Seventy one pediatricians attended the REACH Institute intensive training at five sites across the state and are currently involved in weekly telephone case presentations, and using clinical phone consultation services to help them serve their children with mental health needs. This is the result of our work with the CAP PC (Child and Adolescent Psychiatry in Primary Care) Program, offered by the University of Buffalo, Child Psychiatry Program, in partnership with the five Academic Medical School sites with Child Psychiatry faculty, The REACH Institute, and with the financial support of the State Office of Mental Health. In addition, another 70 pediatricians have attended one or more sessions of the C.A.P.E.S (Child and Adolescent Psychiatry Education and Support) Program offered by Four Winds Hospital to the geographic area from Plattsburgh to Dutchess County.

The CAP PC Program and the CAPES Program offer training and support to pediatricians and family physicians across the state who want to develop higher level skills to assess, diagnose and treat mild to moderate children’s mental health problems in the pediatric medical home.

The CAP PC Program offers an intensive two and a half day training experience. Each course is taught by a team of child psychiatrists and pediatricians. The training includes assessment, diagnosis and treatment, as well as medication management. Post training support includes access to psychiatric consultation, and access to a clinical services manager who can help pediatricians find additional needed services for their families who need mental health services and support. There are also plans to include telepsychiatry in the complement of services offered to trainees and their patients. In addition, the training includes a component on coding and billing, so pediatricians who bring their skills into their practices can be paid for their enhanced services.

The C.A.P.E.S Program is designed as multiple three hour segments of single evening or day training sessions. Each session is focused on a particular diagnosis or complement of related diagnoses, such as Assessment and Treatment of Child and Adolescent Anxiety Disorders or Assessment and Treatment of Depression in Children and Adolescents. Seventy seven pediatricians have been trained and remain involved with the CAPES program.

The program also includes: access to telephone psychiatric consultation, a referral service to outpatient mental health services, and an ongoing relationship with both the public and private mental health systems in the geographic area covered.

The goal of both programs, which together, the Office of Mental Health has named TEACH, is to create and support a cadre of trained pediatricians and family physicians who can effectively diagnosis, treat and provide psychopharmacological management for children with mild to moderate mental health challenges in a pediatric primary care medical home.

We are pleased that in this most challenging budget environment, we have been able to work with the state to ensure that this program has been funded, not only for this year, but for a series of trainings in 2011. The work that pediatricians can and will do will help provide high quality, effective mental health services to children who need them in a setting that is comfortable and familiar to both the child and the family.

The evaluations of both CAP PC and CAPES have been very positive. Pediatricians who participated in the CAP PC/REACH training were enthusiastic and appreciative of the detailed and helpful information provided in the training session. They were also pleased with the quality of the take home materials, the didactic and interactive learning experience, and the inclusion of a coding and billing component. Most reported that they believed they left the training with much greater skills and knowledge to provide children’s mental health services in their pediatric practices.

The pediatricians who participated in the CAPES training were also very positive about their experiences. They rated both the training and the ongoing support provided by the CAPES program to be very effective in supporting their efforts to provide a higher level of children’s mental health services in their practices.

Participants in both programs not only indicated that they felt the time spent was extremely valuable, they also were very sure that they would recommend the training to colleagues, and would be willing to take additional training courses should they become available.

Recognizing that our members not only want more opportunities to attend this first level of intensive training to build their skills, as well as more and better ways to fully integrate children’s mental health services into pediatric primary care, the District is working with the State Department of Health and the State Office of Insurance to create a statewide, structured way to pay for the new services for children covered by Children’s Medicaid, the Child Health Plus program, and private insurance. This process will develop in parallel with the building of a corps of trained pediatricians across the state. Various options are being explored to assure that pediatricians can and will be able to be compensated for providing these new services in the primary care setting. We know that in several parts of the state trained pediatricians have been able to work with most of their insurers to get adequate payment for the new services they are providing, but this is not true across the state. We are working to assure that all pediatricians will be able to be paid adequately by all insurers when they offer high quality, effective children’s mental health services in the pediatric medical home. Payment should not be impacted by where you practice, but rather by the quality of the service you provide.

