Workforce Development
NC PAL – North Carolina Psychiatry Access Line:
The intent of North Carolina Medicaid Transformation is an effort to provide more ‘whole-person’ care that includes physical and behavioral health as well as offering services in a cost-effective way.
Integrating behavioral health with primary health care allows for earlier identification of needs, implementation of services and improved health outcomes (both physical and behavioral).
By implementing a statewide psychiatric consultation system (NC PAL), the following results have been observed in other states:
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Increased access to psychiatry services across the state.
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Increasing access to children/youth to psychiatry through their Primary Care Providers.
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Earlier access to psychiatric care leads to less ‘failing up’ to higher and more expensive levels of care.
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Increased numbers of children/youth remain in the community with their families.
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Preserve the limited supply of child psychiatrists for those children/youth with more significant and complex needs.
The impact of this program goes beyond Medicaid as it is Insurance Blind. Its impact is on all populations, no matter the funding source.
Goals
The goal of a Statewide expansion of the North Carolina Psychiatry Access Line (NC-PAL) is to provide the following:
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Consultation to providers- Provide timely access to psychiatric consultation for providers to help them manage behavioral health conditions for 1) children/adolescents, 2) women in the perinatal period, and 3) individuals with intellectual and developmental disabilities (I/DD).
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Consultation to specific programs and agencies- Provide consultation to the Child Developmental Service Agencies around early childhood and developmental conditions, and to treatment programs serving children with more complex conditions including Child Residential Service Array programs (i.e. PRTFs), Emergency Departments, Schools, and the local Department of Social Services offices.
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Referral Support- Support referral coordination and systems navigation for practices and programs attempting to connect these individuals to specific treatment resources (i.e. therapy or further evaluation).
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Practice Engagement- Support dissemination of best practices for screening and treatment at the practice level.
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Provider Education - Provide education both through case discussions with each consultation, as well as through direct practice engagement and outreach, and through formal education initiatives such as training around psychotropic medication prescribing for primary care providers. This may include direct outreach to prescribers with outlier prescribing patterns for psychotropic medications or with other quality concerns.
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Provide Direct and Indirect Patient Care – The capacity to provide direct care at the regional hub or indirect care through telehealth.
Additional Information
For more information on NC PAL, visit their website: NC - Psychiatry Access Line
Co-Partners in the Building of Healthy and Resilient Communities
In addition to the investment in the development of a trauma-informed clinician workforce, the Child Behavioral Health Unit is seeking to deepen community-wide awareness, understanding and even lay skill-building through partnerships with the NC Partnership for Children (via their Healthy & Resilient Communities Initiative), former Center for Child and Family Health Trauma Informed Project team members (including Communities Organized for Racial Equity), and Area L AHEC.
The goal is to assist child and family stakeholders from a variety of sectors and settings to increase their awareness and understanding of trauma and to develop resilience-oriented strategies for their communities. DCFW continues to seek such opportunities and will partner with other local and statewide organizations to support the development of a statewide coordination of such efforts to ensure the maximization of all resources.
Additional Information
https://www.smartstart.org/resilience-intro/
https://www.ccfhnc.org/programs/trauma-informed-communities-project/
The North Carolina Child Treatment Program (NC CTP), a program of the Duke Center for Child & Family Health, was founded in 2006 by three physicians dedicated to provide trauma-focused training to clinicians across the state, so children who experience traumatic events can be effectively treated. Specifically, this training program was developed to address complex behavioral and emotional difficulties among children 3-18 years of age, following psychological trauma.
During the pilot program phase (2006-2013), NC CTP clinician trainees accepted referrals for hundreds of children who had experienced or been exposed to trauma, including physical abuse, sexual abuse and assault, community violence, interpersonal violence, natural disasters, traumatic grief, or frightening or painful medical conditions/treatments. In October of 2013, the scope of training provided by NC CTP increased from one evidence-based child trauma treatment model called Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for children 3-18 years of age to a total of five evidence-based treatment models. The models of treatment that are now part of this training program are:
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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
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Parent-Child Interaction Therapy (PCIT)
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Child-Parent Psychotherapy (CPP)
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Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS).
These models of treatment address attachment difficulties, trauma symptoms, and significant behavioral-emotional challenges.
The North Carolina Child Treatment Program trains approximately 450 mental health providers per year. These mental health providers participate in a rigorous learning collaborative training process and work with CTP master trainers and consultants to become proficient in a specific treatment model.
Since 2013, NC CTP receives annual funding from the NC General Assembly for statewide program expansion.
The NC CTP Website is located at: https://www.ncchildtreatmentprogram.org/about-us/.
Mental Health First Aid is a skills-based training that teaches participants about mental health and substance use challenges. Mental Health First Aid teaches participants how to identify, understand and respond to signs of mental illness and substance use issues. The training gives participants the skills to reach out and provide initial support to someone who may be developing a mental health or substance use problem and help connect them to the appropriate care.
Most people would know how to help if they saw someone having a heart attack— start CPR, or at the very least, call 9-1-1. But too few people know how to respond if we see someone having a panic attack or if we are concerned that a friend or co-worker might be showing signs of alcohol abuse. Mental Health First Aid takes the fear and hesitation out of starting conversations about mental health and substance use problems by improving understanding and providing an action plan that teaches people to safely and responsibly identify and address a potential mental illness or substance use disorder.
Beginning in fall 2022, through $5,000,000 GEER funding awarded by the Governor’s Office, the Child Behavioral Health Unit will begin delivering Youth and Teen Health First Aid training to school personnel and teens in middle and high schools across NC
Additional information: https://www.mentalhealthfirstaid.org/population-focused-modules/youth/
NCDHHS has partnered with Alliance Health and Cardinal Innovations to bring MATCH training to North Carolina’s child mental health clinicians. MATCH is an evidence-based intervention for children 6-18 years and their families. Based on cognitive behavior therapy, MATCH is an individualized, flexible model for children who have anxiety, depression, trauma symptoms, disruptive behavior, or any combination of these issues.
MATCH has been shown to produce better outcomes in shorter treatment times with high clinician satisfaction. In addition, the improved outcomes last over time after treatment ends. One MATCH innovation is the use of Treatment Response Assessment for Children (TRAC) System where clinicians track outcomes and monitor progress so adjustments can be made in treatment as needed.
The Baker Center for Children and Families is DCFW’s MATCH training partner. More information on MATCH can be found at: https://jbcc.harvard.edu/match-trac