In this newly released study, Walter et al highlight a well-resourced intervention to provide much-needed mental health services in the primary care setting (10.1542/peds.2020-001073). They summarize the current epidemiology highlighting the 20% prevalence of mental health disorders in children (30% among children in military families) and acknowledge the gap between those who need versus receive appropriate care for their conditions. This is particularly well-timed given the emerging evidence outlining the additional mental health toll that the COVID-19 pandemic has had on pediatric patients.
Their intervention had three components including education (in person and virtual monthly presentations), consultation (on-demand access to child and adolescent psychiatrists) and clinical/operational support (telephone and video support from for service integration), which facilitated on-site delivery of behavioral health services and builds on a pilot program that demonstrated increased service access without a concomitant increase in cost. Their primary hypothesis was to determine whether the increased access is seen in subsequent rollouts of the program and, secondarily, to determine if the program’s rollout was practical as defined by several outcome domains.
Despite the non-randomized nature of the study design, the authors found that there was increased access, that screening for mental health disorders increased by nearly 50% and that there was a near quadrupling of selective-serotonin reuptake inhibitor (SSRI) prescribing. The three most common diagnoses were anxiety, depression, and ADHD. Although asking questions about medications was the most common reason for telephone consultations, more than half of patients continued to be managed by their primary care provider.
Candidly, the authors delineate that many of the educational and consultative activities are not reimbursable and outlines the funding sources used to support this intervention. Of note, the American Rescue Plan Act signed into law by President Biden authorized $80 million for the support and expansion of such mental health integrated programs. Hopefully more practices, cities, and states take advantage of this funding to provide much-needed screening, diagnosis, and treatment of mental health disorders for all of our patients. While we are building toward the ideal of having on-demand psychiatric consultation for our patients, this study reminds us that general pediatricians will need to find ways to improve our comfort and expand our knowledge about the screening, diagnosis, and treatment of mental and behavioral health disorders.