SPM 3 - The number of pediatric and/or behavioral health providers receiving training and support services on pediatric mental health care in underserved communities/counties statewide.
Introduction: Children’s Mental Health Access
Data: The state measure for this project-focused priority is a process indicator that reports the number of providers receiving training in behavioral health care topics and, eventually, data on the teleconsultation model (once established). Training was provided to 98 pediatric or behavioral healthcare providers through the Project ECHO series of webinars, exceeding the year's objective. There were 191 attendees participating in the ECHO training series; however, 93 were not specifically healthcare providers.
Evidence: HRSA promotes the Pediatric Mental Health Care Access Program as a strategy to address the shortage of behavioral health providers by providing pediatric primary care providers with behavioral health training and a telephonic/telehealth consultative warmline. The warmline, staffed by a psychiatrist, psychologist, care coordinator, and social worker, provides teleconsultation, training, technical assistance, and care coordination so that pediatric primary care providers can more effectively diagnose, treat, and/or promptly refer children and youth with behavioral health conditions. The program's overarching goal is to use telehealth modalities to provide timely detection, assessment, treatment, and referral of children and adolescents with behavioral health conditions, using evidence-based practices, such as web-based education and training sessions. The MCH Evidence Center provided ample evidence indicating that telehealth services improve access to healthcare for underserved MCH populations.
Title V lead/funding: The PMHCA grant is administered by FHSD and funds two staff positions to manage and build the program. Although no Title V funds are used to support the program directly, Title V-funded staff assist with data, contractual, and media support. In kind contributions from two FHSD staff and contracts supporting Health Equity initiatives and data training was utilized for the state match. FHSD will support and coordinate community mental health needs for children and youth.
Key Partners: This project is a unique collaboration between the Department of Health, John A. Burns School of Medicine (JABSOM), DHS Med-QUEST Division, Project ECHO Hawaii, Hawaii Primary Care Association, American Academy of Pediatrics-Hawaii Chapter, and University of Hawaii Pacific Basin Telehealth Resource Center. This multi-agency collaboration will strengthen pediatric providers’ access to needed mental health consultation services in underserved communities statewide.
Objective: By July 2025, provide training and support services on pediatric mental health care to 80 pediatric and/or mental health care providers in underserved communities statewide.
Strategies: The strategies to implement the project focus on three key areas:
- Refine, develop, and implement a pediatric mental health care access model.
- Promote workforce development and training on pediatric mental health care.
- Support services and linkages in underserved communities.
Updates for FY 2023 on the three strategies follow.
Strategy 1: Refine, develop, and implement pediatric mental health care access model
The first strategy focuses on the system infrastructure to support the PMHCA grant. The PMHCA grant deliverable is developing a pediatric mental health care access model that pediatric providers will access to work with behavioral health providers. Activities are highlighted.
Staffing. The PMHCA Coordinator and Specialist were hired in the Fall of 2022, continued hosting Advisory Committee meetings, and met with stakeholders to promote and develop the model. The grant Coordinator left the grant for another FHSD position; however, the Specialist easily transitioned into the lead and continued the grant work.
Model Development for Hawaii. Staff worked with the HRSA Project Officer who provided technical assistance (TA) to connect Hawaii to national consultants who lent their expertise to help develop the Hawaii warmline model.
Logo Development. The logo for the Pediatric Mental Health Care Access model was approved by the Advisory Council. Developing a logo was considered effective by other states to help promote the training and warmline efforts. The logo is based on the traditional weaving arts, symbolizing the many cultures of Hawaii working together. It represents unity and community within the Pediatric Mental Health Care Access network and the support this network brings to both pediatric providers and their patients. The logo is shaped into a heart to show PMH's support for pediatric providers while highlighting how professionals from differing practices come together to care for patients.
Partnering with Pacific Jurisdictions. The Hawaii project merged with efforts in the Pacific jurisdictions. The HRSA Project Officer convened the Pacific Jurisdictions - Palau, Federated States of Micronesia (FSM), - Commonwealth of the Northern Mariana Islands (CNMI) and Guam- and encouraged Hawaii to develop a warmline that could be used throughout the Pacific given the severe shortage of behavioral health providers in this region. HRSA hosts monthly calls among the Pacific Jurisdictions to support this critical partnership.
