P2.286: Partnership and Persistence: Lessons learned from implementation of a pediatric collaborative care initiative in community practices

Purpose/Objectives: Functional impairment due to behavioral health (BH) concerns impacts 20% of youth, yet half of these patients never receive treatment. Team-based, integrated warm-handoff BH been shown to radically increase both speed of access and utilization of BH services. However, building such models in an independent community practice remains a significant challenge. A unique collaboration between The Children’s Hospital of Colorado, an independent pediatric practice, and a pediatric collaborative care staffing/infrastructure provider(Trekwise) has addressed these challenges. This new model combines an integrated behavioral health provider, a pediatric-focused Psychiatric Collaborative Care Model (COCM) staffing service, and an independent provider office.

This pilot quality improvement project aims to 1: change physician practice patterns to include behavioral health evaluation and referral at all well-child visits, 2: improve the behavioral health functioning of referred children and 3: create a financially self-sustaining model.

Design/Methods: A process evaluation of this partnership gathered data on physician practice change, patient outcomes, and financial impact. Qualitative and quantitative data across pilot sites was collected. Physician practice change was assessed by tracking percent of eligible well-child visits referred to the program as well as via qualitative interviews with practice leaders. Patient outcomes are assessed via the Pediatric Symptom Checklist-17, parent report, a parent report Patient Global Impressions of Change (PGIC), and qualitative feedback. Financial impact is calculated based on cost of staffing the program vs billed charges.

Results: Early data shows pilot practices moving from referring under 5% of eligible children seen for well-child checks in the partnership's initial months to approximately 20% of patients 6 months post-launch. Over 500 patients received care through the initiative in the program's first 6 months.
Provider perspectives on the program, across all sites, followed a similar pattern of early excitement, followed by resistance to altering practice patterns when pushed to make identification of BH concerns a part of every well-child visit. Systematic change-management by leadership at each pilot site turned this around into marked enthusiasm.

Child outcomes also demonstrate the strength of the model. 75% of children who entered the program at risk of a BH concern as identified on the PSC-17, and completed at least 3 months of care, moved out of the risk category at the last assessment available. 70% of parents report their child was very much or much improved on the PGIC.

The program is also showing net-positive revenue, ensuring its long term stability.

Conclusion/Discussion: While challenging to launch and sustain financially in an independent pediatric practice, this model is a win-win-win for providers, patients, and practices. The key to successful implementation of such a model starts with having the correct partners, thoughtfully developing the program vision, and skillfully navigating a change process of in-practice implementation.