A Philanthropic Dialogue on Collaborative Care in Pediatric Practice

May 10, 2023

Briefing provided to a diverse group of more than 50 philanthropists and their representatives, including individual philanthropists and foundation representatives from national, place-based and community foundations.

Nancy Caruso, Chief Operating Officer of The Goodness Web, kicked off the briefing by noting that more than 50% of adolescents in our country experience mental health disorders, and suicide is the second leading cause of death among 10 to 24-year-olds. She introduced Collaborative Care as a proven practice protocol that directly reduces the youth suicide rate, and improves early detection and intervention for anxiety and depression.

Collaborative Care: A Proven Practice Protocol

Dr. Matt Press, Physician Executive, Penn Primary Care at Penn Medicine, introduced Collaborative Care as the solution to integrating mental healthcare into primary care. He said:

“This for me started several years ago as a primary care physician caring for adults when I was incredibly frustrated not be able to access mental health care for my patients. Despite the tremendous numbers of patients who came to me with mental health issues, the coexisting medical conditions that those mental health conditions interacted with, there just were not enough psychiatrists either available or participating insurance to be able to care for those patients, so I stumbled across Collaborative Care.”

He then learned about the Collaborative Care model and its overwhelming evidence base—more than 80 randomized control trials demonstrating improved mental health outcomes, improved outcomes on comorbidities, and reductions in overall costs.

After five years of implementing collaborative care in the Penn Health system and treating over 20,000 patients, U. Penn has achieved upwards of a 50% remission rate for depression and anxiety based on standardized measurements. They have identified over a thousand patients with suicidal ideation and seen improvements in their scores over time. Additionally, their research confirms that this model lowers the overall cost of care.

He further notes:

“Perhaps surprisingly to us, we’ve noticed that our primary care physicians have become completely dependent on this program in a really good way. We didn’t fully appreciate how much our primary care clinicians were struggling to manage the mental health issues of their patients. They were adrift at sea facing a tidal wave of mental health issues, and now they have support, a life raft.”

Applicability to Pediatrics

Dr. Roshni Koli, Chief Medical Officer at the Meadows Institute then introduced Pediatric Collaborative Care as a way of serving more children and freeing up the very limited number of psychiatric specialists for the most serious cases. She cited the severe shortage of child psychiatrists: roughly 14 child and adolescent psychiatrists per 100,000 children versus a need three to four times this.

The Meadows Institute recently convened a roundtable of 24 academic practitioners leading collaborative care efforts in their communities–representatives from child psychiatry, pediatric psychology, and behavioral healthcare management from 11 states. It was the largest group of this kind in the country.  This roundtable was envisioned as the first in a series that Meadows Institute will host on pediatric Collaborative Care.

The roundtable revealed several key takeaways:

  • While there is a robust evidence base to warrant the implementation of Collaborative Care for ages 12 and up, every clinic is unique and children are not simply miniature adults. Therefore, further research and adaptation are needed to make the model even more effective for young people.
  • Involving families, caregivers, schools, and pediatric specialists is crucial for successfully addressing children’s needs in collaborative care.
  • Comprehensive training for behavioral healthcare managers is essential to connect primary care physicians with psychiatric consultants.
  • Another area for further exploration and recommendation is adapting the model to accommodate cases where a clear diagnosis is not immediately apparent, allowing time for a better understanding of the child’s condition.
  • Effective communication is vital to empower pediatric primary care providers in addressing the growing number of mental health concerns.

Dr. Koli urged all present to continue to pursue opportunities for Collaborative Care in their communities and noted that in Texas, Meadows Institute is implementing pediatric collaborative care pilots at multiple sites.

Role of Philanthropy

Bob Zorich, founder of the Robert L. and Barbara Zorich Family Foundation, had his interest in mental health sparked 25 years ago when one of his children was diagnosed with OCD. When he had the means to make a difference, he chose to focus on addressing the significant gaps in the field of mental health. He joined a local charity that trains laypeople how to handle mental health issues within existing infrastructures like schools, churches, and businesses.

As he became more involved and eventually chaired the organization, he was introduced to Path Forward. Being a logical businessman, he recognized the potential impact and decided to get involved. He asked how to implement a similar initiative in Houston, and offered to connect Path Forward with board members and hospital leaders in the area. He says:

“I’m not a medical professional, but as an encourager, I urge philanthropists and those with connections to leverage their influence because it can truly have an impact.”

Through these connections and introductions, progress began. Zorich recently received an update from Houston Methodist, one of the major health systems in Houston, that they are currently rolling out the Collaborative Care Model across all 42 of their locations. While challenges remain, it’s an exciting step forward. Memorial Hermann, another prominent Houston health system, is also making strides towards implementation, and Texas Children’s is implementing a robust pediatric version of the Collaborative Care Model.