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Can Primary Care Address Limited Pediatric Behavioral Healthcare?

Less than half of pediatric patients showing signs of behavioral healthcare issues have access to care, but better primary care may be able to close that gap.

Primary care interventions may be required to help expand behavioral healthcare access to underserved children, but providers are facing a number of obstacles as they try to improve access to care, according to a report in the journal Pediatrics.  

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Despite the fact that up to ten percent of children under the age of five have mental health issues that may impact their day-to-day lives, providers are struggling with three key barriers to delivering pediatric behavioral healthcare, including a limited number of qualified providers, billing and reimbursement issues, and perceived social stigma, researchers found.

“Emotional, behavioral, and relationship disorders rarely are transient and often have lasting effects, including measurable differences in brain functioning in school-aged children and a high risk of later mental health problems,” researchers from the American Academy of Pediatrics said.

“Children with emotional, behavioral, and social relationship problems, as well as their families, experience distress and can suffer substantially because of these problems,” the researchers said.

Despite the pressing issue, fewer than 50 percent of children displaying signs of behavioral health problems receive any kind of treatment, the report said.

READ MORE: Mental Healthcare Access Shrinks as Patient Demand Grows

“These children may demonstrate impairment across multiple domains, including social interactions, problematic parent–child relationships, physical safety, inability to participate in child care without expulsion, delayed school readiness, school problems, and physical health problems in adulthood.”

Limited qualified providers may be the result of inadequate medical school training, the researchers said.

“Residency training and continuing medical education has traditionally provided limited opportunities for collaboration between pediatric and child psychiatry residents and with other mental health providers, including doctoral level and master’s level clinicians, although there are calls to increase these opportunities,” the research team explained.

“The limited opportunities for collaboration in training and limited supervised opportunities to assess young children with mental health problems likely result in graduating residents having limited experience in early childhood mental health as they enter the primary care workforce.”

This dearth of qualified providers is a pressing issue in rural areas and regions far away from academic medical centers. Although the researchers did not provide an explanation for the phenomenon, most child psychology specialists tend to practice around academic medical centers, making those areas some of the few regions where pediatric behavioral health is regularly checked and treated.

READ MORE: 33% of Primary Care Providers Also Deliver Palliative Care

The American Academy of Pediatrics advocates for expansive practice transformation efforts, including better educational opportunities for primary care providers. Medical schools should reexamine how they expose students to child psychology, the researchers said, and current pediatric providers should also educate themselves to integrate psychology into their workflows.

Reimbursement also serves as a barrier to pediatric behavioral healthcare, the researchers said. The way many insurance agencies pay for these services may discourage providers from administering pediatric behavioral healthcare.

When providers do administer pediatric behavioral healthcare, it is often limited.

“When emotional and behavioral health services are ‘carved out’ of health insurance, important barriers to accessing care include limitations on primary care physicians’ ability to bill for ‘mental health’ diagnoses, limits on numbers of visits, payer restriction of mental health providers, and low payment rates.”

Lastly, children may face limited opportunities to access behavioral healthcare due to stigma.

READ MORE: How Health Payer Communication Boosts Patient Care Access

“Parents’ interest in treatment may be influenced by perceived stigma related to the mental health problem or their own experiences with the mental health system,” the researchers explained. “Provider stigma about mental health and concerns about a child being ‘labeled’ may reduce referrals as well.”

Additionally, parents may fear that accessing behavioral healthcare for their child may increase their likelihood of referral to child protective services.

According to the researchers, expanding access to pediatric behavioral health foremost lies with primary care providers.

“For children with emotional, behavioral, or relationship problems, the pediatric medical home remains the hub of a child’s care, just as it is for other children with special health care needs,” the researchers noted.

Within the point of care, providers may work to deliver pediatric behavioral healthcare by using the HELP approach: offer hope, demonstrate empathy, demonstrate loyalty, using the same language the family uses, and partnering with the family to carry out a plan with the parent’s permission.

By working to integrate pediatric behavioral healthcare into a central hub such as the primary care office, providers can help increase pediatric patient access to care. In the long run, this may help pediatric patients with chronic mental of behavioral issues, encouraging better mental well-being into early adulthood.

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