PMHCA Awardees

This document serves as a centralized hub for awardees to access recordings, PowerPoints, and summaries from past TA events hosted by the TA Innovation Center

Abstract

BACKGROUND: There is a well-documented gap between the need for and availability of mental health services for children nationwide. To address this gap, over 30 regional Child Psychiatry Access Programs (CPAPs) provide psychiatric consultation and other services to primary care providers. 

OBJECTIVE: Summarize the methods used to evaluate CPAPs in the United States. 

DATA SOURCES: PubMed, PsychInfo, CINAHL, and reference checking.

 STUDY APPRAISAL METHODS: A systematic literature review was conducted searching 3 databases. The search produced 307 unique articles, 278 were excluded for irrelevance, leaving 29 for data extraction. Data extracted included author(s), publication year, provider types, CPAP formats, study sample, design, outcomes examined, results, and limitations. Articles were also appraised for quality using the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide. 

RESULTS: The 29 articles evaluated 13 unique CPAPs. Most evaluations used nonexperimental observational designs (68.9%), 6.9% used quasi-experimental designs, and none used true experimental designs. Evaluations examined the following outcomes: usage of program services (82.8%), provider satisfaction (48.3%), provider comfort/confidence with managing mental health concerns (31.0%), provider practice change (24.1%), patient outcomes (13.7%), and family satisfaction (6.9%). Outcomes were measured using surveys, qualitative interviews, or insurance claims data. 

LIMITATIONS: Review was limited to articles published in English in 3 databases or identified by reference checking. 

CONCLUSIONS: Evaluations of CPAPs have largely been descriptive in nature, focusing primarily on program usage and provider satisfaction. Few studies have examined the impact of CPAPs on patients, families, or health systems. Future studies should evaluate the broader impacts of CPAPs.

Full Article

Because of significant shortages in the behavioral health workforce, primary care providers (PCPs) have become the de facto mental health providers to address poor access to mental health care. Child psychiatry access programs (CPAPs) could support PCPs through case consultations. This column describes the innovative Missouri Child Psychiatry Access Project, highlighting the unique enhancements to existing CPAPs and the partnership between community and academic settings to support behavioral health access in primary care. Using an implementation science approach, the authors applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework to disseminate replicable steps for other systems; they also discuss future directions for expanding utility and scope.

Full Article.

For decades, the medical community has been dealing with a shortage of child psychiatrists in the United States. A study published in Pediatrics in November 2019 demonstrated that although the number of child psychiatrists increased in the last 10 years, there are still not enough to meet demand, and counties in the United States with lower levels of income and education particularly struggle to meet demand.1 Thirty-six states have fewer than 10 child psychiatrists per 100 000 children, with only 3.3 child psychiatrists per 100 000 in the most extreme case.1 This imbalance translates into wait times of over 11 months for an appointment with a child psychiatrist in some areas.2 Furthermore, up to 20% of children in the United States have a mental health disorder, with suicide the second most common cause of death among 12 to 17 year olds.3 A commentary by David Axelson, MD,4 published alongside the Pediatrics study, called for innovation in the delivery of mental health services to children to leverage the existing workforce to make the greatest possible impact. Over the years, many proposed solutions have addressed the workforce shortage, including developing accelerated training pathways for child psychiatrists, recruiting nurse practitioners to the field, and expanding federal loan forgiveness programs, but the shortage has persisted despite these efforts. Read More.