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
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Elise Fallucco (00:21):
welcome back to Psyched for Peds, the child
mental health podcasts forpediatric clinicians, helping
you help kids.
I'm your host, Dr.
Elise Fallucco childpsychiatrist and mom.
Well happy may everybody.
And as you know, may is mentalhealth awareness month.
It is also May-Cember andthere's a ton of end of school
(00:42):
year craziness, at least in ourhouse.
So I wanted to take this momentand this opportunity to share a
hidden gem, a free clinicalon-demand resource that can help
you take care of kids withmental health problems.
So this resource is called thepediatric mental health care
access program or PMH C APS,which is a little bit of a
(01:05):
clunky acronym.
The pediatric mental health careaccess programs are designed to
help pediatric healthprofessionals integrate mental
health into pediatric primarycare.
And so what they do is theyprovide telephone consultation
for pediatric clinicians to helpthem take care of kids with
mental health problems.
They also often provide trainingin child mental health care free
(01:28):
for clinicians in the state.
And they help with referrals andresources.
And these pediatric mentalhealth care access programs are
available in 46 states, as wellas some tribal nations and us
territories, including theVirgin islands.
Um, side note.
If you are running the Virginisland program, I would be happy
to consult.
(01:49):
And you may have heard about these.
We've mentioned them in a coupleof our previous podcasts, but I
wanted to dive in deeper to helpyou get a feel for what it
really is.
So each one of these programstypically has a child and
adolescent psychiatrist whoserves as a consultant.
And is available on call fivedays a week from about 9:00 AM
to 5:00 PM.
To help you when you're gettingstuck in taking care of a kid in
(02:12):
your office or in your practice.
There's also a care coordinatoron each team that helps you find
resources and facilitatereferrals oftentimes to a
behavioral health provider inyour area of the state.
So common questions or sometypical questions that pediatric
clinicians might ask the carecoordinator would be, where do I
(02:33):
refer a preschool age child whoneeds evaluation for possible
behavioral and emotionalproblems.
Or where do I refer a teenagerwho needs trauma focused
therapy.
So the pediatric mental healthcare access program, this
hotline can get you connectedwith a care coordinator who can
help you answer those questionsthat are and help you access,
(02:54):
help you find and try to accessresources in your area.
Some programs also havelicensed.
Some programs also have licensedbehavioral health counselors or
social workers, or evenpsychologists on staff.
And in the United States, theseare funded by HERSA, the health
resources and servicesadministration.
So they're free to you.
(03:15):
And I would like to say,especially in the age where
we're really trying to achievehealth equity, especially in
access to behavioral healthcare.
These programs are particularlygreat for clinicians who are in
rural or other underserved areaswhere it's very extra difficult
to try to access mental healthresources.
In some states.
These programs, not only helpprimary care providers, but they
(03:38):
also support school systems andclinicians in emergency
departments.
So full disclosure.
I am on the board of directorsfor the national network of
these programs.
And most relevantly I've had thepleasure for working for the
past year and a half for one ofthese statewide programs, as one
of the child psychiatryconsultants.
So I can tell you from personalexperience, how they can help
(03:59):
you help kids and families inyour practice.
So I'm going to use an examplefrom one of our, one of the
recent days when I was on call.
To help you step through whathappens when you call, what
should you expect?
And how could this maybe behelpful?
So, as I mentioned before, Thesehotlines are available during
regular business hours, Mondaythrough Friday in a various by
(04:20):
state, but typically, you know,9:00 AM to about 5:00 PM.
So.
So the other week, Dr.
M called the hotline in thestate where I was working and
immediately.
One of our staff members pickedup and spoke with Dr.
M to triage the call and ourstaff member asked Dr.
M a few questions, including, doyou need help with referrals?
(04:42):
What sort of resources are youlooking for?
And do you want to talk to achild psychiatrist?
Do you have any questions aboutdiagnosis or treatment?
Um, or do you just want a phoneconsultation about a case?
If Dr.
