1
|
Daskalska L, Broaddus M, Young S. Closing the gap in access to child mental health care: provider feedback from the Wisconsin Child Psychiatry Consultation Program. BMC PRIMARY CARE 2024; 25:300. [PMID: 39143470 PMCID: PMC11323596 DOI: 10.1186/s12875-024-02538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics. OBJECTIVES The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider's ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care. METHODS A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann-Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach. RESULTS Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage. CONCLUSIONS This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.
Collapse
Affiliation(s)
- Lora Daskalska
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Michelle Broaddus
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Staci Young
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
2
|
Milaniak I, Davidson S, Leewiwatanakul B, Benton TD. The Impact of COVID on Adolescent Anxiety: Trends, Clinical Considerations, and Treatment Recommendations. Pediatr Clin North Am 2024; 71:601-612. [PMID: 39003004 DOI: 10.1016/j.pcl.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
Rates of clinical anxiety have increased during COVID and post-quarantine in youth, with older adolescent girls and youth with minorized racial, gender, and sexuality identities most vulnerable. Given that increased anxiety to a threatening/uncertain environment is adaptive, it is important to conceptualize anxiety from a balanced perspective, evaluating its functionality. For adolescents continuing to struggle with re-integration into their social environments and school avoidance, an exposure framework is necessary to encourage approach behaviors to recalibrate the social environment as safe. Disproportion between demand for services and available providers increased greatly due to the pandemic. Evidence-based treatments for anxiety can be delivered via telehealth, in school, or in primary care settings.
Collapse
Affiliation(s)
- Izabela Milaniak
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, CHOP Center for Advanced Behavioral Healthcare, 4601 Market Street, Third Floor, Philadelphia, PA 19139, USA.
| | - Stephanie Davidson
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, CHOP Center for Advanced Behavioral Healthcare, 4601 Market Street, Third Floor, Philadelphia, PA 19139, USA
| | - Bruce Leewiwatanakul
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, CHOP Center for Advanced Behavioral Healthcare, 4601 Market Street, Third Floor, Philadelphia, PA 19139, USA
| | - Tami D Benton
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, CHOP Center for Advanced Behavioral Healthcare, 4601 Market Street, Third Floor, Philadelphia, PA 19139, USA
| |
Collapse
|
3
|
Godoy L, Williams R, Druskin L, Fleece H, Bergen S, Avent G, Robb A, Biel MG, Wissow LS, Beers LS, Long M. Linking Primary Care to Community-Based Mental Health Resources via Family Navigation and Phone-Based Care Coordination. J Clin Psychol Med Settings 2024; 31:471-492. [PMID: 38265697 DOI: 10.1007/s10880-023-09987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/25/2024]
Abstract
Family navigation (FN) and phone-based care coordination may improve linkages from primary care to community-based mental health referrals, but research on their differential impact is limited. This mixed-methods study compared FN and phone-based care coordination in connecting families to mental health services from primary care. Families of children (56.3% male, mean age = 10.4 years, 85.4% Black) were sequentially assigned to either receive FN through a family-run organization or phone-based coordination via the child psychiatry access program (CPAP). Caregiver-reported children's mental health improved in both groups and both groups were satisfied with services. More families in the CPAP group had appointments made or completed (87%) than families in the FN group (71%) though the difference was not statistically significant. Future research with a larger sample that matches family needs and preferences (e.g., level and type of support) with navigation services would be beneficial.
Collapse
Affiliation(s)
- Leandra Godoy
- Children's National Hospital, Washington, DC, USA.
