APPENDIX 2

System Challenges

Resources• Identify national programs to assist parents and pediatricians in identifying mental health resources such as Help Me Grow,69 which has established a centralized call center
• Advocate for a greater workforce of mental health providers and developmental-behavioral pediatricians
• Advocate for additional community mental health services and ensure they are of high quality
Screening• Develop additional well-validated screens to identify psychosocial risk
• Develop and validate screens appropriate for use in low-literacy and non–English-speaking populations
Payment• Advocate for payment for
 behavioral, emotional, and substance abuse screening
 non–face-to-face time including care plan oversight, complex chronic care coordination and prolonged services
• Evaluate enhanced payment systems for medical-home practices and monitor financial viability of hiring care coordinators
• Consider payment incentives for medical homes that include potentially enhanced reimbursement for behavioral and emotional screening, family psychosocial, or substance use screening and all follow-up care, case management, care plan oversight, and prolonged services in their capitation calculations.
• Evaluate cost savings associated with the detection and treatment of behavioral and emotional problems
Collaboration• Establish payment for collaborative care models that include telephone communications between providers, etc.
• Develop efficient methods to ensure that results of community-based screening are reported to the medical home
Other• Develop quality improvement initiatives related to behavioral and emotional screening as a part of maintenance of certification
• Develop electronic health records that incorporate screening but maintain patient privacy regarding behavioral and emotional problems and family psychosocial stressors