43. Curbside Child Psychiatry Consultation with your Pediatric Mental Health Care Access Programs!

Do you ever wish you had a child psychiatrist on speed dial? Well, now you can!  This week, we talk about how to get connected to a Pediatric Mental Health Care Access Program (PMHCAP) near you that offers:
* phone consultation with child psychiatrists to help you care for kids in your office
* care navigation services to help you find resources
I will walk you through what to expect when you call your local PMHCAP and how they can be helpful for you and for your patients.

For a list of statewide PMHCAPs near you, check out:
https://mchb.hrsa.gov/programs-impact/programs/pmhca-awardee-teleconsultation-phone-lines

Link also available on our website, PsychEd4Peds.com

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds

Transcript

Dr. Elise Fallucco: 0:21

welcome back to Psyched for Peds, the child mental health podcasts for pediatric clinicians, helping you help kids. I'm your host, Dr. Elise Fallucco child psychiatrist and mom. Well happy may everybody. And as you know, may is mental health awareness month. It is also May-Cember and there's a ton of end of school year craziness, at least in our house. So I wanted to take this moment and this opportunity to share a hidden gem, a free clinical on-demand resource that can help you take care of kids with mental health problems. So this resource is called the pediatric mental health care access program or PMH C APS, which is a little bit of a clunky acronym. The pediatric mental health care access programs are designed to help pediatric health professionals integrate mental health into pediatric primary care. And so what they do is they provide telephone consultation for pediatric clinicians to help them take care of kids with mental health problems. They also often provide training in child mental health care free for clinicians in the state. And they help with referrals and resources.

1:33

And these pediatric mental health care access programs are available in 46 states, as well as some tribal nations and us territories, including the Virgin islands. Um, side note. If you are running the Virgin island program, I would be happy to consult.

Dr. Elise Fallucco: 1:49

And you may have heard about these. We've mentioned them in a couple of our previous podcasts, but I wanted to dive in deeper to help you get a feel for what it really is. So each one of these programs typically has a child and adolescent psychiatrist who serves as a consultant. And is available on call five days a week from about 9:00 AM to 5:00 PM. To help you when you're getting stuck in taking care of a kid in your office or in your practice. There's also a care coordinator on each team that helps you find resources and facilitate referrals oftentimes to a behavioral health provider in your area of the state. So common questions or some typical questions that pediatric clinicians might ask the care coordinator would be, where do I refer a preschool age child who needs evaluation for possible behavioral and emotional problems. Or where do I refer a teenager who needs trauma focused therapy. So the pediatric mental health care access program, this hotline can get you connected with a care coordinator who can help you answer those questions that are and help you access, help you find and try to access resources in your area. Some programs also have licensed. Some programs also have licensed behavioral health counselors or social workers, or even psychologists on staff. And in the United States, these are funded by HERSA, the health resources and services administration. So they're free to you. And I would like to say, especially in the age where we're really trying to achieve health equity, especially in access to behavioral health care. These programs are particularly great for clinicians who are in rural or other underserved areas where it's very extra difficult to try to access mental health resources. In some states. These programs, not only help primary care providers, but they also support school systems and clinicians in emergency departments. So full disclosure. I am on the board of directors for the national network of these programs. And most relevantly I've had the pleasure for working for the past year and a half for one of these statewide programs, as one of the child psychiatry consultants. So I can tell you from personal experience, how they can help you help kids and families in your practice. So I'm going to use an example from one of our, one of the recent days when I was on call. To help you step through what happens when you call, what should you expect? And how could this maybe be helpful? So, as I mentioned before, These hotlines are available during regular business hours, Monday through Friday in a various by state, but typically, you know, 9:00 AM to about 5:00 PM. So. So the other week, Dr. M called the hotline in the state where I was working and immediately. One of our staff members picked up and spoke with Dr. M to triage the call and our staff member asked Dr. M a few questions, including, do you need help with referrals? What sort of resources are you looking for? And do you want to talk to a child psychiatrist? Do you have any questions about diagnosis or treatment? Um, or do you just want a phone consultation about a case? If Dr. N decided that she wanted to talk to a child psychiatrist, the goal in most states is to have a call back in less than 30 minutes. And while this is great. I know. Pediatric primary care providers are very busy and they can't sit around and wait for 30 minutes for a call back. And so very often what happens is they'll go into the next room and keep seeing patients. And when the child's psychiatrist calls back, they'll just overhead page. The pediatrician who will come out and we'll have as long of a conversation or short of a conversation as you want to have about the case. And I also want to let you know that we've often received non-urgent questions too. So let's say you're reflecting on one of the patients you saw and you're thinking, you know what? I'm not sure. Where I want to go with this, or if I made the right decision about starting this med or referring them to this place. And so you can always call and. If you're not available to immediately talk. And it's a non-urgent question. You can always call and request a call back at a scheduled time. So often I'd get a message saying, please call Dr. M back tomorrow after one to discuss whatever it is. And so then I just called them at whatever number they wanted me to call and we'd have a conversation. And to help you get a better feel for how this resource works. I wanted to just share some recent examples that we had in our telephone consultation program. Sometimes we get called with a very specific, straightforward question that can honestly take a minute or less to address. So for example, I have a kid who's failed a stimulant for ADHD, and I'm wondering about dosing recommendations for this next stimulant that I want to try. And. Issues like this can usually be solved. In a minute or two and then. Depending upon how much time the pediatric clinician has, we can always go into more detail or oftentimes they'll say that's great. That's all I wanted to know. Thanks so much. Bye. And then they get on with their day.

