Phone Line Helps Rural Docs Care for Kids With Mental Illness

Megan Brooks

May 31, 2019

SAN FRANCISCO — A telephone mental healthcare access line is helping pediatricians in rural North Carolina improve their ability to care for kids with mental health issues.

Access to specialized child and adolescent psychiatry services in rural communities across the country is an ongoing problem.

To address the problem in rural North Carolina, Duke Integrated Pediatric Mental Health partnered with Cardinal Innovations, a state Medicaid behavioral health managed care organization, to create a telephone-based mental health access line for rural pediatric providers. The program, called the North Carolina Pediatric Access Line (NC-PAL), targets six rural counties home to roughly 60,000 children. There are no child psychiatrists in any of the counties.

The NC-PAL treatment team includes a child psychiatrist, therapist, and social worker.

"Pediatricians in these rural counties can give us a call in real-time for kids that they have mental health questions about," J. Nathan Copeland, MD, MPH, child and adolescent psychiatrist at Duke Health, who participates in NC-PAL, told Medscape Medical News. "Children with mental health needs that are too complex to be managed by phone can be seen in person by the NC-PAL team for a one-time consultation," he said.

Copeland described the program and feedback from those involved in a poster here at the American Psychiatric Association (APA) 2018 Annual Meeting.

The program has been fully operational for about 16 months. Since launch, the cumulative number of pediatric practices that have used NC-PAL has steadily increased and the number of monthly calls to the access line has also trended upward. Pediatricians are "interested and willing" to use the mental health access line, Copeland told Medscape Medical News.

"There are probably about 40 to 45 pediatric practices in these six rural counties and 35 have called us since we have gone live," he noted.

The vast majority of pediatricians who have used the access line said it improved their ability to care for their patients with mental health issues and reduced a patient's immediate need for a mental health specialist or higher level of care (ambulance or emergency department).

After calling the access line a few times to get advice some of the pediatric providers have reported being more comfortable addressing mental health issues that come up on their own. "That is at the heart of this program," Copeland said.

Valuable, Much-Needed Service

"This consultation program at Duke is providing a valuable and much-needed service to pediatricians and children and adolescents in rural and underserved areas," Shabana Khan, MD, member of the telepsychiatry committees of the APA and American Academy of Child and Adolescent Psychiatry (AACAP), told Medscape Medical News.

"There is a nationwide shortage and maldistribution of child and adolescent psychiatrists and other healthcare professionals with specialty training and expertise in pediatric mental health disorders. Many rural counties don't have any practicing child psychiatrists," said Khan, director of telepsychiatry and assistant professor, child and adolescent psychiatry, Hassenfeld Children's Hospital of NYU Langone Health in New York City. 

Because of these shortages, pediatricians are often on the frontline of child mental healthcare without specialty training, Khan noted.

She added that many states are using innovative programs and technology to help address access issues, including telephonic specialty consultations into pediatric practices, and telepsychiatry using live, interactive videoconferencing for consultation, direct patient care, education, iterative guided practice, and telementoring.

"The APA and AACAP telepsychiatry committees have done a significant amount of work to help advance the field of telepsychiatry and remove legal, regulatory, and reimbursement obstacles," said Khan.

Khan also noted that despite the availability of effective, evidence-based treatments, many children with mental health conditions, particularly those living in rural areas, do not get the treatment they need, and for those that do, there is often a significant delay from onset of symptoms to diagnosis and treatment initiation.

"The longer that psychiatric illness or family dysfunction goes on, the more difficult it is for a child to succeed," she said. "Efforts aimed at prevention and early intervention are very important to reduce the risks of long-term consequences such as school drop-out, unemployment, substance abuse, incarceration, and suicide."

This research had no specific funding. Copeland and Khan have reported no relevant financial relationships.

APA 2019. Presented May 20, 2019. Abstract 166.

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