As we prepare for a second year of both the CAP PC and the CAPES programs, we look forward to offering training and supportive consultation services to at least another 140 pediatricians across the state. Our final goal is to create and support a system that will provide high quality training and ongoing supportive clinical consultation to any pediatrician who wishes to integrate children’s mental health services into the pediatric medical homes.

If you are interested in participating in the next round of CAP PC/REACH training, or if you would like more information about the CAPES program, please contact your Chapter President for more information:

The National AAP has identified Early Brain and Child Development as one of its Child Health Priorities for 2010-2011. To reflect the national priority, the District II Committee on Early Childhood Development will address developmental issues that face New York State’s children and families and the pediatricians who care for them. The Committee will join with local and state agencies and organizations working with children, families and allied professionals to identify access, quality and treatment challenges in early childhood developmental services at the state and local levels and propose possible solutions, whether through education of stakeholders and/or families, or through regulatory or legislative recommendations. All committee activities will be integrated with existing and developing District priorities.

The Committee activities will focus on supporting the achievement of children’s optimal developmental trajectories in all domains in the first 5 years of life. The Committee will draw its members from the three NY Chapters. Each Chapter will be invited to propose three or four members who have a special interest in early childhood development. In addition, the Committee will, when appropriate, create external topic focused advisories that will include additional District representatives, allied professionals, parents, and representatives of organizations working in the area of child development and early brain development. The membership of the Topic Advisories will reflect the expertise in both practice and academia that may be needed to most effectively address any particular issue that comes before the full committee.

Dr. Marie Casalino and Elie Ward, MSW, will be the Co-Chairs of the Committee. District and Chapter leadership will be ex-officio members. It is anticipated that the Committee will meet by conference call once a month to start. Ongoing communication and other work as needed will be conducted via e-mail.

The District Committee on Early Childhood Development will produce materials as needed.  Proposed initiatives include:

All printed and internet materials will be reviewed by the District prior to public distribution and will go out under the auspices of the District.

The District is enthusiastic in its support of this new initiative and looks forward to the contributions that this Committee will make to improve the quality of care for all children during the critical first five years of life.

If you are interested in joining the Committee, please contact your Chapter President: 

• NY Chapter 1: Dr. Michael Terranova, mterrano@buffalo.edu (all NYS counties not listed below)

• NY Chapter 2: Dr. Abraham Jelin, bramjel@aol.com (Brooklyn, Queens, Nassau & Suffolk)

• NY Chapter 3: Dr. Andrew Racine, aracine@montefiore.org (Bronx, Manhattan, Staten Island, Dutchess, Orange, Putnam, Rockland & Westchester)

The NYSDOH Bureau of Early Intervention, through funding from the federal Maternal Child Health Bureau of the Health Resources and Services Administration (HRSA), is working with New York’s pediatricians to improve and increase screening for Autism Spectrum Disorders (ASD) and provide appropriate referrals to local early intervention programs. Substantial scientific evidence now exists to show that early identification and treatment leads to significant improvement in developmental outcomes and functioning for children affected by autism.

The AAP has published guidelines for early identification, screening, and clinical management of children with ASD and an Autism Toolkit "Caring for Children with Autism Spectrum Disorders." The AAP is asking its member pediatricians to work to improve universal screening for ASD and provide appropriate referrals to early intervention programs.

On August 31, 2010, as an inaugural event, the NYSDOH Bureau of Early Intervention and AAP District II held a meeting for pediatricians on the early identification and referral of young children with Autism, Pervasive Developmental and other Developmental Disabilities in Albany, NY. The goal of the meeting was to educate pediatricians about ways to incorporate screening for ASD, to demonstrate red flags for ASD in young children through video vignettes, and to present an opportunity for the doctors to speak with colleagues, parents, and county early intervention officials. The meeting included presentations by developmental pediatricians, a clinical psychologist, and a parent/advocate, about physician involvement in the early intervention process. Meetings with pediatricians who have participated in an ongoing Learning Collaborative were held in Rochester and Long Island in October and November 2010.

NYSDOH and AAP District II plan to continue this collaboration and provide additional opportunities for pediatricians to learn about autism around the State.

Additionally, NYSDOH is exploring an on-line tool, which could serve as a clearinghouse of important and relevant local, state, and national autism resources, to support pediatricians’ efforts to screen and make appropriate referrals in their communities.