Tips for AAP Chapters: Increasing Access to Behavioral Health Care via Telehealth by Partnering with Pediatric Mental Health Care Access Programs

Pediatric Mental Health Care Access (PMHCA) Programs, sometimes referred to as Child Psychiatry Access Programs (CPAPs), are collaborative programs that provide timely training and support to pediatric primary care clinicians (PCCs) and other clinicians related to detection, assessment, treatment and referral of behavioral health conditions within their practice. This support is provided as part of a peer-to-peer, telehealth-based consultation model – PCCs can connect with off-site child/adolescent behavioral health professionals by phone, video call or email/web-based consultation.

Note: The term “behavioral health” is used throughout this content to encompass mental health and substance use conditions. The terms “pediatric primary care clinicians”, “primary care clinicians” and “clinicians” are used to refer to pediatric clinicians who provide primary care to children. This can include pediatricians, family physicians and nurse practitioners.

The primary goal of these programs is to increase access to pediatric behavioral health services, especially at the primary care level. PMHCA programs provide training, technical assistance, teleconsultation and care coordination support services to PCCs to increase their comfort and enhance their skills in managing mild to moderate behavioral health conditions within the medical home. These programs also provide referral advice for more complex conditions, guidance regarding clinical management and help with finding resources.

Through training and support to pediatric PCCs, PMHCA programs can increase access to behavioral health care within the medical home, helping to reduce disparities and inequities in child and adolescent behavioral health care.

PMHCA programs provide a full array of services to all providers and practices located either within a specific geographic region of the state, or statewide, and may require registration or enrollment to participate. If programs do provide care directly to patients until they can see behavioral health professionals in their communities, the services are usually available to all patients within a practice, regardless of insurance coverage.

Click here for more information about Health Resources and Services Administration (HRSA)-funded PMHCA programs, including project abstracts and teleconsultation phone lines.

Visit the National Network of Child Psychiatry Access Programs at nncpap.org for a list of states that currently have PMHCA programs/CPAPs, regardless of funding source.

The National Network of Child Psychiatry Access Programs (NNCPAP) is an association of national leaders in pediatrics and child psychiatry that supports existing and emerging child psychiatry consultation programs and works toward national progress on the integration of behavioral health within primary care. NNCPAP provides resources to child psychiatry consultation programs across the country and facilitates relationships and communication among behavioral health and child psychiatry access programs that are located in the primary care setting.

Some states have “partial” programs, which can be defined as a state in which some, but not all, of the counties in the state or territory can use the program.

See below for frequently asked questions about PMHCA programs:

How can PMHCA programs increase access to behavioral health services?

PMHCA programs can:

Provide real time (typically within 24 hours) help for a patient in your office, to keep care within the medical home or to act as a bridge for direct patient care and care coordination support services while waiting for an outside behavioral health referral.
Support all professionals within a patient’s medical home, and at any step in the AAP Algorithm: A Process for Integrating Mental Health Care into Pediatric Practice.
Provide access to a trusted mentor to build your knowledge of pediatric behavioral health care. In larger states, PMHCA programs may have multiple teams/hubs to build and maintain local connections.
Support the integration of behavioral health care into pediatric practices where clinicians have longitudinal and trusting relationships with families. Receiving behavioral health care within the medical home reduces stigma and sends the message to families that they can come to you with any behavioral health concerns.
Increase comfort and confidence with assessing and managing behavioral health issues by providing formal training in a variety of formats (Project ECHO, lunch and learns, case conferences, webinars, newsletters, etc.) and/or developing and practicing skills by caring for patients with behavioral health concerns alongside a specialist who can act as a mentor or advisor.
Provide consultation to assist in providing measurement-based care which is associated with improved patient outcomes.
Meet increased behavioral health needs of patients and families.
Help to advance health equity by covering all practices within a total population of children, serving all demographics.
- PMHCA programs are particularly helpful for rural practices with little access to specialty behavioral health services.

What is the impact of PMHCA programs?

One study reported that children and adolescents living in states with PMHCA programs/CPAPs received more behavioral health services than those living in states with partial PMHCA programs/CPAPs or no PMHCA programs/CPAPs.

Surveys of parents indicate high levels of satisfaction with their PCC's management of their child’s behavioral health problems following PMHCA program/CPAP consultations.

