Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC.

OBJECTIVE: Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. PROGRAM DESCRIPTION: CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. METHODS: The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. RESULTS: CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CONCLUSIONS: CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.

Long-term safety and use-effectiveness of intrauterine devices.

The long-term safety and effectiveness of Lippes Loops, A, C, and D, Dalkon Shields, Saf-T-Coils, and Cu 7-200 intrauterine devices (IUDs) were evaluated on the basis of 670 insertions in 588 women. Ten-year life-table rates for the Lippes Loops C (291 first insertions) and D (213 first insertions) were evaluated. The Loop C was consistently associated with a significantly higher expulsion rate but lower pregnancy rate as compared with the Loop D. Over-all, the removal rates for these two IUDs were similar. The incidence of pelvic infection and abnormal Papanicolaou smears, the time from IUD removal to conception, pregnancy outcome, and the need for any surgery post-IUD insertion were evaluated for all IUDs and all segments of use.

Consultation with the extended family. Primary process in clinical practice.

In this article, the authors have attempted to describe a method from their pattern of experiential family psychotherapy and to demonstrate its usefulness. Consultations with the extended family serve many purposes, but the one the authors highlight is the way they provide access to the unconscious components of the family. The extended family consultation interview is like an emotional hot tub that precipitates what the authors call a family group psychosis, an inherently therapeutic experience.