Wednesday, July 23, 2008

Pediatricians and Children's Mental Health Reform

A colleague with whom I worked many years ago invited me to breakfast the other day, to find out what this "Rosie D" stuff is all about. She's an excellent pediatrician, in a very good group, who has always taken special care to attend to the psychological needs of her patients.  In short, she was one of the good guys.  
In her estimation, Rosie D made her job harder.  Patients were supposed to have time to fill in the screening forms before they saw the doctor-  sometimes they did, often they didn't.  The instruments were  similar to the screening regime in our office (PEDS under 5, MCHAT at 18 mon, PSC over 5), yet staff frequently gave patients the wrong screen, or the patients didn't complete it.  Interpreting a positive test was sometimes tricky, particularly with the PEDS, and most of the patients did not want to be referred to therapy.  And finally, the U1 and U2 codes were odd-  noone else asks us to do that.  She found the process unhelpful to patients, and that it added to her late nights poring over the electronic medical record.
My colleague saw the CBHI solely in terms of how it affected pediatric practice;  she knew nothing of CANS and CSAs and Mobile Teams and Wraparound and Parent Advocates.  When I explained to her the rest of the services that would be available in the next round of Rosie D settlement implementation, she was impressed by the scope of the effort.  She asked; "Do you think that it has a chance?"  She had been to the briefings and the trainings;  she hadn't read the newsletters and the circulars.  It really underscored to me how we really need to make sure that all of this change is put forward in context, so that people see it as a developmental process rather than an end in itself.

I wonder how many more good pediatricians are out there in the Commonwealth, seeing the CBHI as an extra administrative burden rather than as an oppportunity to expand our practice and better serve our patients.

Much depends on the House Ways and Means committee.  The bill, "An Act Relative to  Children's Mental Health" will help to codify the regulatory changes that will need to be made to let this happen.  It also depends on the Center for Medicaid and Medicare Studies.  The waiver is now out of our hands,  but we can do much for the children on our own.
 Speaker DiMasi, the time for this bill actually is NOW.  Thanks.

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