All About Children Pediatric Partners (AACPP) opened its doors in 1991 in Reading, Pa. It currently has 15,000 patients, with 66% being Hispanic and 22% Caucasian. After decades of growth, AACPP joined Penn State Health in 2019 and became Penn State Health Medical Group - All About Children, expanding children’s access to comprehensive health care services in the greater Reading area.
“This practice has always been an early adopter in many things, including having electronic health records before they were required, and embracing the American Academy of Pediatrics (AAP) medical home concept and participating in the Pennsylvania chronic care initiative pilot program,” said Adrienne Salaneck, MSN, RN, CRNP, who has been with All About Children for 27 years. She is about to complete her doctoral dissertation from Frontier Nursing University in improving effective patient-centered care among adolescents with depression.
Adrienne Salaneck, MSN, RN, CRNP
Through a federal Substance Abuse and Mental Health Services Administration grant awarded to the state of Pennsylvania, AACPP was first able to use bhworks software to screen children, teenagers, and young adults.
“It enabled us to screen effectively for depression, anxiety, post-traumatic stress, sexuality–the whole gamut–that is covered in a concise, organized, and private way,” Salaneck explained.
Another plus was that the American Board of Pediatrics approves bhworks as a Maintenance of Certification (MOC) Part 4 for Quality Improvement for Patient Care.
Behavioral Health Screen (BHS)
The Behavioral Health Screen (BHS) within the bhworks software identifies mental health problems and psychosocial risk factors. It consists of psychiatric symptom scales and risk behaviors covering all the psychosocial areas suggested by best practice guidelines. Results are immediately scored, summarized, and securely sent to a designated clinician for review. Most clinicians can scan the report within 10 seconds.
The BHS covers the following domains:
● Suicidality ● Anxiety
● Depression ● Substance Use
● Eating Disorders ● Traumatic Stress
● Self Harm ● Psychosis
● Gun Access ● Exercise
● Bullying ● Physical/Sexual Abuse
● Work/School Activities ● Family Environment
● General Medical ● Safety Practices
Different versions of the BHS have been developed for multiple age groups and care settings. In addition to the BHS, bhworks gives users access to a variety of validated screens, intake forms, and outcomes measures. Over 140 forms and assessments are available on bhworks, and additional tools can be readily added.
“When we started screening, the numbers of positive screens were high, but we were getting better data, particularly with eating disorders,” Salaneck commented. “We definitely noticed there was more honesty with the kids feeling more empowered to answer the questions in private on an iPad or laptop.”
At that time, the pediatric practice was not as comfortable treating behavioral and mental health issues, but that has changed over time. Now they initiate medication treatment if needed, offer an in-house, evidence-based Cognitive Behavioral Therapy treatment program, and have developed a collaborative care agreement with a community behavioral health provider in the Reading area. They also use Telephonic Psychiatric Consultation (TiPs), which is a Department of Human Services-supported statewide phone line that connects primary care providers to a child psychiatrist and referral support for children with Medicaid.
Pediatric Data over Five Years
AACPP uses the bhworks real-time data primarily to identify global statistics and rates of positivity. Said Salaneck, “When the practice runs the basic BHS report within bhworks, it breaks down the data beautifully, showing such information as to past and current history of suicide.
“I was shocked we had over a 50% positive depression rate, much higher than state and national data,” she said. With bhworks, they reviewed the data collected over five years, starting with 2017 to 2021, and it showed that their depression rate had been consistently that high.
Theirs is a safety net practice with a population of 71% Medicaid eligible and a poverty rate 32% higher than Philadelphia. Salaneck remarked it would be interesting to see Philadelphia’s population metrics compared to Reading’s.
“Overall, we conducted about 1700 screens in 2021; approximately 900 were positive, and about 25% of those showed moderate to severe depression and high anxiety,” she explained.
Salaneck went on to say that because the software is 100% web-based, “you can hand an iPad to the teenager, and they can complete the screening questions in 10 minutes confidentially in another room, so a parent isn't hovering over them. It’s even more helpful if the adolescent finishes the screening–sent to them via an electronic link– before they arrive at the office for their appointment.
“Teenagers take extra time and it’s already hard to deal with the amount of anticipatory guidance required,” Salaneck remarked. Such guidance is specific to the patient’s age and includes information about the benefits of healthy lifestyles and practices that promote injury and disease prevention.
For pediatricians and pediatric nurses, the quickly generated assessment report gives them insight into the patient before walking into the room. Completing the survey this way cuts down on provider time and allows them and/or a care manager to prioritize and spend that time dealing with issues that need to be addressed.
One of the many tools included in the bhworks platform is electronic consent. All About Children rarely has issues with gaining parental consent as behavioral and mental health screening is a standard of care. Adrienne said, “The parents who decline aren't worried about stigma; they worry about their kids being too young to answer such questions.” Only about 10 to 15 parents a year decline to give consent, which isn’t statistically significant, according to Salaneck.
One challenge is that the BHS often generates a number of ‘mild’ screens. Kids don’t always understand all the questions’ intent. They often have to clarify to students what it means to ‘hear voices.’ A patient’s personal medication history is also separate from bhworks, so providers have to access that to pull up prescriptions.
Primary Care Practice Connecting with SAP Agencies
The bhworks software platform is currently used by Pennsylvania Student Assistance Program (SAP) agencies in 47 counties. The use of bhworks has increased the identification of youth at risk for suicide in this population from 8% to 33% and has offered SAP agencies a way to measure behavioral health across demographics, regions, and shared risk factors.
With this connection, independent primary care offices in Pennsylvania can jointly work with a local SAP agency to get students the services and treatment they need. All About Children makes direct referrals to the SAP programs in Reading, Wilson, and Wyomissing School Districts.
“I would be very upset if we were told to give [bhworks] up,” said Salaneck. “We showed the BHS to independent primary care practices when we were considering a merger partner, and all of them were impressed,” said Salaneck. “Keeping this software was one of our criteria, including when Penn State was looking at us.”
Editor's Note: Adrienne Salaneck can be reached via her email, firstname.lastname@example.org, with any questions.