N decided that she wanted totalk to a child psychiatrist,
the goal in most states is tohave a call back in less than 30
minutes.
(05:02):
And while this is great.
I know.
Pediatric primary care providersare very busy and they can't sit
around and wait for 30 minutesfor a call back.
And so very often what happensis they'll go into the next room
and keep seeing patients.
And when the child'spsychiatrist calls back, they'll
just overhead page.
The pediatrician who will comeout and we'll have as long of a
conversation or short of aconversation as you want to have
(05:25):
about the case.
And I also want to let you knowthat we've often received
non-urgent questions too.
So let's say you're reflectingon one of the patients you saw
and you're thinking, you knowwhat?
I'm not sure.
Where I want to go with this, orif I made the right decision
about starting this med orreferring them to this place.
And so you can always call and.
(05:46):
If you're not available toimmediately talk.
And it's a non-urgent question.
You can always call and requesta call back at a scheduled time.
So often I'd get a messagesaying, please call Dr.
M back tomorrow after one todiscuss whatever it is.
And so then I just called themat whatever number they wanted
me to call and we'd have aconversation.
(06:08):
And to help you get a betterfeel for how this resource
works.
I wanted to just share somerecent examples that we had in
our telephone consultationprogram.
Sometimes we get called with avery specific, straightforward
question that can honestly takea minute or less to address.
So for example, I have a kidwho's failed a stimulant for
ADHD, and I'm wondering aboutdosing recommendations for this
(06:32):
next stimulant that I want totry.
And.
Issues like this can usually besolved.
In a minute or two and then.
Depending upon how much time thepediatric clinician has, we can
always go into more detail oroftentimes they'll say that's
great.
That's all I wanted to know.
Thanks so much.
Bye.
And then they get on with theirday.
(06:53):
More, oftentimes we get consultsthat are a little bit.
More involved.
Like for example, I had a, pediatrician
call with a question about ateenage girl with depression.
And some suicidal thoughts andthe pediatrician, he just wanted
to work through.
Questions about how do I know?
If she's safe to go home, whatadditional questions should I
(07:14):
ask?
And are there any otherresources I should be thinking
about?
As I mentioned before.
If, you know, you've got areally busy day and you have a
non-urgent question it's notunusual to call the hotline and
say, Hey, I want to be calledback tomorrow or at a given time
when you know you won't bedistracted or more importantly,
you won't be disrupting patientcare so one of the cases I had,
(07:37):
like this was from apediatrician we'll call her Dr.
M who had, was really interestedin learning and had set aside
time in her schedule for morelengthy discussion.
And so she presented the case ofa 10 year old boy with autism
and ADHD.
Who had tried certainmedications and developed
anxiety.
And she just wanted to talkabout how do I think through
(07:58):
cases like this?
Do I have an algorithm forapproaching 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 andwe talked about possible
alternatives and dosingrecommendations.
And also just generally how tothink through management of
(08:19):
comorbid ADHD and autism.
And so that discussiondefinitely took longer than a
couple of minutes, but it wasdriven by.
The pediatrician's request forcase-based learning.
And so there's a lot offlexibility with these
consultations and really our jobas child psychiatry consultants
is to be responsive to whateveryour needs are as pediatric
(08:42):
clinicians, and also to berealistic and practical about,
you know, do you have oneminute, do you have five
minutes?
Do you have a thousand questionsand no time limit?
Um, we're here for you.
And luckily in the state where Ipractice, they have a beautiful.
Online resource available forall pediatric clinicians, where
it has dosing guidelines andinformation for working through
(09:04):
some of these complicated.
Clinical issues.
And so I recommended that Dr.
M check the online resource andalso just call us back if she
has any further questions.
And it turned out.
She was also having troubleaccessing ABA.
And so I referred her to ourcare navigator who was going to
separately call the pediatricianand the family.
To provide them with resourcesfor locating ABA in their area.
(09:28):
And as a bonus, most statestypically send written copies of
the recommendations to thepediatricians after the phone
call.
