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7:05 - 7:10 Purpose of the Chapter Chat

Diane Dooley MD

7:10 - 7:15 Introduction of Speakers

Diane Dooley, MD

7:15 - 7:30 CYBHI Innovations Impacting Primary Care - Dyadic Services and Wellness Coaches

Sohil Sud, MD, Director

7:30 - 8:10 Cal MAP Part 2: Delving Deeper into Mental Health Support for Patients

Petra Steinbuchel, MD and Joan Jeung, MD

8:10 - 8:25 Discussion & Questions

8:25 - 8:30 Closing Remarks

Agenda

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Sohil R. Sud, MD, MA, FAAP

Introducing the Chapter Chat

Sohil R Sud, MD, MA, FAAP is the Director of the Children & Youth Behavioral Health Initiative, part of the California Health & Human Services Agency.

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Joan Jeung, MD, MPH, FAAP

Speaker

Joan Jeung MD MPH FAAP is a Clinical Professor in the Department of Pediatrics, Division of Developmental Medicine at the University of California San Francisco (UCSF) School of Medicine. Dr. Jeung serves as Senior Associate Director of the Child & Adolescent Mental Health Access Portal (Cal-MAP), the pediatric mental health care access program for California. She also directs the Resilience Clinic at UCSF Benioff Children’s Hospital Oakland, a primary care-based, caregiver/child group intervention for young children (ages 0-5) exposed to adversity. Outside of UCSF, Dr. Jeung serves on the Executive Committee for the American Academy of Pediatrics (AAP) Council on Healthy Mental and Emotional Development and on the AAP Pediatric Mental Healthcare Access National Advisory Group.

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Petra Steinbuchel, MD

Speaker

Dr. Petra Steinbuchel is a child and adolescent psychiatrist and clinical professor at UCSF. She is the Director of the California Child and Adolescent Mental Health Access Portal (Cal-MAP), a consultative pediatric mental health access program designed to increase access to timely, culturally responsive and evidence-based pediatric mental health care within primary care for youth age 0-25.

She has held several key leadership and teaching positions at UCSF and has led efforts to implement expanded access of evidence-based interventions to diverse and vulnerable populations, including developing collaborative partnerships between behavioral health and pediatric primary care providers in medical inpatient, outpatient and school-based settings.

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Cal-MAP: California Child and Adolescent Mental Health Access Portal �Part 2: Training & Resources��A CalHOPE program powered by UCSF

May 28, 2024

Cal-MAP

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Introductions

Please use the chat to share:

Your name, role
Your organization and location
Answer Poll Question: What enables you to provide a little more mental health care in your practice?

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What is Cal-MAP?

California’s pediatric mental health care access program designed to increase timely access to evidence-based, trauma-informed and culturally responsive mental health care for youth 0-25 throughout California’s communities, especially in the state’s most rural and underserved areas
Empowering Primary Care Providers with increased knowledge, skills, confidence, and interprofessional collaboration can help identify and address many more mental health problems earlier, with continuity of care in lower-stigma primary care settings

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Cal-MAP Services

Consultation

Telephone or e-consultation for PCPs with child/adolescent psychiatrist, child psychologist and/or care coordinator

Education

Live webinars
Recorded webinars
Project ECHO, including topics by diagnosis relevant to PCPs at core and advanced levels, universal therapeutic skills, and topics relevant to school-based professional audiences
Live in-person training

Resource Navigation

Telephone or e-consultation with LCSW/MSW to provide guidance on resources and referrals to PCPs
Direct support for families facing significant linkage barriers

Cal-MAP Services

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Synergy Between Our Services

All these components (consultation, education/training, resources, care coordination) act synergistically to:

Promote evidence-based practice
Build confidence and mastery
Promote health equity

Consultations

CME/Training

Website Resources

Care Coordination

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Advance Equity

Designed for Youth by Youth

Start Early, Start Smart

Center around Children & Youth

Empower Families & Communities

Right Time Right Place

Free of Stigma

California’s Child Youth Behavioral Health Initiative Aims

Cal-MAP Aims

Access

Equity

Connection

Workforce

Development

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+ Evidence-based best practice recommendations

+ Culturally responsive, trauma-informed practical tips and tools to best meet unique needs of various patients and caregivers, practice settings, practitioners and available resources

+ Care team member interprofessional collaboration guidance to effect improved outcomes across systems and settings i.e. medical, school, regional centers etc

+ Coaching, Connection & support to improve confidence & decrease risk of burnout

= ____________________________________________________________________________________________________________________

Increased equitable access to appropriate care by the right provider at the right time for the right length of time

Advance Equity

Designed for Youth by Youth

Start Early, Start Smart

Center around Children & Youth

Empower Families & Communities

Right Time Right Place

Free of Stigma

Cal-MAP Aims

California’s Child Youth Behavioral Health Initiative Aims

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Another day in the office…

Petra does brief intro, then we do role play

Role Play Part 2: [Joan’s first time starting an anti-depressant]- cap at 15 minutes

[Petra]: Hello, this is Petra Steinbuchel from Cal-MAP returning your call. How are you doing today?

