45.9 An Innovative Approach to Address the Child and Adolescent Psychiatry Shortage: Extended Consultation Model

Abstract

Novel approaches are needed to address the shortage of child and adolescent psychiatry providers in the United States. As of 2018, 1 in 5 children in the United States have a mental, emotional, or behavioral disorder, yet only 20% of those children receive care from a specialized mental health provider. Exacerbation of child and adolescent mental health problems were evident amidst the COVID-19 pandemic; from mid-March to October 2020, the proportion of pediatric emergency department visits that were mental health–related rose by 44%. The Massachusetts Child Psychiatry Access Program (MCPAP) provides one-time consultation from a child and adolescent psychiatry provider to support primary care providers (PCPs) in treating mental health patients. However, PCPs continue to feel overwhelmed regarding the ongoing lack of direct care by specialists that is often necessary for complex mental health cases. Inspired by the Chronic Care Model, we propose an extended consultation model that includes 6 to 9 months of evaluation, treatment initiation, and reevaluation with treatment plan adjustments as indicated by a child and adolescent psychiatry provider with subsequent referral back to the PCP after stabilization.