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Child Health Advocacy Institute, Children's National Hospital, 1 Inventa Place, Silver Spring, MD, 20910, USA.
| | | | | | | | | | - Gail Avent
- Total Family Care Coalition, Washington, DC, USA
| | - Adelaide Robb
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Matthew G Biel
- Georgetown University Medical Center/MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Lee Savio Beers
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Melissa Long
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
4
|
Lee CM, Yonek J, Lin B, Bechelli M, Steinbuchel P, Fortuna L, Mangurian C. Systematic Review: Child Psychiatry Access Program Outcomes. JAACAP OPEN 2023; 1:154-172. [PMID: 38189028 PMCID: PMC10769201 DOI: 10.1016/j.jaacop.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Objective There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs. Method A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health. Results None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost(n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs. Conclusion Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs. Diversity & Inclusion Statement One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. Clinical trial registration information Child Psychiatry Access Programs: A Systematic Review; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410; CRD42020146410.
Collapse
Affiliation(s)
- Chuan-Mei Lee
- University of California, San Francisco
- Stanford University School of Medicine
| | | | | | | | | | | | - Christina Mangurian
- University of California, San Francisco
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital
| |
Collapse
|
5
|
Harris K, Aguila Gonzalez AI, Vuong NX, Singh N, Brown R, Ciccolari Micaldi S. Expert Team in Your Back Pocket: Recommendations From a Pediatric Mental Health Access Program. Clin Pediatr (Phila) 2023; 62:1217-1228. [PMID: 36880385 DOI: 10.1177/00099228231154122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Nationwide challenges with the lack of access to mental health care for youth have prompted efforts to integrate mental health into pediatric primary care. Kansas Kids Mental Health Access Program (KSKidsMAP) was developed to promote mental health workforce development through primary-care practitioners (PCPs) by offering free access to consultations, training, and care coordination. Kansas Kids Mental Health Access Program, a federally funded pediatric mental health care access program (PMHCA), is highly interprofessional in nature, and recommendations reflect the team composition and collaboration efforts. Therefore, a mixed-methods study was conducted to assess the type of recommendations provided to PCPs who requested case consultation services. Seven themes were identified: (1) psychotherapy; (2) diagnostic evaluation; (3) community resources; (4) pharmacotherapy; (5) patient resources and toolkits; (6) education; and (7) other health recommendations. This study highlights the multifaceted approach of KSKidsMAP in addressing PCPs' pediatric mental health concerns.
Collapse
Affiliation(s)
- Kari Harris
- Department of Pediatrics, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Amanda I Aguila Gonzalez
- Department of Population Health, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Ngoc X Vuong
- Department of Pediatrics, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Nikita Singh
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rachel Brown
- Department of Psychiatry & Behavioral Sciences, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Susanna Ciccolari Micaldi
- Department of Psychiatry & Behavioral Sciences, The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| |
Collapse
|
6
|
Tengelitsch E, Hughes-Krieger E, LePlatte D, Shaw-Johnston S, Marcus S. The integration of behavioral health consultants within a state-wide psychiatry consultation program: a community case study. Front Psychiatry 2023; 14:1187927. [PMID: 37663604 PMCID: PMC10471313 DOI: 10.3389/fpsyt.2023.1187927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
This paper describes the integration and role of masters-prepared behavioral health consultants (BHCs) within a state-wide psychiatry consultation program for children, adolescents, and perinatal women. Data from the Michigan Clinical Consultation and Care (MC3) program are reviewed, with attention to the role that BHCs play in the consultation process, integrated care, screening, and their dual roles with Community Mental Health Services Programs (CMHSPs) in Michigan. Approximately 82% of MC3 services are provided by the BHCs and involve resources or integrated care. BHCs play a role in managing provider consultations and connecting patients and providers to resources in the MC3 program.