[Joan, picking up phone]: Thanks for calling! I’m calling back about the same 15 yo girl I called in about a few weeks ago. To recap, she has a history of daily, severe headaches, was crying and begging me for help at her last visit with me, saying that she was at the brink of just wanting to quit everything, with lots of family conflict (and financial stress) in the background, compounded by prior war-time trauma that the family experienced as refugees. I see cut marks near her wrist (nothing fresh), and recent passive SI without plan/intent or prior attempt (which she’s not currently reporting). As it turned out, even though I recommended meds and the patient wanted them, her parents were resistant to the idea and wanted to try therapy first. They did leave room for considering meds if she was still depressed after therapy. We did find a therapist for her at her school-based health center (Yay!) and she likes her therapist, and says that they’ve started having some good conversations. However, she’s still feeling really depressed and anxious, and I’m still wondering about meds for her. I just saw her earlier this morning, and here’s her PHQ-9 [NEXT SLIDE]

[ad lib from here]

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PHQ-9 on

Cal-MAP.org under

Resources tab

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Depression Algorithm

on Cal-MAP.org under Resources tab

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SSRI Tip Sheet

on Cal-MAP.org under Resources tab

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Depression Algorithm

on Cal-MAP.org under Resources tab

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Talking About the Black Box Warning

Q: Is my child/teen more likely to hurt or kill themselves being on an anti-depressant?

A: Based on 24 RCTs, possible increased risk of suicidal thoughts/behaviors in young people up to age 25 (3.8% vs 2.2% placebo). However, no actual increase in suicides was found in these studies.
A: Suicidal thoughts/behaviors are most likely the result of pre-existing depression
A: FDA black box warning 🡪 fewer PCPs prescribed these meds to youth🡪 nationwide increase in child/teen depression and suicide. Depression is worth treating.

From SSRI Tip Sheet on cal-map.org under “Resources”

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Sign up on cal-map.org under Trainings

Link to role play on safety assessment: https://cal-map.org/s/primary-care-physicians/webinars?language=en_US

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Instant Poll

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�Cal-MAP Training and Education

Project ECHO

Anxiety/Depression
ADHD
Suicidality/Self-Harm
Autism
Eating Disorders
Screen Time
And more!

Live Monthly Webinars

On-Demand Webinar Recordings

Asynchronous learning
Watch webinar recordings and pass a quiz to earn CME credit
Up to 18 hours CME & ABP MOC Part 2 credit provided

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Cal-MAP Training Benefits

Free CME Credit

AMA Category 1 credit
American Board of Pediatrics – Maintenance of Certification (MOC) Part 2
(in future): applying to add CAFP, ACE ASWB +/- APA

Highly rated

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Cal-MAP Core Certification

Ways to Earn:

Live webinars (attendance at all 6 core topic presentations)
On-Demand (recorded) webinars: watch core topics + pass quiz
Project ECHO: Attend the whole core series

Topics:

ADHD
Anxiety
Depression
SSRI’s
Suicidal ideation
Autism

Syncs with Linked In

Add certification to CV

Badge:

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Cal-MAP Webinars: Live & On-Demand

Core curriculum
Disruptive behavior disorders
Trauma/PTSD
Eating disorders
OCD

Mental Health Assessment
Common Factors
Motivational Interviewing
Parent management training
CBT principles
Bullying
Racism

All webinars, recorded and available for viewing on your own time
Earn CME & MOC Part 2 credit by passing a short quiz after each module that you view

Medical Focus by Diagnosis

1^st Thursdays

Interdisciplinary Skills

3^rd/5^th Thursdays

On-Demand Recordings

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Cal-MAP

Tele-mentoring Communities

Brief didactics
Case-based discussions with peers and subject matter experts

Tracks

PCPs: Core + Advanced (Dx)
Schools/SBHC
Therapeutic Skills (Universal)

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Education Format Preferences

2023 PCP Survey

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ECHO 2021-2023 �Qualitative Feedback

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Education Format Preferences

2023 PCP Survey

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Training and Education

Visit https://cal-map.org to view our trainings and recordings

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Feedback from PCP Participants

"Thank you so much for helping us help patients in a positive supportive environment"

