Giving Pediatricians the Right Support

Placing therapists in the pediatric primary care practice can help identify and treat behavioral health issues before they become severe -- but is it feasible?

An integrated model in which licensed mental health practitioners were placed in pediatric primary care offices to facilitate the early screening and treatment of behavioral issues in children produced favorable outcomes, according to presentations given by two researchers on Tuesday, Oct. 26, at the AACAP 57th Annual Conference in New York, NY.

In 2008, an integrated pediatric mental health collaboration—the Services United Pediatricians and Psychiatry Outreaching to Texas (Support) program—was launched in Texas to help manage a statewide child psychiatrist shortage, according to Steven R. Pliszka, MD, University of Texas Health Science Center at San Antonio, who discussed what it takes to blend the cultures of psychiatry, psychotherapy, and pediatric primary care.

The ultimate goal is improved outcomes, he said, noting that putting psychiatric services right in the pediatric practice “helps to make this type of care normalized and destigmatized,” both in the eyes of providers and patients. In this type of model, licensed mental health practitioners can “float” throughout the clinic, so that they are always available to speak with a patient at the request of the pediatrician, and schedule a follow-up visit. At that visit, the therapist can then work with the patient to identify and treat behavioral issue that might exist—before they become severe. The therapists, he noted, are able to discuss cases with child psychiatrists, and work with them to provide guidance for pediatricians to treat (or refer) patients with mental health issues.

According to another presenter, Valerie Robinson, MD, of Texas Tech University Health Sciences Center in Lubbock, TX, the Support project can offer key benefits through the following:

  • Placing a licensed mental health professional in pediatric primary care offices provides therapists with an avenue in which they can conduct an intervention while remaining in close contact with the pediatrician or primary care physician;
  • Providing access to child and adolescents through faster referrals, telephone consultations, and continued communication in follow-up;
  • Increasing provider confidence by addressing mental health disorders through education (online CME for psychotropic medications and conferences to discuss difficult cases) and creating medication guidelines to aid in treatment.

The primary diagnosis in the Support project has been ADHD, following by phase of life issues such as adjustment disorders, sleep problems, and obesity. “That is exactly what we need to tackle early,” he noted, adding that three-month outcomes have demonstrated high satisfaction ratings from both pediatricians and clinical staff.

There are, however, existing challenges that must be addressed before the program is implemented on a broader scale, said Pliszka, including the following:

  • Compliance issues, such as patients failing to show up for follow-up appointments with the licensed mental health practitioner
  • Lack of education regarding the difference in integrated care model between pediatrics and adult medicine
  • Gap in pediatric psychotropic medication training (more CME programs are needed, as well as consultants to help with these issues)
  • Issue of who manages behavioral consultants’ time (whether they are part of the professional staff, who supervises them, etc)

Although there are issues that need to be addressed, according to Pliszak, the Support program offers significant potential for improving outcomes in children with mental health issues. “It appears to be having an impact in the right direction,” he said.