Collapse
|
7
|
Overstreet K. Effective evidence-based pediatric mental health care in primary care. Nurse Pract 2023; 48:8-11. [PMID: 37368550 DOI: 10.1097/01.npr.0000000000000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
- Kari Overstreet
- Kari Overstreet is a pediatric NP in the child division of the Duke University Department of Psychiatry and Behavioral Sciences, Durham, N.C., and a trainer at the REACH Institute in New York, N.Y
| |
Collapse
|
8
|
Harris K, Aguila Gonzalez A, Vuong N, Brown R, Ciccolari Micaldi S. Understanding Pediatric Mental Health in Primary Care: Needs in a Rural State. Clin Pediatr (Phila) 2022; 62:441-448. [PMID: 36352499 DOI: 10.1177/00099228221136121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The need for mental health care for pediatric patients outstrips the supply, especially in states, like Kansas, that experience shortages of mental health professionals. Pediatric mental health care access programs, like KSKidsMAP (Kansas Kids Mental health Access Program), increase access to care by building competence and confidence in primary care physicians and clinicians (PCPs) through a statewide integrated system that includes a consultation line. This study is a secondary analysis of KSKidsMAP consultation Line inquiries regarding patients aged 0 to 21 years with mental and behavioral health concerns. The study employs a mixed-method approach with descriptive statistics and thematic analysis of inquiries. Five themes were identified: (1) pharmacotherapy, (2) diagnostic evaluation, (3) community resources, (4) psychotherapy, and (5) other. This study sheds light on PCPs needs and illustrates the importance of Pediatric Mental Health Care Access programs offering interprofessional expertise to consulting PCPs, allowing for expansion of pediatric mental illness care into the primary care setting.
Collapse
Affiliation(s)
- Kari Harris
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Amanda Aguila Gonzalez
- Department of Population Health, University of Kansas School of Medicine-Wichita, KS, USA
| | - Ngoc Vuong
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Rachel Brown
- Department of Psychiatry & Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Susanna Ciccolari Micaldi
- Department of Psychiatry & Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| |
Collapse
|
9
|
Gray NN, Villalobos LR, Matherne M, Schadler A, Bosley TE. Association of Chemotherapy Regimen Intensity and Use of Psychotropic Medications in Pediatric Oncology Patients. J Pediatr Pharmacol Ther 2022; 27:649-654. [DOI: 10.5863/1551-6776-27.7.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
Pediatric oncology patients endure treatments that may include chemotherapy, surgery, radiation, and transplant. These treatment modalities often have an effect on a patient's mental health. To date, little is known or published about the association between certain cancer treatment regimens and the use of psychotropic medications. The goal of this study is to identify associations between the use of psychotropic medications in pediatric oncology patients in relation to the intensity of their oncologic treatment regimen.
METHODS
A retrospective chart review was completed for pediatric oncology patients seen between the years of 2009 and 2019 with prescriptions and/or inpatient orders for specific psychotropic medications. The intensity of the oncologic regimen was categorized using the Intensity of Treatment Rating Scale (ITR-3) tool. Association between the intensity of therapy and use of psychotropic medications were compared using Pearson χ2 and Fisher exact tests as appropriate.
RESULTS
There were 172 patients identified as having inpatient and/or outpatient orders for psychotropic medications during the study period. Ninety-one pediatric oncology patients were included in data analysis. It was found that psychotropic medications were used consistently in pediatric oncology patients despite a specific ITR-3 score. There were no statistically significant associations found when comparing ITR-3 scores to psychotropic medication use or to age at diagnosis.
CONCLUSIONS
Significance was not obtained in this study; however, we found that psychotropic medications were used across the spectrum of diagnoses, age, and oncologic treatment intensity. This suggests that all pediatric oncology patients should be evaluated for psychiatric needs throughout their course of oncologic treatment.
Collapse
Affiliation(s)
- Natalie N. Gray
- Department of Pharmacy (NNG, LRV, TEB), University of Kentucky Healthcare, Lexington, KY
| | - Lindsay R. Villalobos
- Department of Pharmacy (NNG, LRV, TEB), University of Kentucky Healthcare, Lexington, KY
| | - Milre Matherne
- College of Pharmacy (MM, AS, TEB), University of Kentucky Lexington, KY
| | - Aric Schadler
- College of Pharmacy (MM, AS, TEB), University of Kentucky Lexington, KY
| | - Tyler E. Bosley
- Department of Pharmacy (NNG, LRV, TEB), University of Kentucky Healthcare, Lexington, KY
- College of Pharmacy (MM, AS, TEB), University of Kentucky Lexington, KY
| |
Collapse
|