Modern Medicaid Alliance Featured Medicaid Solution: Massachusetts Child Psychiatry Access Project
Access to behavioral health care for children is essential to improving long-term health care outcomes. Pediatric primary care providers have an essential role to play in identifying and treating behavioral health problems in children, but many providers do not have the training or time to fully address the wide range of behavioral health issues that their patients often experience. Due to these challenges, many children covered by Medicaid do not receive behavioral health screenings during well-child visits.
A 2015 study by Massachusetts General Hospital found that primary care providers (PCPs) are the sole physician managers for one-third of children with mental health conditions, meaning these patients see only a PCP to manage their conditions over the course of a year.
Integrating mental health services into a primary care setting increases the chances of ensuring that children have access to appropriate behavioral health treatment. However, primary care providers often lack the training and the time to fully address the wide range of psychosocial issues presented by their patients resulting in missed opportunities for early identification and treatment.
In 2003, a pilot program was developed at the University of Massachusetts Medical School in Worcester to address this problem by providing psychiatric consultation to pediatricians by phone. Primary care physicians enrolled in the program may request consultation with a psychiatrist regardless of the patient’s insurance status, so patients covered by private insurance, as well as Medicaid, benefit from the program. In 2014, 42% of encounters – including telephonic consultations, face-to-face consultations, and care coordination support – were for patients covered by Medicaid (36% of children in the state are covered by Medicaid).
In 2004, the Massachusetts Department of Mental Health and Massachusetts Behavioral Health Partnership, (MBHP), a Beacon Health Options company, adapted the model and implemented the Massachusetts Child Psychiatry Access Project (MCPAP) statewide. The goals of the project were to increase knowledge and skills about behavioral health needs among pediatric primary care providers, as well as utilizing psychiatrists for the most high-risk and complex children. Established in 2004, the project consists of six regional hubs, each of which has one full-time-equivalent child psychiatrist, licensed therapist, and care coordinator. Collectively, the hubs are available to over 95 percent of the 1.5 million children in Massachusetts. Education was delivered both through didactic sessions, often in the primary care office and case-based learning during telephonic consultations. In 2016, MCPAP staff performed 10,412 telephone consultations, 2,524 consultation visits and arranged 4,701 referrals. Equally as impressive, 80% of the well child visits with primary care physicians included a behavioral health screen. In 2009, MCPAP assisted in implementing a remedy to a lawsuit against Massachusetts Medicaid that called for pediatric behavioral health screenings of all Medicaid beneficiaries at well-child visits. As part of the remedy, the court ordered that all primary care providers are required to screen children at well-child visits for behavioral and developmental problems. MCPAP can support these health care providers with the training and consultation needed to comply with the directive.
In 2014, Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) was launched, expanding on the MCPAP model. MCPAP for Moms provides real-time, perinatal psychiatric consultation and care coordination for obstetric, pediatric, primary care and psychiatric providers to effectively prevent, identify, and manage their pregnant and postpartum patients’ mental health and substance use concerns.
MCPAP has addressed the lack of access to behavioral health services for children by making available telephone child psychiatry consultations and specialized care coordination support to over 95 percent of the pediatric primary care providers in Massachusetts. In fiscal year 2016 the Massachusetts Child Psychiatry Access Project served 7,302 children. Pediatric primary care providers enrolled in the project reported a dramatic improvement in their ability to meet the psychiatric needs of their patients. Telephone child psychiatry consultation programs for pediatric primary care providers, many modeled after the Massachusetts project, have spread across the United States, now reaching the PCPs for over one third of all the children in the country (24 million). Nationwide, there are programs in 32 states, many of which are based on the MCPAP model. See more about these programs by visiting the National Network of Child Psychiatry Access Programs. In Massachusetts, the program has helped increase the behavioral health screening rate for children covered by Medicaid from 17% to 80%.
With the enactment of the 21st Century Cures Act on December 13, 2016, Congress directed the Health Resources and Services Administration to provide grants to states to support statewide child psychiatric access programs to include “pediatric mental health teams” and telehealth services. In addition, funding was authorized to expand the development of programs modeled after MCPAP for Moms.
“There’s no question now that the mental health of children has a long-term effect on their physical health as well as their mental health. We’re not trying to make a primary care doctor a psychiatrist — no more than we would try to make a primary care doctor a pulmonologist.”
– John H. Straus, MD, Founding Director, Massachusetts Child Psychiatry Access Project