Monday, April 20, 2015

A Guiding Hand in Pediatric Psychiatry: The Massachusetts Child Psychiatry Project in Action

By: Joann Schulte  DO, MPH; Editorial Board Member
      It should come as no surprise that the mental health care needs of children and adolescents has increased more than that of adults during the period 1995-20101.  The responsibility for dealing with that increase seems to fall more and more  on primary care pediatricians.. The reasons are multiple: a shortage of child mental health specialists; mental health problems are more complex; and the use of psychotropic medications by primary care pediatricians due to the lack of child psychiatrist availability is increasing.
      So what’s a pediatrician to do when you want to consult a psychiatrist or other mental health specialist and they are not readily available? You create a program that enables primary care providers to consult with mental health practitioners in their region about diagnostic issues and use of psychotropic medication.  One such program, the Massachusetts Child Psychiatry Access Project is described in a new study being published this month by Van Cleave et al. (doi:10.1542/peds.2014-0720) in Pediatrics.
      The Massachusetts program (between 2005 and 2011) enrolled 285 practices whose providers called for advice a mean of 5.2 times per 1000 patients per year and saw calls steadily increase as seen in the figure below from the article.
Calls per month to all MCPAP sites by PCPs, May 2005-July 2011
       Calls most frequently concerned medication/evaluation questions and most commonly referred to  patients with diagnoses of ADHD and anxiety.  The researchers found that 46% of the time the call resulted in a referral back to the primary care provider and another 42% of calls led to an evaluation by a psychiatrist or to a care coordinator to identify appropriate resources for the patient.
      The demand for mental health services by pediatric patients is increasing and the evaluation of this project in Massachusetts suggests the use of a consulting service was of help to practicing pediatricians. Having somebody in the mental health world who is accessible by phone and can listen and provide appropriate advice to a practicing pediatrician is important if we are going to help our patients with their mental health needs.

1.  Olfson M et al. National trends in the mental health care of children, adolescents and adults by office-based physicians. JAMA Psychiatry 2014; 7(1):81-90

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