Four million children and adolescents in the United States suffer from a mental health issue – but only 20 percent receive mental health services.
A new grant from The Duke Endowment is helping a major health care system tackle that challenge in the Carolinas. The program will give pediatric patients access to behavioral health services through privacy-protected virtual care. By integrating primary care and behavioral health care, the goal is to offer seamless – and critical – services to children.
The Endowment’s $800,000 grant to Carolinas HealthCare System will support design and implementation. Project leaders say it’s an opportunity to improve how behavioral health care is delivered in the region and establish a model for others.
“By offering access to behavioral health services in a pediatric primary care setting, we are not only improving overall health outcomes, we are driving down the cost of care,” says Martha Whitecotton, senior vice president of behavioral health services at Carolinas HealthCare. “Most importantly, it will help us identify and address behavioral health issues in young patients at an early stage, before emergency treatment is required.”
Whitecotton speaks more about the initiative in the following interview.
How will this program work?
If the pediatrician identifies a behavioral health or mental health issue during a check-up or sick visit, he or she will use a video screen to connect the child with a behavioral health provider. After a diagnostic interview, we can start the process of managing the illness through the primary care provider. The program design will include access to the entire behavioral health team –psychiatry, pharmacy, health coach, navigator, scheduler and educator.
What is the target population?
Pediatric patients in the primary care setting who are ages 0 to 17.
How many pediatric practices in the Carolinas will be involved in the pilot?
Six to seven.
How will the Endowment grant support the project?
Supporting Crisis Mental Health Care
Many people suffering from mental illnesses don't have access to the services they need. Both North Carolina and South Carolina are experiencing shortages of psychiatrists, especially in rural and remote communities. Those experiencing mental health crises often end up with long waits in hospital emergency departments, where emergency care providers are left to diagnose and treat behavioral health needs, despite a lack of training.
Since 2007, The Duke Endowment has awarded more than $11.7 million in grants to improve mental health care and decrease health care spending through the development of telepsychiatry networks. Telepsychiatry uses consulting providers to deliver acute mental health or substance abuse care, including diagnosis and treatment, by means of two-way real-time interactive audio and video.
Endowment funding will be used to provide salary support, conduct onsite research into best practices, underwrite training and educational programs, and provide technology support.
Why is early intervention important?
When a child has an anxiety disorder that goes untreated, for example, and it escalates into depression that goes untreated, and that escalates into substance abuse, it can become a very difficult issue. If you can intervene early, the chances improve for a full and productive life.
Why is integrated care important?
For years, we have treated mental health and physical health as if they were separate. But they’re not. Mental illness affects physical health. Physical health affects mental illness. The two are linked inextricably and we have to address them together.
For adults, the second reason is stigma. People who need a behavioral health provider often won't go because of the stigma. But most people don’t feel that way about their primary care provider.
Seventy published randomized controlled trials have shown that integrating behavioral health services with primary care is effective.
How did this pediatric behavioral health integration project begin?
Carolinas HealthCare System has already piloted a telemedicine model for integrating adult behavioral health and primary care and we've had great success. We started planning for that in late 2013 and went into our first practice around April 2014. We've seen nearly 3,000 patients.
Many skeptics said patients wouldn’t want to talk to a mental health professional on a computer screen, but we haven’t had one person refuse. It can make all the difference in the world when you can talk to someone right away.
Have results been positive?
The adult patients we've enrolled and treated have seen a 47 percent decrease in symptom severity. Over the next two years, we will also be tracking overall health improvements and utilization of health care resources in patients receiving treatments.
This new grant will allow us to extend the existing model into the pediatric care setting. I think we're uniquely positioned to be the pilot because we have such a robust virtual care platform in place.
Don’t pediatricians already do some mental health screening?
Pediatricians are really at the forefront of this. The American Academy of Pediatrics has done a lot of work around building the competency of pediatricians to manage low- to moderate-risk mental illness. The beauty of this is that it marries the work they're already doing with the support they need from the behavioral health side.
When we talk about mental health issues in children, what do we mean?
There’s a broad spectrum, but it can be depression, anxiety, ADHD, autism spectrum disorders, etc.
Why do only 20 percent of children receive services?
It's lack of access to providers. Of the 100 counties in North Carolina, 28 do not have a single practicing psychiatrist, and the shortage of child and adolescent psychiatrists is even more significant. If we can improve access through virtual care, we can start to address that.
Do you see virtual care as an answer?
Absolutely. We just don’t have the physician workforce available without it. Telemedicine is an extremely effective way to expand access and be efficient in the delivery of care.
When it comes to behavioral health services, are we graduating enough providers to meet the need?
We're not coming close. In child psychiatry, it’s an even bigger problem. People are waiting three, six, seven, eight months to get appointments.
This new initiative builds on the momentum of a commitment by The Leon Levine Foundation to establish the Sandra and Leon Levine Psychiatry Residency Program at Carolinas HealthCare System.
What excites you about behavioral health integration?
Number one: Patients can get better. That’s what all of us want to happen. Number two: We can support primary care physicians. If we can help them care for their patients, that’s a huge win.
Learn more about how the Endowment has supported telespychiatry.
Lin B. Hollowell III
Director of Health Care