Friday, February 15, 2008

A Voice from the Heartland

I heard some interesting work today, from Susan G. Pfefferle, a researcher from Washington University in St. Louis, who spoke of the intersection of Policy, Organizations and Evidence-Based Services.  This seemed relevant to where we are going in this area, so I listened to see what we know about this.  A few observations:
1)  Access is more than existence.  People need to be walked through the mental health system if it is going to work.
2)  Policies, organization and evidence-based practices all affect provider behavior, sometimes in ways that we can't imagine.
3)  Pediatricians are taking care of a lot of kids with mental illness, whether we like it or not.
There is a bunch of research looking at some of these issues, but our guest focused on provider behavior.
 In order to think about provider behavior,  she surveyed pediatricians in six states with really different policies.  (CT, KS, SC, UT,WA, NH) using a fairly rigorous methodology.  Again, the data were complex, and will likely be published soon, but she found that state policy had a huge impact on what pediatricians do.  Some the markers that she looked at were:
use of validated screening tool; regular mechanism for case conferencing and formal mechanism for case consultation all varied with state policy.  One of her findings seemed to show that, in states with mental health carve outs, pediatricians end up treating more mental health problems on their own.  Her findings are vast and complex, and have lots of implications for what we are doing here in Massachusetts.  But when asked to summarize what policy makers can take away from this, the answer was "relationships".
The published paper is "Pediatrician Coordination of Care for Children with
Mental Illnesses" in Medical Care (44:1085-91 (2006). E-mail me if you can't find the .pdf in your library.

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