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Systematic Review: Child Psychiatry Access Program Outcomes

Chuan-Mei Lee^1,2, Juliet Yonek¹, Brendon Lin¹

¹University of California, San Francisco.

|January 8, 2024

Insights

Child Psychiatry Access Programs (CPAP) are growing to support pediatricians in mental health care. While well-received by providers, more research is needed on patient mental health outcomes.

Area of Science:

Child and Adolescent Psychiatry
Health Services Research
Pediatric Primary Care

Background:

Child and adolescent psychiatry workforce shortages necessitate innovative support models.
Child Psychiatry Access Programs (CPAPs) aim to equip pediatric primary care providers (PCPs) with mental health service capabilities.
CPAPs facilitate rapid remote mental health consultations from specialists to PCPs.

Purpose of the Study:

To systematically review and synthesize the existing literature on Child Psychiatry Access Programs (CPAPs).
To evaluate the adoption, provider, patient, and caregiver experiences, costs, and mental health outcomes associated with CPAPs.

Main Methods:

A systematic literature search was conducted across PubMed, PsycInfo, Embase, and Web of Science databases.
Studies published from database inception to April 6, 2022, were included.
Outcomes assessed included program adoption, provider/patient/caregiver experience, cost, and patient mental health.

Main Results:

33 studies were included, none were randomized controlled trials.
Most studies focused on program adoption (n=30) and provider experience (n=18).
CPAPs demonstrated year-over-year growth in adoption and positive provider/caregiver reception, but patient mental health outcomes were underreported.

Conclusions:

Rigorous research on CPAP impact is limited, with a notable gap in patient-level mental health outcome data.
High provider satisfaction exists, but evidence on patient mental health improvement is lacking.
Prioritizing and investing in research is crucial to build a stronger evidence base for CPAPs.

Read full analysis

Abstract

Objective:

There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs.

Method:

A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health.

Results:

None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost(n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs.

Conclusion:

Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs.

Diversity & Inclusion Statement:

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Clinical Trial Registration Information:

Child Psychiatry Access Programs: A Systematic Review; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410; CRD42020146410.

Keywords:

child psychiatry mental health services pediatrics primary care referral and consultation

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