As pediatricians are increasingly being called upon to play a primary role in the diagnosis and care of children with mental disorders, improved communication with mental health specialists is viewed as a way to enhance the quality of care. One method to accomplish closer teamwork and improve access to children and parents is to house the services under one roof.
In research published online in the journal Clinical Pediatrics, Jane Williams, Ph.D., and colleagues from Wake Forest University Baptist Medical Center and the N.C. Chapter of the American Academy of Pediatrics describe three practice models, which combined clinical and mental health services in a cost-effective manner.
Williams comments, “With the increased need for identification, diagnosis and treatment of mental health disorders in primary health care settings, location of mental health providers in primary care practices is a concept whose time has come.”
“Across all three models, enhanced communication between medical and mental health providers was consistently perceived as improving quality of care for patients, increasing comfort in diagnosis and treatment of behavioral health disorders by physicians and providing educational opportunities between disciplines,” Williams said. “Pediatricians perceived themselves to be more efficient in their practices.”
In one model, a practitioner who was employed by a community Mental Health Center was stationed in a large pediatric practice, Aegis Winston East. Williams said the model “provided more convenience for patients, less stigma and better communications with primary care physicians.”
In the second model, a master’s degree-level, licensed psychological associate was directly employed by a private pediatric practice in Washington, N.C., that assumed all responsibility for expenses and reimbursement. The practice chose that type of practitioner because of a contract with the local school system to provide psychological testing services.
Other services included diagnostic interviews, individual and family therapy and informal consultation with the physicians in the practice, Washington Pediatrics.
In the third model, a self-employed psychologist practiced in the same suite of offices with a rural pediatric practice in Sylva. High demand for mental health services resulted in the addition of a second psychologist, a clinical social worker and a psychological associate.
Patients said that having the two offices together “contributed to a high level of satisfaction and trust,” Williams said. “Pediatricians indicated increased confidence in prescribing psychotropic medications due to exposure to the mental health group as well as increased skills in caring for children who had been hospitalized for mental health disorders.”
While some practices have had mental health professionals working directly with them for years, reimbursements came only from private insurers. Until recently, children with mental health diagnoses who were on Medicaid could be treated only in public clinics.
A number of changes in N.C. Medicaid policy allowed mental health providers to serve a mix of Medicaid and privately insured children. Up to 26 visits annually per child are now permitted, which can be billed to Medicaid either by a primary care provider or a mental health professional.