Collaborative Care: a Pilot Study of a Child Psychiatry Outpatient Consultation Model for Primary Care Providers

Abstract

A Child Psychiatry Consultation Model (CPCM) offering primary care providers (PCPs) expedited access to outpatient child psychiatric consultation regarding management in primary care would allow more children to access mental health services. Yet, little is known about outpatient CPCMs. This pilot study describes an outpatient CPCM for 22 PCPs in a large Northeast Florida county. PCPs referred 81 patients, of which 60 were appropriate for collaborative management and 49 were subsequently seen for outpatient psychiatric consultation. The most common psychiatric diagnoses following consultation were anxiety (57%), ADHD (53%), and depression (39%). Over half (57%) of the patients seen for consultation were discharged to their PCP with appropriate treatment recommendations, and only a small minority (10%) of patients required long-term care by a psychiatrist. This CPCM helped child psychiatrists collaborate with PCPs to deliver mental health services for youth. The CPCM should be considered for adaptation and dissemination.

Shared Care Models in the Treatment of Pediatric Attention-Deficit/Hyperactivity Disorder (ADHD)

“…Three studies used a prospective cohort design. 16,17,19 The others used the following designs: a randomized controlled cluster trial 18 and a randomized comparative effectiveness trial. 20 In 4 studies, the outcome assessed was ADHD symptoms and functioning.…”

“…16,[18][19][20] Three studies assessed PCPs' satisfaction. [17][18][19] The quality of the studies varied. The risk of bias is described below.…”

“…One study indicated that PCPs had high level of satisfaction regarding improvement in capacity. 17 Multiple factors have likely contributed to the reported satisfaction. Expedited access to a psychiatric consultation, that is, within less than 3 weeks, in the study by Fallucco et al, 17 probably contributed to the increased satisfaction level.…”

“…17 Multiple factors have likely contributed to the reported satisfaction. Expedited access to a psychiatric consultation, that is, within less than 3 weeks, in the study by Fallucco et al, 17 probably contributed to the increased satisfaction level. Additionally, all PCPs in this study participated in specialized training in the management of mental illness.…”

Utilization of Child Psychiatry Consultation Embedded in Primary Care for an Urban, Latino Population

“…Models integrating a child and adolescent psychiatrist in pediatric primary care are less well studied, despite a persistent lack of access to these subspecialists. Studies to date have focused on collaboration with off-site specialists, 16–20 and none have reported on embedded models. Integrating a child psychiatrist within the pediatrics clinic could have benefits beyond those provided by other integrated mental health professionals, similar to those described in the adult literature.…”