Supporting kids’ whole wellness

How the Massachusetts Child Psychiatry Access Program educates pediatric primary care providers on serving children’s behavioral health needs

 

Whole-child health is a priority

 

There is a nationwide shortage of mental health professionals, especially for youth. The U.S. Department of Health and Human Services (HHS) has estimated that by 2025 the nation will have 10,000 fewer mental health professionals than it needs.¹

The Journal of the American Medical Association (JAMA) reports that mental health-related visits to emergency rooms by children, teenagers, and young adults soared from 2011 to 2020. The sharpest increase was for suicide-related visits, which rose fivefold.²

Children’s behavioral health is an integral part of their overall well-being. When children receive early intervention and treatment for their emotional and behavioral needs, they can live happier, healthier, and more fulfilling lives. The Health Resources and Services Administration (HRSA) reports that behavioral healthcare, when included in a primary medical care setting, reduces stigma and discrimination, improves cost benefits, and promotes improved patient outcomes.³

Pediatric primary care providers are essential child advocates. To implement the best treatment plan, prescribe appropriate medications, and suggest key resources, the provider needs to understand a child as much as possible — behavioral health is essential to this understanding.

The Massachusetts Child Psychiatry Access Program (MCPAP) , administered by Carelon Behavioral Health, is a resource that provides behavioral health education and consultation to pediatric primary care clinicians.

 

What is MCPAP?

 

Behavioral health is a fundamental component of overall health and wellness. MCPAP is a system of regional children's behavioral health consultation teams that helps primary care providers and their practices manage pediatric patients’ behavioral health. MCPAP’s main goal is to support the integration of behavioral and physical healthcare. In Massachusetts, MCPAP has three teams spread over seven academic hubs.

 

MCPAP's origins

 

MCPAP began in Massachusetts in 2004: it is now the model for similar programs in 46 states, four territories, and two tribes.

“Before the program started, many pediatric primary care physicians were increasingly prescribing medications to their patients,” explains John Straus, Health Services Director at Carelon Behavioral Health and Founding Director of MCPAP. “The medical community began asking questions as to whether this was the right approach for treating children’s health needs. They thought that kids could have better options.”

 

The MCPAP solution

 

MCPAP stepped in to help provide these better options, with teams of experts acting as coaches and consultants.

These teams engage practitioners via an educational model, informing practitioners and providing real-time consults on behavioral health management. The teams help with referrals and offer second opinions on more complex cases; they also have the option to see a youth for a one-time consult.

All consultants are local and have ongoing relationships with their pediatric primary care partners. Our teams include child psychiatrists, licensed professional counselors, social workers, and child psychiatric nurse practitioners.

 

How do primary care practices use MCPAP?

 

Pediatricians rely on MCPAP’s consultants to help fill gaps in patient care needs. When PCPs need help in determining the best courses of treatment that lie beyond the typical scope of services, MCPAP plays a vital role.

“Since child psychiatrists are rare, consultants train pediatric primary care clinicians on treating mild to moderate issues in patients. PCPs learn how to manage certain types of medications and diagnose conditions such as ADHD, anxiety, depression, and substance use,” adds Straus. “This frees up the scarce number of child psychiatrists to manage the more complex patients, particularly those youth needing hospitalization and other forms of higher-level care.”

A PCP typically contacts an MCPAP consultant when a patient presents with a behavioral health issue. The consultant normally responds within 30 minutes, often while the family is still in the PCP’s office. The consultant may schedule a follow-up telehealth visit with the family, or they may ask their team’s care coordinator to help the PCP and family find a community resource.

MCPAP also supports providers with resources that include educational opportunities , newsletters, webinars, and guidelines.

 

MCPAP creates results

 

77% of PCPs enrolled in MCPAP say they feel comfortable treating ADHD, 68% say they are comfortable treating depression, and 67% feel comfortable treating anxiety.⁴

Studies indicate that in states with MCPAP programs, 3% more families surveyed were receiving help for their child’s emotional and behavioral health needs (12.3% vs. 9.5%).⁵

Since the program’s founding in 2004, the PCPs of approximately 30% of all Massachusetts children with behavioral health needs have consulted MCPAP.⁶ Today, internal data shows that MCPAP helps approximately 6,000 children per year.

 

How families access MCPAP

 

Families discover MCPAP through their pediatric primary care provider. Over 95% of all Massachusetts pediatric practices have enrolled in the program.⁷

By asking families to fill out pre-appointment behavioral health screening questionnaires, providers can gain a greater awareness of any behavioral health issues a child may be experiencing.

These questionnaires also help PCPs to reduce stigma. When a family becomes accustomed to thinking about behavioral health issues, they are more likely to approach their PCP in the event of acute behavioral health symptoms.

When patients seek care for substance use issues, MCPAP can connect PCPs to substance use disorder (SUD) experts.

 

Who pays for MCPAP 

 

The Massachusetts Department of Mental Health (DMH) funds MCPAP through a state legislative earmark in partnership with major managed care organizations (MCOs).

 

Replicating MCPAP’s success

 

Most programs modeled on MCPAP start with either state legislative funding or federal funding through the HRSA Pediatric Mental Health Child Access (PMHCA) program .

Based on existing templates throughout the country, a program with the necessary funding and supports will thrive and grow.

Straus concludes, “MCPAP is the key to practitioners being able to serve their patients’ behavioral health needs as well as being happier and more successful in their practices.”