Pediatric Primary Care Provider Comfort with Mental Health Practices: A Needs Assessment of Regions with Shortages of Treatment Access

Abstract

Objectives Nearly 50% of children with a mental health concern do not receive treatment. Child Psychiatry Access Programs like Behavioral Health Integration in Pediatric Primary Care (BHIPP) address regional shortages of mental health treatment access by providing training and consultation to primary care providers (PCPs) in managing mental health concerns. This study assessed PCPs’ comfort with mental health practices to inform expansion of BHIPP services. Methods Pediatric PCPs in 114 practices in three rural regions of Maryland were recruited to participate in a survey about their comfort with mental health practices and access to mental health providers for referral. Descriptives, Friedman’s test, and post hoc pairwise comparisons were used to examine survey responses. Results Participants were 107 PCPs. Most respondents were physicians (53.3%) or nurse practitioners/physician’s assistants (39.3%). Friedman’s test, χ2(7)= 210.15, p<.001, revealed significant within and between-group differences in PCP comfort with mental health practices. Post hoc pairwise comparisons indicated greater comfort providing mental health screening and referrals compared to prescribing psychiatric medications, providing psychoeducation or in-office mental health interventions. A Wilcoxon-signed rank test showed significantly more respondents agreed they could find a therapist than a psychiatrist in a timely manner, Z= −5.93, p<.001. Conclusions Pediatric PCPs were more comfortable with providing mental health assessment and referrals than treatment. However, PCPs reported difficulty finding therapists and psychiatrists for their patients. Findings underscore the need for longitudinal training to increase PCP comfort with mental health treatment. Additionally, strategies such as telepsychiatry are needed to address the disproportionate need for child psychiatrists.

Understanding Pediatric Mental Health in Primary Care: Needs in a Rural State

“…Our findings with respect to the questions asked by PCPs are similar to those reported elsewhere. 15-17…”

Effective evidence-based pediatric mental health care in primary care

“…A survey of physicians and advanced practice providers (NPs and physician assistants) in regions with limited access to psychiatry services found that PCCs were more comfortable providing mental health assessment and referrals than with providing psychiatric medication, psychoeducation, or nonpharmacologic in-offi ce interventions. 18 However, use of evidence-based medication and brief interventions off ered in the primary care setting are eff ective for improving patient outcomes. 3,7 Pediatric mental health training programs, including the REACH Institute's PPP Mini-Fellowship, have demonstrated effi cacy in improving greater individual PCC confi dence in identifying and managing mental health disorders as well as PCC implementation of broader changes, including increasing use of symptom rating scales, prescribing according to treatment guidelines, and completing mental health follow-up visits.…”

“…A survey of physicians and advanced practice providers (NPs and physician assistants) in regions with limited access to psychiatry services found that PCCs were more comfortable providing mental health assessment and referrals than with providing psychiatric medication, psychoeducation, or nonpharmacologic in-office interventions 18. However, use of evidence-based medication and brief interventions offered in the primary care setting are effective for improving patient outcomes 3,7.…”

Expert Team in Your Back Pocket: Recommendations From a Pediatric Mental Health Access Program

“…11,12 Many primary-care practitioners (PCPs) do not feel comfortable offering psychoeducation or mental health treatment in their practices. 13 However, PCPs in Kansas are willing to answer the call to integrate psychiatric care into their practices with appropriate training and support as evidenced by the increasing enrollment in the state's Pediatric Mental Health Care Access Program (PMHCA), Kansas Kids Mental Health Access Program (KSKidsMAP).…”