P3B304: Meeting the Need for Mental Health Care in Pediatrics: A Statewide Model for Support

Background: In 2022, Virginia ranked 48th in the US regarding access to youth mental health services according to Mental Health America. The Virginia Mental Health Access Program (VMAP) is critical in meeting the mental health (MH) needs of children in Virginia through an integrated care model that offers primary care providers (PCP) a means to better serve their patients through education and access to consultation. Mental health concerns in individuals under 21 years of age are often under-identified. While integrated care is the goal, it is often challenging to develop and maintain in smaller practice settings.

Methods: VMAP provides a 40 hr/week consult line, enabling PCPs to engage with clinicians for timely consultation. Consults give PCPs access to region specific services that support and address the ongoing MH needs of children. Core services offered include diagnosis, medication management, and teaching points. VMAP measures and compares dozens of specific data points collected throughout the consult line. All consults are facilitated by either a child and adolescent psychiatrist (CAP) and/or licensed mental health provider (LMHP). Since August 2019 through the end of 2022, there have been 2,799 consults completed on behalf of 639 unique providers. A total of 2,028 care navigation cases were also completed during the same time period, supporting patient access to community resources.

Consult line data was cross-examined using various statistical tests (e.g., Chi-squares, t-Tests, etc.) and other aggregate, frequency-based analyses to identify trends concerning provider and patient outcomes. VMAP reporting measures included 1) length of time between call intake and a PCP receiving care, 2) screening outcomes, and 3) exploratory analyses regarding the joint implementation of consultations and VMAP-sponsored trainings.

Results: Since the consult line opened in August 2019, VMAP has identified the following:
1) In 2022, 93% of calls to VMAP were answered live and almost all consults were received by a PCP within 30 minutes.
2) For 83% of consults (n=2,799), PCPs were able to continue treating the patient within their practice following a consult with a CAP or LMHP. This reserves referrals to specialty care to more moderate or severe mental health needs.
3) PCPs who participated in a Project ECHO training were more likely to use specific screening tools than their non-participating colleagues as reported in consult line data. For example, 41% of Project ECHO participants reported using a screening tool for Anxiety, compared to 30% for non-participants.

Conclusion: Mental health access programs are a promising option to build capacity for integrated care models, allowing PCPs to treat more kids in their care and broadening their skill set. VMAP has demonstrated early evidence to support timely care for the mental and behavioral health needs of youth while minimizing delays in access to specialty care.