Strategy 2: Promote Workforce development and training on pediatric mental health care
Like most of the nation, Hawaii has a workforce shortage of behavioral health and primary care providers. There are 230.2 FTE pediatricians and 351.4 FTE family medicine and general practice providers statewide (as of November 2020), with an estimated workforce shortage of 567.4 FTEs across all islands (AHEC).
This strategy focused on identifying providers and providing training on pediatric mental health care to address shortages of both pediatric and behavioral health providers and enhance knowledge and skills of existing providers.
Because of the workforce shortages and increases in youth mental health needs, FHSD focused on offering providers access to timely mental health training. This strategy focuses on workforce training efforts.
Project ECHO. FHSD continued working with Hawaii’s Project ECHO to conduct training for healthcare providers. In FY 2023 a series of nine pediatric behavioral health sessions were offered. A second round of mental health topics was developed and presented to providers starting in the summer of 2023.
REACH Institute. The PMHCA Staff met with The REACH Institute (Resource for Advancing Children’s Mental Health) to provide training on evidence-based therapies to better diagnose, treat, and manage child and adults with mental health issues. A contract is under development to pilot this training in Hawaii.
AAP-Hawaii Chapter. The AAP-Hawaii Chapter selected a Pediatric Mental Health Champion to assess provider needs around mental health and promote the PMHCA model. With the PMHCA coordinator, focus groups were conducted with pediatricians across the counties. This work is supported through the PMHCA Program Utilization Chapter Funding Opportunity grant submitted collaboratively by HRSA.
Workforce Summit. The PMHCA staff sponsored a behavioral health track at the annual Hawaii Health Workforce Summit in September 2023 for approximately 900 participants, including physicians, physician assistants, ARNs, Community Health Workers, Medical Directors, Office Managers, Allied health Professionals, and more.
Strategy 3: Support services and linkages in the community
FHSD identified service capacity issues and linkages needed to support children’s mental health. Hawaii continues to look at a coordinated intake and referral system to help promote the coordination of services to ensure no gaps between intakes and referrals and services. There is the recognition, however, that not all communities have mental health services and treatment options available. This strategy focused on assuring mental health service availability and access for families throughout the state.
Needs Assessment. The PMHCA Coordinator is partnering with the DOH Child and Adolescent Mental Health Division (CAMHD) and Suicide Prevention Coalition to conduct an environmental scan of existing mental health services statewide, including behavioral health services, inpatient treatment programs, treatment programs, inpatient hospitalization or emergency departments, clinical providers, nonprofits addressing mental health and practicing mental health clinician as part of the CAMHD Needs Assessment.
Promising Minds. PMHCA partnered with Hawaii Community Foundation’s Promising Minds initiative to improve early childhood behavioral health in Hawaii. Promising Minds will be funding the Maui Warmline Pilot and collaborating with the PMHCA team on a series of Early Childhood training for pediatric providers.
Current Year Highlights for FY 2024 (10/1/2023 – 6/30/2024)
This section highlights the Year 3 work for the PMHCA grant. Significant progress has been achieved in the grant over the past year, thus, current year activities are outlined by strategy.
Strategy 1: Refine, develop, and implement pediatric mental health care access model
Staffing. The vacancy for the PMHCA Specialist position was filled in Fall of 2023. The PMHCA team continued hosting Advisory Committee meetings and met with stakeholders to promote and develop the model. The PMHCA team alongside partners from JABSOM, AAP and Hawaii Community Foundation (HCF)
Maui Fire Updates/pilot. With the recent devastating impacts of the Maui wildfires, FHSD recognizes the immediate need of resources and services needed for disaster aftermath recovery for community members directly and indirectly impacted. The focus is to pilot the consultation access line in Maui. The Maui Pilot is in collaboration with Hawaii Community Foundation’s Promising Minds Initiatives and Queens Medical Center.
Sustainability. The PMHCA team is exploring long-term sustainability for PMHCA beyond the completion of grant funding. This includes engaging in discussions with Medicaid, health plans, and state legislators. In January, the PMHCA Coordinator spoke to the Health and Homeless Committee about the PMHCA grant and the importance of addressing children's mental health needs in Hawaii.
Strategy 2: Promote Workforce development and training on pediatric mental health care
This strategy focuses on workforce training efforts. Highlights of activities include:
- Worked with Hawaii’s Project ECHO and completed a third round of mental health topics and to provide training to providers starting in the Fall of 2023.
- The PMHCA Staff continues to attempt to contract REACH Institute (Resource for Advancing Children’s Mental Health) to provide training on evidence-based therapies to better diagnose, treat, and manage child and adults with mental health issues. However, REACH has not been able to meet the compliance status preventing Hawaii PMHCA from contracting with them.
