Child Psychiatry Consult

Pediatric Psychiatry Services Infiltrate Primary Care



SAN FRANCISCO – After more than 2 decades as a primary care pediatrician, Dr. Teresa M. Hargrave was so frustrated by the lack of psychiatric services for her patients that she retrained as a child and adolescent psychiatrist. Now, she’s part of a New York state program that spreads her psychiatric skills to more patients than she imagined could be possible.

"If this program had been in place when I was a pediatrician, I would never have had to switch," said Dr. Hargrave of the State University of New York (SUNY) in Syracuse.

Today, New York primary care physicians can call 855-227-7272 toll free on weekdays for an immediate consultation with a master’s level therapist in the Child and Adolescent Psychiatry for Primary Care program (CAP PC). If a patient seems to need psychotropic medication, the therapist connects the pediatrician with a psychiatrist on the program’s team, such as Dr. Hargrave, who helps the primary care physician manage treatment through phone consultations and, if needed, in-person assessments.

Dozens of similar efforts – in a variety of formats – have sprung up across the country. They’re all trying to address a fundamental mismatch: There are only 7,400 practicing child and adolescent psychiatrists in the United States but more than 15 million young people in those age groups who need psychiatric care, according to data analyses from the American Academy of Child and Adolescent Psychiatry.

The National Network of Child Psychiatry Access Programs acts as a hub for these programs in 24 states, with programs in 4 more states set to take their first calls soon.

These model programs are making great inroads in getting care to the estimated 15%-25% of children seen in primary care offices who have behavioral health disorders, but reimbursement problems create a roadblock that must be overcome in the years ahead for the programs to be fully effective, several experts said in interviews at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

New York Program

New York’s CAP PC program modeled itself after one of the first state-wide programs, the Massachusetts Child Psychiatry Access Project, with some key changes. The CAP PC program covers 95% of the New York state population but uses the same toll-free number everywhere, compared with multiple different phone numbers being used in different regions in Massachusetts. New York’s program also added an educational component for primary care physicians – a free 15-hour "Mini-Fellowship" weekend program followed by a dozen 1-hour biweekly case-based conference calls.

Courtesy Dr. Teresa M. Hargrave

Dr. David Kaye

Primary care physicians seem to love the help, Dr. David Kaye said at a poster presentation at the meeting. In its 2 years of operation, the CAP PC program has registered 829 primary care physicians (80% pediatricians, 20% family physicians), 292 of whom took the training sessions. The program handled 1,016 intake and follow-up calls, provided 993 consultations with a psychiatrist, conducted 94 face-to-face evaluations, and referred 305 patients to other services, reported Dr. Kaye, professor of psychiatry and director of child and adolescent psychiatry training at SUNY in Buffalo, N.Y.

Among 325 primary care physicians surveyed 2 weeks after contact with the CAP PC program, 94% said the consultations were very or extremely helpful, and 99% said they would recommend the program to other primary care physicians.


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