6:53

More, oftentimes we get consults that are a little bit. More involved.

Dr. Elise Fallucco: 6:57

Like for example, I had a, pediatrician call with a question about a teenage girl with depression. And some suicidal thoughts and the pediatrician, he just wanted to work through. Questions about how do I know? If she's safe to go home, what additional questions should I ask? And are there any other resources I should be thinking about? As I mentioned before. If, you know, you've got a really busy day and you have a non-urgent question it's not unusual to call the hotline and say, Hey, I want to be called back tomorrow or at a given time when you know you won't be distracted or more importantly, you won't be disrupting patient care so one of the cases I had, like this was from a pediatrician we'll call her Dr. M who had, was really interested in learning and had set aside time in her schedule for more lengthy discussion. And so she presented the case of a 10 year old boy with autism and ADHD. Who had tried certain medications and developed anxiety. And she just wanted to talk about how do I think through cases like this? Do I have an algorithm for approaching medication management? And so we just reviewed. The meds that she had tried, what worked, what didn't work, what side effects? I had the patient developed and we talked about possible alternatives and dosing recommendations. And also just generally how to think through management of comorbid ADHD and autism. And so that discussion definitely took longer than a couple of minutes, but it was driven by. The pediatrician's request for case-based learning. And so there's a lot of flexibility with these consultations and really our job as child psychiatry consultants is to be responsive to whatever your needs are as pediatric clinicians, and also to be realistic and practical about, you know, do you have one minute, do you have five minutes? Do you have a thousand questions and no time limit? Um, we're here for you. And luckily in the state where I practice, they have a beautiful. Online resource available for all pediatric clinicians, where it has dosing guidelines and information for working through some of these complicated. Clinical issues. And so I recommended that Dr. M check the online resource and also just call us back if she has any further questions. And it turned out. She was also having trouble accessing ABA. And so I referred her to our care navigator who was going to separately call the pediatrician and the family. To provide them with resources for locating ABA in their area.

9:28

And as a bonus, most states typically send written copies of the recommendations to the pediatricians after the phone call. So that includes dosing recommendations or written steps for approaching management of a kid with ADHD and autism. And then also. Contact information for various referral resources for the family. And so this is great because practically, if you've got some questions and you've got a long car ride home, you could call the consult line or schedule a call back during your drive home. And just have the conversation while you're driving at the end of work.

Dr. Elise Fallucco: 10:03

I know when one of the states where I've worked first, came out with a statewide telephone consultation line. A lot of the pediatricians who I work with said, I don't know if I want to call them because I don't know who those people are. How can I trust them? What is this going to be like? And I can understand the skepticism. You don't know all the time. Who's on the other line. But having been on the other side and on the line, what I can say is many of these programs are very good about collecting data about each one of the calls and doing quality improvement and reviewing the recommendations that the child psychiatrist and the care navigators are making to make sure that recommendations are evidence-based and that they're keeping up to date with resources. And I would encourage you in whatever state you're in, or if you happen to live in British Columbia. Or in any of the tribal nations where these are available. I would really encourage you to reach out and try it. You know, everybody wishes they had a child psychiatrist that they could curbside, and now you can. So, if you want to list of the programs or a statewide map of where these are available and how to access them. I will have a link on our website, psyched, the number four paeds.com on our resources page. And since we're talking about helpful child psychiatrist and helpful consultation, I just want to close with saying I would be happy. To hear from you about what questions do you have regarding your patients? What have. What do you want to learn more about on psyched for paeds and what are some of the pain points in your own pediatric practices in working with kids with mental health problems and how can we help. Thank you again for all the work that you're doing to take care of kids and families. I wish you a lovely may. Sember. And beyond, and I look forward to hearing from you. Thanks so much for listening. We'll see you next week.