- During the focus group meetings held last fiscal year with the AAP, pediatricians expressed interest in learning about mental health resources in Hawaii, including CAMHD services, DOE Behavioral Health Services and School-Based Health Care. In response, the AAP-Hawaii Chapter and PMHCA team organized a series of meetings featuring speakers from these organizations to inform and educate providers about their services.
- PMHCA is sponsoring the second year of the pediatric mental health track at the annual Hawaii Health Workforce Summit in September 2024.
- PMHCA team in collaboration with the Promising Minds and Association for Infant Mental Health Hawaii (AIMHI) Initiative will be hosting trainings for providers and allied professionals in diagnosing and treating mental health needs for ages 0 to 5.
- PMHCA team and Hawaii’s Project ECHO partnered to develop another round of mental health topics for the pediatric ECHO for sessions from November 2023 to February 2024. A total of six sessions were offered to continue providing pediatric mental health topics. Topics included introductions of the PMHCA models and CPAP interventions, trauma-informed care for caregivers, suicide prevention/resiliency, infant mental health, and ADHD medication management.
Strategy 3: Support services and linkages in the community
The PMHCA Coordinator continues to connect with community providers, help learn and support community-based efforts, and identify partnership areas.
- The PMHCA Coordinator is partnering with the DOH Child and Adolescent Mental Health Division (CAMHD) and Suicide Prevention Coalition to conduct an environmental scan of existing mental health services statewide, including behavioral health services, inpatient treatment programs, treatment programs, inpatient hospitalization or emergency departments, clinical providers, nonprofits addressing mental health and practicing mental health clinician as part of the CAMHD Needs Assessment
- The PMHCA Coordinator with CSHNB conducted the Mental Health Snapshots event, bringing together mental health partners to share information about their respective programs. This event aimed to enhance understanding of statewide services and promote collaboration across sectors and the community. Based on the post evaluation comments another event is being held to support for system coordination/collaboration.
- PMHCA Coordinator and Specialist collaborate with community partners such as Hilopaa Family to Family Information Center and Family Hui Hawaii with family and youth engagement meetings to discuss perspectives on mental health and experiences in accessing care.
Challenges Encountered
Some of the major challenges for this priority measure include:
- Although HRSA provided extra funds to support PMHCA efforts in Hawaii, systemic procurement challenges and contracting delays make it difficult to encumber and expend funds promptly.
- Like many other states, Hawaii saw an increase in children and youth mental health needs exacerbated by COVID, which continues to be a problem. Mental health issues existed prior to COVID; however, there is an increase in mental health needs for children and youth due to anxiety and depression caused by social distancing and lack of socialization of youth; increased social media and cyberbullying; and family stress due to economic concerns.
- Limited mental health services and treatment options are currently available, which often means that children and youth in rural communities and neighbor islands must fly in or drive to Honolulu for services. This is true for both intensive treatment options and preventive services.
- Mental Health services along the continuum of care are being worked in different sectors and silos creating a fragmented mental health system. This creates a challenge for the PMHCA team to ensure there is no overlap of services that could further complicate access to necessary mental health services in the community.
- There is a lack of comprehensive/directory of system services. New federal and state funding for mental health services resulted in new service options; however there is little awareness of many of the new and existing available services.
- Based on the experience of other states, even those with a larger population size than Hawaii, building a well-staffed/costly warmline service for a relatively low call volume is challenging.
- Cultural understanding and responses to mental health need more research and evidence for best practices as an effective option to traditional Western therapy and mental health treatment.
- Staffing/ Workforce Capacity Projects and initiatives are delayed due to our partners not having sufficient staffing or capacity to take on new projects.
Overall Impact
The PMHCA grant allows FHSD to implement primary prevention efforts addressing the mental health needs of children in Hawaii, primarily by supporting pediatric providers to increase children's access to mental health services. The PMHCA team has shifted its focus to a systems-building approach, aiming to break down silos and enhance collaboration across sectors, thereby extending the reach of mental health services at all levels.
In addition, the PMHCA team is incorporating a health equity perspective into their initiatives, ensuring that cultural components and the geographical barriers faced by residents of neighboring islands are considered. Despite the onboarding of PMHCA staff, challenges remain in establishing the warmline and encouraging pediatric providers to participate in trainings and utilizing the consult model.
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