>>KEVIN SHEAHAN: Nemours is actually a multi-state integrated health system.
Here in Delaware we have the mother ship- the A.I.
DuPont Hospital for Children and we provide care to about a quarter of the children in
the state of Delaware
>>JENNIFER SHROFF-PENDLEY: Nemours has 10 primary care sites scattered throughout the
state and we now have psychologists in all of them.
By having the psychologists in those primary care practices we are able to reduce a lot
of barriers to care.
>>KEVIN SHEAHAN: I think it’s been a very positive experience for both the practitioners
and the patients.
Patients like the idea of going to their primary care physician’s office and having a full
range of services including behavioral health available to them.
>>HAL BYCK: Sort of trying to avoid it and hoping that it kind of goes away.
I started working here when the place first opened and it’s mainly to help the underserved.
We’ve been here now 18 years and we’ve grown ever since.
>>CLINICIAN: You have her on a hypertonic saline
>>HAL BYCK: And we’ve increased our amount of ancillary services that we have here including
breast feeding counselor, social worker, and the first thing that we actually integrated
within the office before any of them was psychology-which was 12 years ago.
>>ROGER HARRISON: So tell me about how things have been going.
>>FEMALE CHILD: Good.
>>ROGER HARRISON: I’ve been here since 2003.
I refer to myself as a primary care evangelist.
And the reason I enjoy primary care so much is the integration of behavioral health and
mental health particular in a setting like this serving the families who we serve.
It offers way more seamless service.
It gives me an opportunity to always have the physicians in the office.
We can consult.
They know the families.
I know the families.
We just provide a much better service to the families.
It’s a great model.
I can’t think of doing psychology outside of the model that we do it here - in an integrated
care model.
>>KEVIN SHEAHAN: In most other models to try to get patients to a psychologists often was
a very time intensive and sometimes distance intensive issue.
But now with having them there we can actually literally walk a child from the office down
to another office and have an intervention done right away if needed.
In some of our cases that’s been just an absolute life saver for some of these patients.
>>JENNIFER SHROFF-PENDLEY: In the pediatrician’s office, in our satellite clinics, it’s very
easy.
Sometimes its curbside consultation where in between patients a pediatrician may pull
a psychologists aside.
>>HAL BYCK: If one of the psychologists has a little bit of time in their day they’ll
come up to the room and discuss a few of the patients’ right there and then with us.
>>ROGER HARRISON: He kind of has to take medicine to control his ADHD symptoms.
>>HAL BYCK: So the discussions are ongoing and their more in real-time than delayed where
perhaps you lose that moment to really understand what’s going on.
And now with the EMR available with being able to see the psychology notes, they can
see our notes, I think we provide much much better care.
>>ROGER HARRISON: I can just go into the medical record and read their documentation.
What makes this, for me, an ideal place to work is that we have providers from many disciplines
at different levels.
So we have physicians.
We have medical residents.
We have medical students.
Then we have psychologists on staff.
We have psychology fellows who dedicate one year to being here to provide services.
We have our psychology resident.
We have psychology doctoral students who we also train here.
>>KEVIN SHEAHAN: We really get an opportunity to, as a psychologist, learn the medical model
and the medical side of things.
And at the same time we get the benefit of learning from the psychological side of things.
So it’s a nice blend.
>>JENNIFER SHROFF-PENDLEY: I think by checking the ketones when you came in there we prevented
the hospitalization.
It’s fun.
It’s intellectually stimulating.
I think that we provide better service by learning from one another.
We can complement our services and so it’s better coordinated.
Families aren’t hearing one thing from one provider and another thing from another provider
and then left to sort out which way they should go.
>>HAL BYCK: It almost feels as though to a lot of the patients that the psychologists
becomes an extension of our care.
For instance with ADHD it becomes part of everybody’s diagnosis.
You see us you then see the psychologists.
They know it’s just part of the routine.
>>ROGER HARRISON: It greatly reduces the stigma of seeking mental health services.
The main hospital campus is less than 5 miles from here and the families who we serve in
this community are really unlikely to show up at the hospital for services but they will
come and see me.
And I think part of that is the familiarity of the office.
They know the providers.
They trust their pediatrician.
>>PATIENT'S GUARDIAN: I like coming here because it’s centralized.
Dr. Amorosa is here which is their primary doctor.
Ja’miya and Malik see Dr. Rogers.
So everything is right here.
I don’t have to explain a whole lot because they already know it because they’re here.
>>KEVIN SHEAHAN: This is something I think is actually the model for pediatric care going
forward.
The numbers of children that have unmet behavioral and developmental needs is staggering.
And the only way we really can address that is to do it in an integrated fashion with
the psychologists in the office with the pediatricians working together as a team.
>>PATIENT'S GUARDIAN: I’m 68 years old raising babies.
You know - it takes a village to raise children?
Well, they’re part of my village.