Following the people and events that make up the research community at Duke

Tag: North Carolina

Integrating Pediatric Care in NC: Behavioral Health Perspectives

In healthcare, developing a new treatment is often half of the battle. The other half lies in delivering these treatments to those communities who need them the most. Coordinating care delivery is the goal of NC Integrated Care for Kids (InCK), an integrated pediatric service delivery and payment platform looking to serve 100,000 kids within five counties — Alamance, Orange, Durham, Granville, and Vance — in central North Carolina. The project is a collaborative effort between Duke, UNC, and the NC Department of Health and Human Services (DHHS) funded by a federal grant from the Centers for Medicare and Medicaid Services (CMS). The program’s executive director is Dr. Charlene Wong (MD, MSPH), a Duke researcher, physician, and professor who leads an interdisciplinary team of researchers and policy experts as they explore ways to reduce costs via integrating care for North Carolina youth enrolled in Medicaid and Children’s Health Insurance Program (CHIP).

The five counties that are part of NC InCK

I recently had the opportunity to speak with two of InCK’s service partners: Dr. Gary Maslow (MD, MPH) and Chris Lea (Duke ’18). Both work within the Behavioral Health group of InCK, which seeks to use behavioral health expertise through collaborative care and training providers to help support pediatric care. Maslow, a professor at the Duke Medical School, has focused heavily on child and developmental psychiatry throughout his career. Having entered medical school with a desire to work in pediatric hematology, Maslow recalls how a conversation with a mentor steered him in the direction of behavioral health. At the time, Maslow was part of the Rural Health Scholars program at Dartmouth College; while discussing his aspirations, one of his professors asked him to consider conditions outside of cancer, leading Maslow to consider chronic illness and eventually child psychiatry. “Kids have other problems,” Maslow’s professor told him.

Dr. Gary Maslow (MD, MPH)
Chris Lea (Duke ’18)

When looking at healthcare networks, especially those in rural areas in North Carolina, Maslow noticed a disaggregated service and payment network where primary care providers were not getting the necessary education to support the behavioral health needs of children. His work with Lea, a third-year medical student at Duke, has centered around looking at Medicaid data to understand provider distribution, medication prescription, and access to therapy based one’s area of residence. Lea’s path to NC InCK began as an undergraduate at Duke, where he obtained a B.S. in psychology in 2018. As he explains, mental health has been a vested interest of his for years, a passion reinforced by coursework, research at the Durham VA Medical Center, and NC InCK. He discussed the important of appropriate crisis response, specifically how to prepare families and providers in the event of pediatric behavioral health crises such as aggression or suicidality, as critical in improving behavioral health integration. These safety plans are critical both before a potential crisis and after an actual crisis occurs.

Two main goals of Maslow and Lea’s work are to increase the implementation of safety plans for at-risk youth and expand follow-up frequency in primary care settings. The focus on primary care physicians is especially critical considering the severe shortage of mental health professionals around North Carolina.

The behavioral health group is but one subset of the larger NC InCK framework. The team is led by Chelsea Swanson (MPH). Other collaborators include Dr. Richard Chung (MD), Dan Kimberg, and Ashley Saunders. NC InCK is currently in a two-year planning period, with the program’s launch date slated for 2022.

Services provided by NC InCK

An Expert’s Perspective on Mental Health

In honor of Mental Health Awareness Week and Depression Awareness Month, I interviewed Rae Jean Proeschold-Bell,  an associate research professor of Global Health in the Duke Global Health Institute whose research focuses on positive mental health, clergy health, and the integration of care within health systems.

In 2007, Proeschold-Bell founded the Clergy Health Initiative, a program developed to improve health outcomes among the clergy of North Carolina. In their first study, they performed a longitudinal survey of nine Methodist churches in North Carolina to determine the clergy’s health status. It was found that the clergy had a far higher obesity rate (41%) than the rest of North Carolina (29%). High rates of chronic disease associated with overweight/obese individuals were also present. The most interesting find, though, was that depression rates were double that of the regional average. Why?

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Proeschold-Bell has conducted research in Kenya, Tanzania, Peru, India, and the U.S.

“Being the leader of an organization is difficult, says Proeschold-Bell. Churches are extremely underfunded and are constantly pressed for time. Pastors are expected to do all of the spiritual work that being a pastor entails, and also act as business managers for the church. But, thanks to donations from the Duke Endowment, Proeschold-Bell was able to develop three interventions to improve clergy health. Since then, she’s retrieved ten years of data that has allowed for further improvements in holistic health for the clergy of North Carolina.

When asked about depression specifically, Proeschold-Bell said that “the current model in place to treat depression does not work.” We focus strictly on treating the issue by mitigating its symptoms through an antidepressant, instead of pulling at the issue from multiple roots.

She says our efforts should be focused on increasing positive mental health. Positive mental health refers to the presence of positive emotions and good functioning (in both individual and social environments). Work being done by Corey Keyes at Emory has shown that individuals with high positive mental health are less likely to develop depression and chronic disease. By focusing our efforts towards improving one’s overall mental wellbeing, we can get individuals “ahead of the curve” and prevent them from even being depressed in the first place, says Proeschold-Bell.

Further research focusing on positive emotions has been conducted by Barbara Fredrickson at UNC, who suggests that positive emotions have been scientifically proven to increase people’s open-mindedness. Those with more positive emotions have been more willing to try new things and open up to other people, says Proeschold-Bell. These positive emotions connect greatly to one’s ability to be resilient, and there is research to be done in the overlap between possessing these emotions and being able to recover from situations of trauma and conflict that can be mentally straining.

To tackle mental health issues, we must look at them holistically and extensively. Not only do these issues need to be covered from all angles, but interventions need to be culturally competent and context-specific. Keeping these values in mind, will help improve global mental health outcomes.

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Post by: Lola Sanchez-Carrion

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