We've managed to put together a program where we have integrated mental health services into a primary care practice in a large rural county outside of Pittsburgh. This was a practice that really didn't have any access to psychiatric care. They really were suffering and would get kids discharged from the hospital on 3 or 4 psychoactive medications and were asking for help with this.

So what we did is really try to develop a partnership so we could essentially fit round pegs into square holes because what you're trying to do when you're trying to do mental health services in a traditional medical setting is that you are really trying to mix different pots of money.

What we essentially did was we had the practice declared a mental health site, so what this allowed us to do would be for my time up there, they could contract for my time, and it would allow us to build through mental health funding streams, using the advantages the county had for kids who had MA and that sort of thing. So we blended these two different cultures. We built it around a nurse who was a nurse practitioner with mental health training who was owned half by the pediatric practice, half on the mental health side.

What we've done is we've built a little care team around that, primarily the primary care clinician, the nurse care manager. I go out there half-day, one day a week. We have a psychiatric social worker. The right way to do this model actually is to have a lot of different primary care practice and then at the hub of the wheel what I would say is you have a psychiatrist and a Ph.D. psychologist who is very highly trained in terms of the delivery of evidence-based psychotherapy who can provide backup and supervision to the folks out at the spokes. That's a model that we're hoping to start to study.

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