The Massachusetts Child Psychiatry Access Project: Improving Access to Mental Health Treatment
The Association of State and Territorial Health Officials is working on building the capacity of state health agencies to facilitate systems transformation activities by disseminating best practices and materials from the Centers for Medicare and Medicaid Services State Innovation Model (SIM) Initiative related to behavioral health (which includes both mental health and substance use), and other key areas impacting population health. The goal of this initiative is to create multi-payer models with a broad mission to improve health, improve care, and decrease costs for beneficiaries of Medicare, Medicaid, and the Children’s Health Insurance Program.
Behavioral health has often been excluded from traditional primary care practice, making access to these services difficult, particularly for children. To address this concern, the Massachusetts Executive Office of Health and Human Services has used the SIM grant to advance the integration of behavioral health and primary care for children. Specifically, the Massachusetts Department of Mental Health is enhancing their existing program, the Massachusetts Child Psychiatry Access Project (MCPAP), with grant funds to help pediatricians better meet the needs of children and youth with behavioral health issues.1
Established in 2004, MCPAP is a system of regional children’s psychiatric consultation teams designed to improve access to treatment for children with behavioral health problems. MCPAP achieves this by strengthening pediatric primary care providers’ (PCPs) ability to screen, diagnose, and treat children with mild to moderate behavioral health problems (e.g., ADHD, anxiety, depression) in primary care. Additionally, it supports PCPs in referring children with more serious behavioral health problems to appropriate psychiatric specialty care. As a result, MCPAP promotes the rational utilization of child psychiatry for the most complex children, such as children whose conditions require treatment with complex or multiple psychiatric medications.
MCPAP’s regional consultation teams, which consist of psychiatrists, advanced practice registered nurses, therapists, care coordinators, and administrative support, are available to assist any pediatric PCP regardless of a patient’s insurance status. MCPAP will provide a telephone consultation within 30 minutes of PCP request. In addition to providing telephonic and in-person child psychiatry consultations, MCPAP staff assist with referrals to community-based behavioral health resources and provide transitional care while families are waiting for outpatient behavioral health services. Over 95% of pediatric PCPs in Massachusetts are enrolled in MCPAP. In 2014, 75% of enrolled practices and 41% of providers used MCPAP at least once. In future MCPAP utilization analyses, the program plans to identify factors that facilitate and hinder provider use of MCPAP.
Since 2013, MCPAP has been building on its successful model to address early childhood mental health, adolescent substance use, and postpartum depression. In the early childhood mental health arena, MCPAP is implementing the Positive Parenting Program in primary care, which involves a brief, 4-session intervention aimed at increasing parents’ confidence and skills in managing their children’s challenging behaviors. Using SIM grant funds, MCPAP will roll out statewide training of PCPs in adolescent substance use screening, brief interventions, and referral to treatment in mid-2015. Finally, in July 2014, MCPAP implemented MCPAP for Moms, which addresses postpartum depression by providing psychiatric consultation and support to obstetricians, midwives, and PCPs.
Through its innovative integration of behavioral health services and primary care, the state of Massachusetts is helping to address the serious issue of mental illness in children. Through PCP satisfaction surveys conducted before enrollment and annually, MCPAP has found that PCPs’ reported ability to meet the needs of children with behavioral health problems has increased. At enrollment into MCPAP, 8% of PCPs said they agreed or strongly agreed that they could meet the needs of children with behavioral health problems. The 2012 survey data showed that 64% of PCPs agreed or strongly agreed with this statement. The SIM grant is supporting the MCPAP Evaluation Advisory Group to explore additional ways to assess the impact of this innovative program.
1Commonwealth of Massachusetts. Department of Mental Health. Annual Report: Fiscal Year 2014. Available from http://www.mass.gov/eohhs/docs/dmh/publications/annualreport-fiscalyear2....
Massachusetts Child Psychiatry Access Project
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