9.2 Children's Mental Healthcare Needs in Primary Care: Results From a Statewide Needs Assessment for Primary Care Physicians in Vermont

Abstract

The objectives of this presentation are to: 1) provide a qualitative and quantitative description of the experience of a cohort of pediatric primary care providers (PCPs) across the State of Vermont with the treatment and referral of mental health conditions including use of a phone and email consultation service; and 2) describe the barriers that these PCPs report to recommending psychotherapy, medication, wellness strategies, and connecting their patients to care in the community. Individual PCPs engaged around this issue were identified. Online and paper surveys were sent, and 32 responses collected in May-June 2019. Seventy-four percent of respondents were seeing 6 or more children per week with mental health–related complaints. Sixty-two percent reported at least one-quarter of patient encounters involving mental health issues. Nearly all were comfortable with managing mild-moderate ADHD, depression, and anxiety, and reported using rating scales/screening tools to assess for these conditions. Seventy-eight percent had moderate-to-severe complexity patients they were treating without specialty input, with a mean of 4 active cases. The PCPs felt that with these cases, they were operating outside of their scope of practice and comfort. The vast majority were referring cases to child and adolescent psychiatry when there was diagnostic or medication complexity or a high level of acuity. Forty-eight percent reported access to a consultation phone/email service, which was used mostly sporadically, with cited barriers including time and feeling that patients needed to be seen in person to be effective. Diagnostic uncertainty was the most commonly cited barrier to medication prescribing. Barriers to nonmedication treatment included lack of interest or follow through from families, not knowing which particular therapy to recommend or where to refer, and difficulty accessing treatment. Quality concerns and frequent clinician turnover were also mentioned. This selected sampling of pediatric PCPs reported seeing significant numbers of children with mental health issues. For several conditions, they felt comfortable managing mild-to-moderate–level acuity. Many had moderate-to-severe cases they were managing without specialty input. PCPs would welcome increased communication between providers, improved quality measures, databases of community providers and their area of expertise, and consideration of expanded consultative services.