Surveys show PMHCA programs/CPAPs increase pediatrician confidence and satisfaction in managing behavioral health conditions, particularly depression, anxiety and ADHD.

How are PMHCA programs/CPAPs funded?

Funding varies by program. However, some common sources of funding are outlined below.

Initially, programs are often funded through a grant or a state legislative earmark. The federal government, through the HRSA Pediatric Mental Health Care Access Program, has made 45 awards in 40 states, as well as the District of Columbia, the US Virgin Islands, the Republic of Palau, the Chickasaw Nation and the Red Lake Band of the Chippewa Indians. Programs can also receive funds from foundations, insurers and state legislatures.

Developing partnerships with governmental agencies and payers can help to foster program sustainability.

How can AAP Chapters support PMHCA programs?

In states or territories without an existing PMHCA program:

Determine if child-serving government agencies are involved in applying for funding.
- Formalize relationships with various agencies and offer expertise for grant applications, including any opportunities related to the HRSA Pediatric Mental Health Care Access Program.
- If there are no state agencies involved in applying for funding opportunities, consider building relationships with various agencies (like the local Title V agency, State Department of Mental Health or Medicaid) and work to foster interest in the creation of a PMHCA program or the expansion of an existing CPAP program.
- Offer information about how to connect with pediatricians and other pediatric primary care clinicians throughout the application process.
Inform stakeholders about behavioral health needs within the community and educate stakeholders on the benefits of PMHCA programs.
Serve as a source of information regarding gaps, barriers and disparities in access to behavioral health care within the community, to inform applications for funding as well as promotional efforts for programs.
Share information about system approaches that have worked well in other communities.
Create a Child Mental Health Task Force with wide stakeholder participation. Stakeholders can include:
- Primary care practices, including pediatricians, family physicians, physician associates and nurse practitioners
- Subspecialty practices
- Adolescent and addiction medicine specialists
- Developmental-behavioral pediatricians
- Child psychiatrists (American Academy of Child and Adolescent Psychiatry regional organizations, academic child psychiatry programs)
- Advocacy organizations (National Alliance on Mental Illness, child mental health parent group, other child health groups)
- Organizations focused on family engagement (Family Voices)
- Pediatric representatives from academic medical centers/medical schools/hospitals
- Child-serving government agencies (Title V, Medicaid, Mental Health, Public Health)
- Other mental/behavioral health groups (psychologists, social workers, state mental health associations)
- Health insurers
- School-based health centers, school health and educational advocates (nurses, counselors, state leaders)
- Adolescents and families with mental health needs

Contact the National Network of Child Psychiatry Access Programs for technical assistance. If the program in your state/territory is funded by HRSA, contact the PMHCA program directly for technical assistance. Additional technical assistance specific to tribal populations can be provided through SAMHSA.gov/tribal-ttac.

In states or territories with an ongoing or newly established PMHCA program:

Develop a relationship with the PMHCA program administrative and clinical leadership
Consider appointing a member as a liaison to the PMHCA program
Be a champion for behavioral health integration and how PMHCA programs can offer critical support
Understand any development needs of the PMHCA program, especially if the program is expanding to new regions
Offer to publicize local PMHCA program information to Chapter membership (eg, the PMHCA program can write an article for the Chapter newsletter).
Invite members of the PMHCA program in your state to participate in AAP Chapter meetings and conferences
Feature information about the PMHCA program in your state on your AAP Chapter website
Work with the PMHCA program in your state on products and publications
Offer to have personal discussions with practices that are hesitant to register for the program
Offer to be a member of a PMHCA program advisory group
Review educational offerings from the PMHCA program to ensure that they meet member needs and include AAP behavioral health materials (see helpful resources)
Develop a Child Mental Health Task Force (as described above)
Strategize with the PMHCA program regarding sustainable funding

“The involvement of our state AAP Chapter in our Virginia Mental Health Care Access Program (VMAP) has been essential to the transformation of our pediatric mental healthcare delivery system. With increasing numbers of children and adolescents presenting with mental health conditions, programs like VMAP support pediatricians and pediatric clinicians so that we can care for our patients sooner and with more confidence.”

Sandy L. Chung, MD, FAAP
Medical Director, VMAP
Past President, Virginia AAP

Additional Resources

This resource is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $6,000,000 with no percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the US Government.

Last Updated

10/29/2021

Source

American Academy of Pediatrics