PCP Project ECHO Participant

"I get so nervous about any level of self-harm! Now I know how to stratify and manage what to do to help, how to shape my words and questions, connect in a way that allows the young person to feel ok about sharing." -Webinar Participant

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Website Resources

https://cal-map.org

For providers
For families
For school-based health center staff

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Rating Scales & Clinical Decision-Making Tools

Organized by diagnosis
Rating scales/screeners
Clinical pathways
Resource toolkits

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Patient & Family Handouts

Organized by concern/diagnosis (ADHD, anxiety, depression, etc)
Curated videos, online mental health tools, toolkits for patients and families

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Resources and Referral Navigation�Bridge Care Coordination

Psychiatrist Consultants can provide resources and referrals during telephone consultation
Bridge Care Coordination Services provides additional support:

Guidance on resources and referrals to PCPs
Direct support for families facing significant linkage barriers to connect with services

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Care Coordination

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I was part of a Bridge CC pilot and I really found it SO HELPFUL!

Being able to email questions on resources and being given resources was so helpful! CAPP PCP Survey 2023

Priorities for Future Care Coordination Services

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Coming Soon

Reach Out and Connect (ROC) consultations for PCPs with UCSF psychologists for specialized advice on concerns like early childhood mental health, eating disorder, autism, behavioral concerns, and substance use disorders.
PCP-to-Care Coordinator consults for patients with known diagnoses and/or treatment plans, but there are significant barriers to accessing care.
E-Consult and Text Consult pilot and future roll-out

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Cal-MAP Benefits

Improved Communication

90% 2023 Survey PCPs endorsed increased ability to communicate with youth & parents re: mental health concerns

Supports Measurement-Based Care

50% of PCPs reported increase in use of diagnostic tools & use of non-pharmacologic interventions to address pediatric mental health.

Increases Timely Access to Care

“I have been able to handle medication management more myself, rather than having to refer the patient to a psychiatrist. This allows the patient to get more timely access to treatment.”

-PCP Cal-MAP User

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Promotes Health Equity

Supports Measurement based Care

Increases Timely Access to Care

Reduces Burnout

Improved Communication

Disseminates practical, culturally attuned and trauma-informed guidance on evidence-based approaches to all of California’s communities, including the most rural & underserved, and within lower-stigma, early intervention and prevention-focused primary care settings.

50% of PCPs reported increase in use of diagnostic tools, approaches & use of non-pharmacologic interventions to address pediatric mental & behavioral health.

Consults with prior validated screening tools have more than doubled

“I have been able to handle medication management more myself , rather than having to refer the patient to a psychiatrist. This allows the patient to get more timely access to treatment.”

90% 2023 Survey PCPs endorsed ability to communicate with youth & parents re: mental health concerns

“CAPP consultation helps to address Provider Burnout, so that you can keep your FQHC staff around, which is beneficial for everyone.

Having resources and tools available increases your feeling of confidence and willingness to keep trying and not to just send everybody to the emergency room. It makes you want to schedule that 2 week follow up appointment and squeeze them in.”

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Better Outcomes...

"You guys are just incredible. I’ve been out here practicing in ‘East Podunk’ for over 35 years, and you have helped me so much now with four cases with outcomes I never would have expected before." -Cal-MAP PCP User

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Cal-MAP.org is live now

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Request a consultation today!

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How to Enroll

https://cal-map.org/s/registration?language=en_US

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Questions? Suggestions?

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Connecting For Care

Sunflowers communicate with each other underground through their root system, to ensure optimal growth for all.

Similarly, we want to ensure we are connecting for care with you, to ensure optimal development of California’s youth.

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Our Team

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Questions?

Contact: Petra Steinbuchel, MD

Petra.Steinbuchel@ucsf.edu

Joan Jeung, MD FAAP

Joan.Jeung@ucsf.edu

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https://www.surveymonkey.com/r/Cal-MAP

Complete Our Survey for a Chance to Win a $50 Gift Certificate!

Please submit your response by June 10!

https://www.surveymonkey.com/r/Cal-MAP

Thank you for participating in our recent Cal-MAP Chapter Chats. We value your input and are committed to enhancing our Cal-MAP consultation program. Your feedback is crucial in understanding your knowledge, needs, and barriers related to the program. We are also interested in identifying additional topics of interest for timely detection, assessment, treatment, and referrals for children and youth with mental health concerns.

To show our appreciation, we are offering a raffle for a $50 gift certificate to the restaurant of your choice for those who complete the survey: https://www.surveymonkey.com/r/Cal-MAP. Your responses will help us improve our program and better support pediatric health care providers. Please submit your response by June 10.