Mental Health, Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration. Pediatrics, volume 123, Number 4, April 2009.