The Partnership Access Line: evaluating a child psychiatry consult program in Washington State

Area of Science:

• Child and Adolescent Psychiatry
• Primary Care Pediatrics
• Health Services Research

Background:

• Primary care providers (PCPs) often face challenges in managing pediatric mental health conditions.
• Access to specialized mental health consultation can improve care for children.
• Telephone-based consult services offer a scalable solution for supporting PCPs.

Purpose of the Study:

• To evaluate the effectiveness and impact of a telephone-based child mental health consult service, the Partnership Access Line (PAL) program.
• To assess PCP satisfaction and changes in mental health service utilization among children receiving PAL consultations.

Main Methods:

• The study involved a review of PAL program records, surveys of PCPs, and analysis of Medicaid claims data.
• Data were collected on 2285 consultations by 592 PCPs between April 2008 and April 2011.
• Medicaid claims for children were analyzed before and after PAL consultations to assess changes in medication use and outpatient visits.

Main Results:

• Most PAL consultations (69%) concerned children with serious emotional disturbances or those on psychiatric medications (66%).
• PCPs consistently received psychosocial treatment advice (87%) and were more often advised to initiate (46%) than stop (24%) medication.
• Following PAL consultations, there were significant increases in ADHD and antidepressant medication use, and a 132% rise in outpatient mental health visits for children with a foster care history.

Conclusions:

• The PAL program effectively supports PCPs in managing complex pediatric mental health cases, including medication management and psychosocial interventions.
• PCPs reported high satisfaction with the PAL service.
• The PAL program is associated with increased utilization of outpatient mental health services for specific pediatric populations.