Integrated Care: Improving the Quality of Care Your Child Receives
By Dana Markey, Program Manager, NAMI Child and Adolescent Action Center
Imagine walking into your child’s primary care office for an annual checkup and in the waiting room you notice resources on the importance of mental health and the early warning signs of various mental health conditions. You scan the materials available and realize your child is exhibiting the early warning signs of depression—sleep problems, loss of interest in friends, sadness and fixations with death. The office’s clear interest in mental health helps you feel confident and comfortable raising your concerns with your child’s primary care provider
When you share your concerns with your child’s primary care provider, she actively listens to you, empathizes with you and assures you she will work with you and your child to address your concerns. First, she does a thorough physical exam to rule out other physical conditions. She also decides to conduct a mental health screening, which reveals that your child is at risk for depression. She lets you know that her office includes a mental health provider on staff who is able to meet with you now so you do not need to come back for an additional appointment. She calls in the mental health provider who is able to evaluate your child further and answer questions you have. You all work as a team to develop future steps and to coordinate how your child’s mental and physical health issues will be addressed together moving forward.
You leave the office feeling empowered, hopeful and confident that your child is receiving quality, comprehensive care from a health team that will work with you and your child to develop a treatment plan that takes into account your child’s strengths, needs and treatment preferences. You also feel relieved knowing that identifying and addressing your child’s mental health issues early has helped to prevent the consequences associated with untreated depression and the development of a more chronic, difficult-to-treat condition.
As many communities develop innovative integrated care approaches to improve the quality of care provided to youth and families, the scenario described above is becoming more of a reality for families across the country.
Integrated care refers to the practice of incorporating mental health care into primary care settings and primary care into mental health care settings for the purpose of improving the quality of care. There is no single, right way to integrate services and supports. There are a number of steps primary care offices can take in moving toward integrated care. These steps, some of which are described in the scenario above, include everything from distributing information to families about mental health care in primary care practices to co-locating mental health and primary care practices to fully integrated, collaborative care.
Communities that have begun to integrate care have seen firsthand the benefits of addressing mental and physical health conditions in a coordinated, collaborative manner. Families, primary care providers and mental health providers who have experience with integrated care have reported the following benefits for families:1
- Improved access to care
- Reduced stigma
- Avoidance of treatment errors and duplicative tests and lab work that are costly
- Greater convenience and satisfaction for families
- Improved adherence to treatment
- Increased likelihood that families follow through with referral for mental health services and supports
- Decreased use of unneeded medical and emergency services
- Reduced treatment errors by using an integrated medical chart
- Increased consultation, referral and collaboration because of regular contact between mental health and primary care providers
- Decreased wait times between mental health referrals and initial appointments
- Encouraged the development of individualized care plans and established clear lines of responsibility for follow-up
- Increased attention to the treatment preferences of families
However, for families and youth to obtain the benefits of integrated care, they must be involved in the development of integrated care programs in their communities to ensure these efforts work for them.
NAMI recently released a family guide, Integrating Mental Health and Pediatric Primary Care [PDF], to provide families with a roadmap to help them navigate the integrated care landscape. The guide also provides practical information on how families and youth can become more involved in the integrated care movement to improve the quality of care they receive. Here is a brief summary of action steps:
- Ask your primary care provider questions about integrated care
- Communicate the importance of integrated care with your primary care provider and share information about your treatment preferences, concerns and cultural perspectives to help your primary care provider develop an integrated treatment plan that works for you and your child
- Help your primary care office implement integrated care approaches
- Gather families to become involved in the integrated care movement to ensure that effective integrated care is delivered in your community
- Reach out to stakeholders in your community, including provider organizations, private insurance companies, state legislators and others, to make the case for integrated care
- Use your network to find creative solutions to the challenges of implementing integrated care
Integrated care promises to improve the experience of families accessing health care for their child, whether it is accessing services for mental health or physical health concerns. However, in order for it to live up to its promise, families and youth must be involved in all aspects of integrated care. NAMI has compiled a broad range of resources to support families and youth with this charge.
To learn more about integrated care and to access the family guide, visit NAMI’s Integrating Mental Health and Pediatric Primary Care Resource Center at www.nami.org/primarycare.
1 These positive outcomes were compiled from personal communication with health care providers, program leaders, and families who have experience with integration efforts and from outcomes data collected by the Massachusetts Child Psychiatry Access Project and ICARE project that are described in this family guide.
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