SAN FRANCISCO — There's no quick way around the barriers faced by children who need mental health care, so pediatricians are developing a string of strategies to improve delivery of mental health services, Dr. Jane M. Foy said.
These strategies offer primary care physicians tools to remove impediments in the health care system, build physician competence in providing mental health care, and incrementally change practices to improve delivery of services, she said at the annual meeting of the American Academy of Pediatrics.
While primary care physicians have the advantages of ongoing relationships with children and families, opportunities for early intervention, and expertise in preventive care (among other strengths), physicians have varying comfort levels with mental health care, said Dr. Foy, chair of the AAP's Task Force on Mental Health and professor of pediatrics at Wake Forest University, Winston-Salem, N.C.
Primary care physicians are constrained by time (pediatric well-child visits average 18 minutes in length), lack of reimbursement for mental health services, variable access to mental health specialists, administrative barriers, and a reluctance by children and families to seek care for mental health problems.
The AAP's Task Force on Mental Health is offering the following tools to address these, some of which are based on successful programs around the country, Dr. Foy said.
▸ Facilitate system changes. A report to be published in the winter of 2007 will help primary care providers create changes in community-level systems.
This could include building relationships with local mental health professionals, creating protocols for the care of children with psychiatric emergencies, and developing a process for collaborating with school personnel.
One of the more promising strategies is to incorporate a mental health professional in the primary care setting, she said. The task force is creating a “PediaLink” module to describe this and other ways to build relationships with mental health specialists.
In September 2007 the AAP sent a new booklet to chapter leaders—Strategies for System Change in Children's Mental Health: A Chapter Action Kit—that's also available on the AAP Web site.
This can guide physicians in pursuing local and state improvements in reimbursement, establishing relationships with mental health professional organizations, and working with family advocacy groups to reduce stigma around mental health care. The AAP offered five $15,000 stipends to projects focusing on one of these areas.
The AAP and the American Academy of Child and Adolescent Psychiatrists (AACAP) created a position paper explaining the rationale for paying primary care physicians for mental health services, and jointly are lobbying insurers on the national level.
▸ Build competence. Core competencies for primary care physicians providing mental health care will be published in the journal Pediatrics in the next few months, Dr. Foy said.
The competencies were created by consensus of several AAP committees and have been endorsed by the AACAP, the American Board of Pediatrics, and the National Association of Pediatric Nurse Practitioners.
Among the competencies, primary care physicians should learn evidence-based, generic techniques that are useful across a wide range of mental health problems, “expand our comfort zone beyond attention-deficit/hyperactivity disorder to anxiety, depression, and substance abuse,” and apply chronic-care principles to children with mental health problems, she said.
▸ Incrementally change practices. In the spring of 2008, the AAP will publish algorithms proposing a process for providing mental health services in a primary care setting.
“We recognize that the process cannot be fully implemented until payment issues” are resolved, relationships with mental health professionals are in place, and clinicians are comfortable with mental health skills, she said.
Tools for screening children and families for mental health problems and for assessing functioning will be offered.