In Massachusetts there are only 400 to 500 pediatric psychiatrists to meet the needs of nearly 300,000 youngsters. A Boston Children’s Hospital study points to one possible solution - give primary-care pediatricians more behavioral health resources.
A lack of psychiatrists means many Massachusetts children suffering with behavioral health problems are not getting the attention they need, according to a newly released Boston Children’s Hospital study.
The focus of the five-year study was to give primary-care pediatricians more resources to treat conditions such as anxiety and depression their patients are suffering from. Results from the “Behavioral Health Integration Program” showed improved access to care, with minor cost increases, according to Boston Children’s Hospital.
Psychologists and social workers were brought into primary-care pediatricians’ offices as added service. Doctors focused on diagnosing and treating anxiety, depression and attention deficit/hyperactivity disorder, freeing up outside specialists to focus on more severe cases.
Information culled from the first 13 Boston Children’s-affiliated pediatric practices enrolled in the program, including Framingham Pediatrics, formed the basis of the study findings that covered the period 2013-2018.
The challenge of serving the mental health needs of Massachusetts’ children is one of supply and demand.
There are only 400 to 500 pediatric psychiatrists statewide to meet the needs of nearly 300,000 youngsters with at least one psychiatric disorder, according to Boston Children’s Hospital.
Getting children the care they need early, before problems become acute, was a focus.
“Nearly a decade can elapse between when a child first shows symptoms of a disorder and when it is diagnosed and treated, which has major consequences in their academic, social, and family lives,” Dr. Heather Walter, a Boston Children’s psychiatrist and one of the study’s authors. “There aren’t enough child psychiatrists to offer this care alone, and we realized we needed partners. The obvious physician partners are pediatricians – they see children for years, know them well, are tuned into child development, and are highly trusted by patients and families.”
Framingham Pediatrics added a psychologist to its practice.
“It’s the greatest change in the practice that I can remember,” said Dr. Richard Garber, who founded Framingham Pediatrics in 1993.
Prior to the study, Garber encountered patients with bellyaches and headaches he suspected were caused by anxiety or depression. Since the staff at his practice lacked the necessary behavioral-health training, Garber would refer patients to an outside psychologist or psychiatrist.
“I hated doing that,” he said. “Many times the patient would get back to me, and say, ‘Nobody returned my call.’”
Now doctors at Framingham Pediatrics consult with the psychologist, and in some cases, prescribe medication. Boston Children’s doctors are also available for consultations.
Besides the Boston Children’s effort, the state Department of Mental Health supports increased behavioral-health training for child psychiatrists.
Since 2005 through its Massachusetts Child Psychiatry Access Program, the state agency funded efforts to help doctors care for children with mild to moderate mental health conditions. The program reached more than 400 primary care pediatric practices statewide, including some affiliated with Boston Children’s.
The Boston Children’s study included a total of 105 pediatricians serving 114,000 children. The study findings include:Psychotherapy visits to primary-care pediatricians increased from .7% to 13%. Prescriptions increased for a class of anti-depressants known as SSRI (selective serotonin reuptake inhibitors). More than 90% of pediatricians surveyed reported an increased ability to manage mild/moderate mental and behavioral health problems
Participating practices saw behavioral-health costs climb a total of 8%.
The study’s authors expected to see a drop in emergency room visits with more services available at participating pediatric practices, but acknowledged more data is needed to get a clear picture.
Overall, the study found a 19% drop in emergency room costs connected to behavioral health visits.
Currently, 85% of pediatric offices in the Boston Children’s network participate in the Behavioral Health Integration Program. The plan is to increase that number and expand services, including family crisis intervention for suicidal adolescents, tele-conferences between a Boston Children’s psychiatrist and patients and web-based training for a national and international audience.
Garber said his Framingham Pediatrics patients have benefited from Boston Children’s program.
Recently, a female patient came to the practice complained that she had lost her appetite for two years. She suspected it had something to do with anxiety, so she was connected with the on-site psychologist at Framingham Pediatrics. One 30-minute session led to another.
“Before, we sent patients on their way. Now we can treat them before things become a problem,” Garber said.