Wednesday, March 12, 2008

Rosie D. and US: implications for the “Medical Home”

Hello there, and thanks to David for letting me “blog” about this great topic. I’ve never “blogged” before (sounds like a trudge through a swamp), so here goes.

As you know, one great thing about the Rosie D. decision is that it mandates mental health screening for all children through their source of primary care. While this is great in that it identifies lots of kids who need mental health services and will hopefully make sure they are connected to those services, not much has been said about the ongoing parent-primary care-mental health provider partnership that such a system should create. For any of you new to the concept of the “medical home”, it has a long, drawn-out definition. However, in 25 words or less, its core is the partnership between parents, children and youth, and the child’s primary care practice as a center of coordination of care.

I’m co-leader with Dr. Rich Antonelli of the Central Massachusetts Medical Home Network Initiative (CMMHNI), a project to improve comprehensive, coordinated, continuous care for children and youth with special health care needs in a group of interested primary care pediatric practices (Medical Homes), and one of our major activities is to build and strengthen connections between Medical Homes and community-based service organizations. The Rosie D. decision represents a tremendous opportunity to strengthen coordination and collaboration between mental health service providers and primary care practices. We are committed to working toward ensuring that the recent court decision will be implemented in a way that benefits Medical Home-mental health service provider partnerships.

Working with our mental health partners in Central Mass. in our thoughts about responding to the recent RFI (Request for Input), we’ve come up with the following principles that, from our perspective, are critical for inclusion in the activities of the Rosie D. initiative as it moves forward:

  • The need for bidirectional education between mental health service providers and Medical Homes about the needs of children and families under our care;
  • The need for bidirectional discussion and idea sharing between mental health service providers and Medical Homes about how to best provide coordinated services to shared patients/clients and their families;
  • The need for ongoing communication between mental health service providers and medical homes about mental health evaluation and services provided to children who are referred, to enable ongoing involvement of the medical home in care, high-quality coordination of these services with other health care and school-related services provided to the family, and more efficient care (including avoidance of duplication of care);
  • The need for crisis plans and crisis teams to engage in communication and coordination with the child's ongoing medical and mental health service providers, as well as with their school. The goal of this process would be to help children and families transition smoothly between levels of care (both up and down the urgency/intensiveness ladder).
  • The need for proactive designation of a person or small group of people as each child's crisis team, ideally determined BEFORE a crisis occurs. This would further enable well-planned, well-coordinated care.

    In a nutshell, we are interested in planning for “what happens after the referral, to make sure children receive the highest-quality coordinated care?”

    Thanks to Beth Pond, Barbara Donati, Rich Antonelli, Meri Viano, and Lisa Lambert for their help in putting this together. I’d be happy to hear any thoughts you might have about this. Feel free to contact me at, or post a reply. Thanks for your attention!

    Chris Stille, MD, MPH
    General Pediatrics, UMass
    Co-Principal Investigator, CMMHNI

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