PMHCA Awardees

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.

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

Full Article

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.