The numbers are sobering. Epidemiology suggests that 12 to 15 percent of children have significant emotional and behavioral health concerns; of these, about half are affected seriously enough to impair development, triggering new problems including school drop-outs, delinquency and a potential future of criminality.
“This is a major social problem,” says John Sargent, MD, Chief of Child and Adolescent Psychiatry at Floating Hospital for Children. “We have 80 million kids in America, at least eight million have mental health problems, and we only have 8,000 child psychiatrists.” When you factor in the social stigma associated with seeking help for mental health issues, the challenge of getting kids the care they need becomes even more daunting.
Here in the Bay State, however, the Massachusetts Child Psychiatry Project (MCPAP) is taking steps to improve access to care. MCPAP is a system of six regional children’s mental health consultation teams (called hubs) designed to help primary care providers (PCPs) meet the needs of children with psychiatric problems. Four child psychiatrists at Floating Hospital for Children are an integral part of the hub serving the greater Boston region.
Coordinated by staff at the Massachusetts Behavioral Health Partnership and funded directly by the Commonwealth budget, MCPAP is free to all Massachusetts PCPs who treat children. A MCPAP-enrolled PCP may call for a consultation with a child psychiatrist regardless of what type of insurance the patient has. If PCPs have any type of question regarding a mental health issue, they simply can call their regional MCPAP hub. The question can be about a specific patient, the diagnosis and treatment of a particular disorder, use of a certain medication, use of mental health screening tools, or to find out what mental health resources are available in their geographic area. As of this past July, the service has been expanded to five days a week.
“For peer consultations, we try to have someone available to answer a call within a half-hour, which means many questions can be answered while the patient and family are in the physician’s office,” Sargent says. “If a PCP feels the family needs to see a child psychiatrist for further evaluation, we reserve several hours a week for these visits and generally can schedule them within two weeks.”
“After we see the family, we’ll call the pediatrician and also write a note about what we saw and recommend,” he continues. “We don’t write prescriptions or take on the patient at this point, but we will help the pediatrician manage the patient in his or her own office, or until such time as the child is able to be seen by a child psychiatrist who’ll take on the case. We’ll make those referrals, sometimes to our own program here, when appropriate.”
Floating Hospital’s Child and Adolescent Psychiatry Division has seven full-time child psychiatrists, eight child psychiatry fellows, three psychologists, two licensed social workers, one nurse practitioner, two psychology interns and one social work student. The division’s expertise covers the gamut of pediatric mental and behavioral health issues, including depression, anxiety disorders, eating disorders, trauma, mood disorders, bipolar disorder, learning disabilities, ADD/ADHD, pervasive development disorders/autism and lesbian/gay/bisexual/transgender issues.
The division also treats patients with serious medical conditions – such as lupus, cystic fibrosis, diabetes, leukemia, juvenile rheumatoid arthritis or organ transplantation – who have difficulty coping with their chronic medical illness and treatment.
Services provided include comprehensive psychiatric diagnostic evaluations for children, parents and families in collaboration with referring physicians, schools and agencies, emergency care for children and adolescents who are in acute psychiatric crisis, and ongoing treatment. Treatment modalities include cognitive, behavioral and supportive therapies, individual and family psychotherapy, and psychopharmacological interventions. Additionally, clinicians in the pediatric neurology and developmental/behavioral pediatrics divisions partner with pediatric psychiatry in the care of these patients whenever that help is needed.
The MCPAP remains a vital point of entry to child psychiatric care statewide.
“In May, MCPAP had the greatest number of engagements ever across the state – 2,073 serving 1,056 patients,” Sargent notes. “It’s clear that pediatricians find the peer consultation, patient consults and resource identification a very worthwhile step.”
“Many folks who use MCPAP say that they now cannot envision practice without MCPAP as a resource,” says MCPAP Executive Director John H. Straus, MD.
The success of MCPAP has led other states to adopt similar initiatives. “There are 30 states that now have or are developing this type of access-to-care program,” Sargent says. “It speaks to the degree to which this is an important and successful program.”
“A huge part of what we do is help families be part of a community of people oriented to supporting one another,” Sargent says. “Social isolation is greatest among parents with difficult children, and we strive to combat that. We’ll help pediatricians and their patients make those connections. Once they’re not isolated, the road is easier to walk.”
“We’re here, and we want to partner with pediatricians to help their patients,” he adds. “Pediatricians are on the front lines and need to be, because they’re the ones parents trust. And if you need mental health resources, a consultation, call MCPAP. We’re in it to do the absolute best we can for children and families. And if we take a case on, we’ll try like hell to make things better.”