So that includes dosingrecommendations or written steps
for approaching management of akid with ADHD and autism.
And then also.
Contact information for variousreferral resources for the
family.
And so this is great becausepractically, if you've got some
(09:52):
questions and you've got a longcar ride home, you could call
the consult line or schedule acall back during your drive
home.
And just have the conversationwhile you're driving at the end
of work.
I know when one of the states where I've
worked first, came out with astatewide telephone consultation
line.
A lot of the pediatricians who Iwork with said, I don't know if
(10:12):
I want to call them because Idon't know who those people are.
How can I trust them?
What is this going to be like?
And I can understand theskepticism.
You don't know all the time.
Who's on the other line.
But having been on the otherside and on the line, what I can
say is many of these programsare very good about collecting
(10:33):
data about each one of the callsand doing quality improvement
and reviewing therecommendations that the child
psychiatrist and the carenavigators are making to make
sure that recommendations areevidence-based and that they're
keeping up to date withresources.
And I would encourage you inwhatever state you're in, or if
you happen to live in BritishColumbia.
Or in any of the tribal nationswhere these are available.
(10:55):
I would really encourage you toreach out and try it.
You know, everybody wishes theyhad a child psychiatrist that
they could curbside, and now youcan.
So, if you want to list of theprograms or a statewide map of
where these are available andhow to access them.
I will have a link on ourwebsite, psyched, the number
four paeds.com on our resourcespage.
(11:17):
And since we're talking abouthelpful child psychiatrist and
helpful consultation, I justwant to close with saying I
would be happy.
To hear from you about whatquestions do you have regarding
your patients?
What have.
What do you want to learn moreabout on psyched for paeds and
what are some of the pain pointsin your own pediatric practices
in working with kids with mentalhealth problems and how can we
(11:40):
help.
Thank you again for all the workthat you're doing to take care
of kids and families.
I wish you a lovely may.
Sember.
And beyond, and I look forwardto hearing from you.
Thanks so much for listening.
We'll see you next week.
welcome back to Psyched for Peds, the child
mental health podcasts forpediatric clinicians, helping
you help kids.
I'm your host, Dr.
Elise Fallucco childpsychiatrist and mom.
Well happy may everybody.
And as you know, may is mentalhealth awareness month.
It is also May-Cember andthere's a ton of end of school
(00:42):
year craziness, at least in ourhouse.
So I wanted to take this momentand this opportunity to share a
hidden gem, a free clinicalon-demand resource that can help
you take care of kids withmental health problems.
So this resource is called thepediatric mental health care
access program or PMH C APS,which is a little bit of a
(01:05):
clunky acronym.
The pediatric mental health careaccess programs are designed to
help pediatric healthprofessionals integrate mental
health into pediatric primarycare.
And so what they do is theyprovide telephone consultation
for pediatric clinicians to helpthem take care of kids with
mental health problems.
They also often provide trainingin child mental health care free
(01:28):
for clinicians in the state.
And they help with referrals andresources.
And these pediatric mentalhealth care access programs are
available in 46 states, as wellas some tribal nations and us
territories, including theVirgin islands.
Um, side note.
If you are running the Virginisland program, I would be happy
to consult.
(01:49):
And you may have heard about these.
We've mentioned them in a coupleof our previous podcasts, but I
wanted to dive in deeper to helpyou get a feel for what it
really is.
So each one of these programstypically has a child and
adolescent psychiatrist whoserves as a consultant.
And is available on call fivedays a week from about 9:00 AM
to 5:00 PM.
To help you when you're gettingstuck in taking care of a kid in
(02:12):
your office or in your practice.
There's also a care coordinatoron each team that helps you find
resources and facilitatereferrals oftentimes to a
behavioral health provider inyour area of the state.
So common questions or sometypical questions that pediatric
clinicians might ask the carecoordinator would be, where do I
(02:33):
refer a preschool age child whoneeds evaluation for possible
behavioral and emotionalproblems.
