Tuesday, May 26, 2009

On Behalf of Children's Mental Health: Why We Need to Cover Collaterals?

Collateral contacts-  adults speaking to adults about a child- are a significant piece of the work of doctoring in all medical problems.  About 10 years ago, I saw a girl because she passed out in the lunch room.  She came in with her mother, who wasn't there, and the girl, of course remembered nothing.  In order to get some history, I called the school nurse, who also had not been present.  No history.  Hard to diagnose with no history, so I prepared to order a bunch of tests to "be sure" that the child was OK.  As the family was leaving to drive to the hospital for bloodwork, the school nurse called me back.  She had found the girls with whom my patient had been sitting, and they admitted to her that they had all been playing a game- they took turns hyperventilating to see who could do it the longest without passing out.  Needless to say, the history solved the mystery; I cancelled the tests, and the mother took the child home for a good "talking to".

That's a collateral contact.  Good clinicians and good doctors do it all of the time;  we take better care of patients when we do.  Right now, we don't get reimbursed for it, and most of us talk ourselves out of its necessity.    This is one of the things promoting the silos that are the mental health care system.  We need to make collateral contact a routine part of the practice.

SB 757/H 3586 would mean that mental health workers COULD get paid for what should be a routine part of practice.  It brings us one step closer to an integrated system of care for children with mental illness.

We will see how I do in my testimony tomorrow.  I'll try to blog about the hearing.

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