PMHCA Awardees

Objective: Pediatric Mental Health Care Access (PMHCA) programs increase access to mental health care by providing training, consultation, and resource-referral support to primary care providers (PCPs). The authors compared trends in services provided by two PMHCA programs during the COVID-19 pandemic. 

Methods: Maryland and Mississippi PMHCA programs had 2,840 contacts with PCPs from January 2019 to March 2021. Descriptive trends on PMHCA program utilization, service type, clinical severity, diagnostic complexity, and PCP contact reasons were reported. 

Results: Both programs observed significant increases in call volume during the COVID-19 pandemic compared with before COVID-19. Increases were observed in calls regarding patients with multiple diagnoses (Maryland, 20% to 37%; Mississippi, 0% to 11%) as well as patients with mood and anxiety symptoms. 

Conclusions: Changes in PMHCA program usage suggest that PCPs identified more complex mental health concerns, particularly regarding mood and anxiety, during the pandemic than before COVID-19. Trends underscore the importance of PMHCA programs in supporting PCPs with managing pediatric mental health concerns

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Abstract

Objectives Nearly 50% of children with a mental health concern do not receive treatment. Child Psychiatry Access Programs like Behavioral Health Integration in Pediatric Primary Care (BHIPP) address regional shortages of mental health treatment access by providing training and consultation to primary care providers (PCPs) in managing mental health concerns. This study assessed PCPs’ comfort with mental health practices to inform expansion of BHIPP services. 

Methods Pediatric PCPs in 114 practices in three rural regions of Maryland were recruited to participate in a survey about their comfort with mental health practices and access to mental health providers for referral. Descriptives, Friedman’s test, and post hoc pairwise comparisons were used to examine survey responses. 

Results Participants were 107 PCPs. Most respondents were physicians (53.3%) or nurse practitioners/physician’s assistants (39.3%). Friedman’s test, χ2 (7)= 210.15, p<.001, revealed significant within and between-group differences in PCP comfort with mental health practices. Post hoc pairwise comparisons indicated greater comfort providing mental health screening and referrals compared to prescribing psychiatric medications, providing psychoeducation or in-office mental health interventions. A Wilcoxon-signed rank test showed significantly more respondents agreed they could find a therapist than a psychiatrist in a timely manner, Z= −5.93, p<.001. Conclusions Pediatric PCPs were more comfortable with providing mental health assessment and referrals than treatment. However, PCPs reported difficulty finding therapists and psychiatrists for their patients. Findings underscore the need for longitudinal training to increase PCP comfort with mental health treatment. Additionally, strategies such as telepsychiatry are needed to address the disproportionate need for child psychiatrists

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Pediatric Mental Health Care Access (PMHCA) Programs, sometimes referred to as Child Psychiatry Access Programs (CPAPs), are collaborative programs that provide timely training and support to pediatric primary care clinicians (PCCs) and other clinicians related to detection, assessment, treatment and referral of behavioral health conditions within their practice. This support is provided as part of a peer-to-peer, telehealth-based consultation model – PCCs can connect with off-site child/adolescent behavioral health professionals by phone, video call or email/web-based consultation.

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The Forum for Children's Well-Being will host a virtual, public workshop focused on telemental health services for children, youth, and families. It will explore the increased use of telemental health services throughout the COVID-19 pandemic, and consider how those services may continue as the pandemic recedes. The workshop will consider how telemental health may address disparities in access to services for some populations of children, including children living in rural communities and children with disabilities. Additionally, the workshop will consider potential barriers to effective telemental health, including reliable access to internet.

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Delivering mental services remotely did not begin during the COVID-19 pandemic, though its use has greatly expanded during this time. Looking ahead, there are questions about how those services for children and youth may continue as the pandemic recedes. To consider these questions, the National Academies' Forum for Children’s Well-Being (the Forum) held a 3-day workshop in October 2021 on the use of telemental health services both before and during the pandemic. The first day of the workshop highlighted examples of how different programs provide mental health services in a digital format. The second day focused on some common challenges associated with providing telemental health services. The third day considered how best to support providers of telemental health services. Each day began with opening remarks, followed by short panel presentations from three speakers and a moderated question-and-answer (Q&A) session with the speakers. This Proceedings of a Workshop—in Brief provides a high-level summary of the topics addressed in the workshop. Additional details, including a recording of the workshop, can be found online.