Or where do I refer a teenagerwho needs trauma focused
therapy.
So the pediatric mental healthcare access program, this
hotline can get you connectedwith a care coordinator who can
help you answer those questionsthat are and help you access,
(02:54):
help you find and try to accessresources in your area.
Some programs also havelicensed.
Some programs also have licensedbehavioral health counselors or
social workers, or evenpsychologists on staff.
And in the United States, theseare funded by HERSA, the health
resources and servicesadministration.
So they're free to you.
(03:15):
And I would like to say,especially in the age where
we're really trying to achievehealth equity, especially in
access to behavioral healthcare.
These programs are particularlygreat for clinicians who are in
rural or other underserved areaswhere it's very extra difficult
to try to access mental healthresources.
In some states.
These programs, not only helpprimary care providers, but they
(03:38):
also support school systems andclinicians in emergency
departments.
So full disclosure.
I am on the board of directorsfor the national network of
these programs.
And most relevantly I've had thepleasure for working for the
past year and a half for one ofthese statewide programs, as one
of the child psychiatryconsultants.
So I can tell you from personalexperience, how they can help
(03:59):
you help kids and families inyour practice.
So I'm going to use an examplefrom one of our, one of the
recent days when I was on call.
To help you step through whathappens when you call, what
should you expect?
And how could this maybe behelpful?
So, as I mentioned before, Thesehotlines are available during
regular business hours, Mondaythrough Friday in a various by
(04:20):
state, but typically, you know,9:00 AM to about 5:00 PM.
So.
So the other week, Dr.
M called the hotline in thestate where I was working and
immediately.
One of our staff members pickedup and spoke with Dr.
M to triage the call and ourstaff member asked Dr.
M a few questions, including, doyou need help with referrals?
(04:42):
What sort of resources are youlooking for?
And do you want to talk to achild psychiatrist?
Do you have any questions aboutdiagnosis or treatment?
Um, or do you just want a phoneconsultation about a case?
If Dr.
N decided that she wanted totalk to a child psychiatrist,
the goal in most states is tohave a call back in less than 30
minutes.
(05:02):
And while this is great.
I know.
Pediatric primary care providersare very busy and they can't sit
around and wait for 30 minutesfor a call back.
And so very often what happensis they'll go into the next room
and keep seeing patients.
And when the child'spsychiatrist calls back, they'll
just overhead page.
The pediatrician who will comeout and we'll have as long of a
conversation or short of aconversation as you want to have
(05:25):
about the case.
And I also want to let you knowthat we've often received
non-urgent questions too.
So let's say you're reflectingon one of the patients you saw
and you're thinking, you knowwhat?
I'm not sure.
Where I want to go with this, orif I made the right decision
about starting this med orreferring them to this place.
And so you can always call and.
(05:46):
If you're not available toimmediately talk.
And it's a non-urgent question.
You can always call and requesta call back at a scheduled time.
So often I'd get a messagesaying, please call Dr.
M back tomorrow after one todiscuss whatever it is.
And so then I just called themat whatever number they wanted
me to call and we'd have aconversation.
(06:08):
And to help you get a betterfeel for how this resource
works.
I wanted to just share somerecent examples that we had in
our telephone consultationprogram.
Sometimes we get called with avery specific, straightforward
question that can honestly takea minute or less to address.
So for example, I have a kidwho's failed a stimulant for
ADHD, and I'm wondering aboutdosing recommendations for this
(06:32):
next stimulant that I want totry.
And.
Issues like this can usually besolved.
In a minute or two and then.
Depending upon how much time thepediatric clinician has, we can
always go into more detail oroftentimes they'll say that's
great.
That's all I wanted to know.
Thanks so much.
Bye.
And then they get on with theirday.
(06:53):
More, oftentimes we get consultsthat are a little bit.
More involved.
Like for example, I had a, pediatrician
call with a question about ateenage girl with depression.
And some suicidal thoughts andthe pediatrician, he just wanted
to work through.
Questions about how do I know?
