Mission: Collaboration among primary care, mental health and educational professionals to enhance the community’s ability to respond to adolescent depression.
Financial Support: Supported by a planning grant from Stanford Medical Center funded by Lucile Packard Children’s Hospital, Stanford University School of Medicine and Stanford Hospital & Clinics.
During the past year, the following organizations have taken part in HEARD work in one or more of following ways: attending a HEARD meeting, consulting on special projects, providing expertise, or pledging mental health treatment slots for youth in the community. (If we have overlooked any individuals or organizations, please forgive us.)
Schools: Palo Alto Unified School District; Mountain View/ Los Altos School District
Primary Care/Pediatrics: Palo Alto Medical Foundation: Pediatrics, Family Practice; Lucile Packard Children’s Hospital/Stanford: Child & Adolescent Psychiatry, General Pediatrics, Adolescent Medicine, Emergency Medicine, Palliative Care
Mental Health: Lucile Packard Children’s Hospital/Stanford (LPCH), Psychiatry; Palo Alto Medical Foundation; Mills Peninsula Health Services; Kaiser Permanente Northern California; Bay Area Children’s Association; Kara: Grief Support & Education; Adolescent Counseling Services; Children’s Health Council; EMQ Families First; One East Palo Alto; Community Health Awareness Council (CHAC) of Mountain View/Los Altos; Asian Americans for Community Involvement; El Camino Hospital; Fremont Hospital; Family & Children’s Services Palo Alto; American Foundation for Suicide Prevention; Gronowski Clinic; Jewish Family & Children’s Services; Individual clinicians from the communities of private practice mental health and county mental health
A. Primary care projects:
focusing on improving mental health screening and co-management of teen depression among primary care and mental health providers. Below is a summary of specific tasks:
1. Mental health screening in primary care. Reviewed and vetted mental health screening tools. Several member groups are piloting these tools. Palo Alto Medical Foundation is uploading these into Sutter’s electronic health record (EHR) and will begin screening in a pilot program in its largest pediatric clinic. LPCH Adolescent Medicine Clinic has begun screening teens for depression during routine well visits.
2. Educational sessions about screening and management of depression and of suicide risk for primary care physicians at Palo Alto Medical Foundation, LPCH, Kaiser and at the Packard Children’s Hospital Annual Pediatric Update
3. “Provider Toolkit” compiled, so that when physicians identify teens with depression, they can readily access the needed resources, such as: diagnosis guidelines to identify and stratify depression along with co existing medical and psychiatric conditions and other risk factors; treatment guidelines; new work flows for screening and managing patients with depression in primary care; depression medication reference guides for primary care physicians; contact and access information for local facilities for emergency evaluation, triage and hospital admission for pediatric psychiatric issues; forms to expedite and improve the sharing of information about mutual patients/students among primary care providers, mental health providers and school staff
3. “Family Resource Guide” compiled for primary care settings, with websites, handouts, and telephone numbers.
B. School projects:
1. Provided expertise to assist the school districts in reviewing literature on intervention, screening, gatekeeper training and prevention.
2. Developed release of information forms that school counselors may use to communicate with primary care physicians and mental health providers.
3. HEARD members took part in educational sessions with PAUSD counseling and special services personnel, spoke at PTA meetings, and met regularly with senior District personnel to develop strategy for effective postvention (i.e. intervention to prevent contagion and decrease distress following suicide)
4. HEARD members have been actively involved in Project Safety Net, the city-schools task force, charged with identifying and helping to implement best practices in the areas of education, intervention, and prevention of adolescent depression.
5. HEARD members hope to implement the Sources of Strength peer support program at Palo Alto Unified School District (PAUSD) high schools in coordination with the national Sources of Strength program run by Mark LoMurray and Peter Wyman, PhD.
6. HEARD members will help to implement two school-based depression education and emotional self-regulation programs programs for teens, parents and teachers at PAUSD High Schools: More than Sad from the American Foundation of Suicide Prevention (AFSP), and Brain Driver Education from Massachusetts General Hospital.
C. Mental Health System projects:
1. Local Mental Health Resources/Relationship building with local mental health agencies:
- Gathered community treatment resources to assess community’s capacity for screening and referrals through the school’s Gatekeeper Program (and for future referrals that come from students and faculty at PAUSD through awareness programs like Sources of Strength, More than Sad).
- Estimated the availability of treatment slots for those youth who are of concern to school staff but not at imminent risk during the spring.
- Developed a list of local organizations that might be willing to help and surveyed them about treatment resources. The survey addressed: capacity to accept adolescents who are at-risk; services provided; how many treatment slots the agency might be able to commit for this time frame; insurances with which contracted; capacity for sliding scale or pro bono work.
- Initiated contact and built relationships with local mental health agencies.
- Project Safety Net is still working on procedures to identify children at risk; the HEARD group remains a resource if they should anticipate high volume and may need help identifying slots.
2. Collaboration with local ER and crisis interventions services: Facilitated contacts with agencies providing emergency and crisis intervention services (EMQ Crisis Team; Emergency Departments at Packard Children’s Hospital, Mills Peninsula Hospital, El Camino Hospital, Fremont Hospital) to invite them to become involved with the PAUSD in discussion of logistics of obtaining emergency evaluation for adolescents at imminent risk and to enhance collaborative care.
Resources and Useful Documents
Local Depression Screening Toolkit for Primary Care Physicians
- How to Access Mental Health Providers – Patient Handout
- Resources for Teens, Parents on Mental Health – Books, Websites, Hotlines, Local Organizations
- Understanding Depression Handout
Physician Tools for Diagnosis, Medication Management, and Resources
- Depression Diagnostic Criteria and Severity Rating
- Antidepressant medication table for Teens
- Antidepressant medication table for Adults
- Depression Management Resources for San Mateo & Santa Clara Co’s
- Hospital Based Psychiatric Services, SF Bay Area
- Primary Care Summary, Adult Depression Management
- PHQ-9 Modified for Teens
- PHQ-9 for Adults survey
- PHQ-2 to 9 for adults, Self Scoring
- Pediatric Sx Checklist for Youth questionnaire
- CRAFFT Drug and Alcohol Screen
Forms to Increase Communication and Collaboration Among Schools, Primary Care, and Mental Health Services
- Discharge Summary following Psychiatric Hospital Care
- Brief Visit Summary from Mental Health Provider
- ROI Parent Signature for Behavioral Health Exchange