If she's safe to go home, whatadditional questions should I
(07:14):
ask?
And are there any otherresources I should be thinking
about?
As I mentioned before.
If, you know, you've got areally busy day and you have a
non-urgent question it's notunusual to call the hotline and
say, Hey, I want to be calledback tomorrow or at a given time
when you know you won't bedistracted or more importantly,
you won't be disrupting patientcare so one of the cases I had,
(07:37):
like this was from apediatrician we'll call her Dr.
M who had, was really interestedin learning and had set aside
time in her schedule for morelengthy discussion.
And so she presented the case ofa 10 year old boy with autism
and ADHD.
Who had tried certainmedications and developed
anxiety.
And she just wanted to talkabout how do I think through
(07:58):
cases like this?
Do I have an algorithm forapproaching 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 andwe talked about possible
alternatives and dosingrecommendations.
And also just generally how tothink through management of
(08:19):
comorbid ADHD and autism.
And so that discussiondefinitely took longer than a
couple of minutes, but it wasdriven by.
The pediatrician's request forcase-based learning.
And so there's a lot offlexibility with these
consultations and really our jobas child psychiatry consultants
is to be responsive to whateveryour needs are as pediatric
(08:42):
clinicians, and also to berealistic and practical about,
you know, do you have oneminute, do you have five
minutes?
Do you have a thousand questionsand no time limit?
Um, we're here for you.
And luckily in the state where Ipractice, they have a beautiful.
Online resource available forall pediatric clinicians, where
it has dosing guidelines andinformation for working through
(09:04):
some of these complicated.
Clinical issues.
And so I recommended that Dr.
M check the online resource andalso just call us back if she
has any further questions.
And it turned out.
She was also having troubleaccessing ABA.
And so I referred her to ourcare navigator who was going to
separately call the pediatricianand the family.
To provide them with resourcesfor locating ABA in their area.
(09:28):
And as a bonus, most statestypically send written copies of
the recommendations to thepediatricians after the phone
call.
So that includes dosingrecommendations or written steps
for approaching management of akid with ADHD and autism.
And then also.
Contact information for variousreferral resources for the
family.
And so this is great becausepractically, if you've got some
(09:52):
questions and you've got a longcar ride home, you could call
the consult line or schedule acall back during your drive
home.
And just have the conversationwhile you're driving at the end
of work.
I know when one of the states where I've
worked first, came out with astatewide telephone consultation
line.
A lot of the pediatricians who Iwork with said, I don't know if
(10:12):
I want to call them because Idon't know who those people are.
How can I trust them?
What is this going to be like?
And I can understand theskepticism.
You don't know all the time.
Who's on the other line.
But having been on the otherside and on the line, what I can
say is many of these programsare very good about collecting
(10:33):
data about each one of the callsand doing quality improvement
and reviewing therecommendations that the child
psychiatrist and the carenavigators are making to make
sure that recommendations areevidence-based and that they're
keeping up to date withresources.
And I would encourage you inwhatever state you're in, or if
you happen to live in BritishColumbia.
Or in any of the tribal nationswhere these are available.
(10:55):
I would really encourage you toreach out and try it.
You know, everybody wishes theyhad a child psychiatrist that
they could curbside, and now youcan.
So, if you want to list of theprograms or a statewide map of
where these are available andhow to access them.
I will have a link on ourwebsite, psyched, the number
four paeds.com on our resourcespage.
(11:17):
And since we're talking abouthelpful child psychiatrist and
helpful consultation, I justwant to close with saying I
would be happy.
To hear from you about whatquestions do you have regarding
your patients?
What have.
What do you want to learn moreabout on psyched for paeds and
what are some of the pain pointsin your own pediatric practices
in working with kids with mentalhealth problems and how can we
(11:40):
help.
Thank you again for all the workthat you're doing to take care
of kids and families.
I wish you a lovely may.
Sember.
And beyond, and I look forwardto hearing from you.
Thanks so much for listening.
We'll see you next week.
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