Pediatric Mental Health Care Access Program
By Jena Pierce on
Nearly one in five children in the U.S. are diagnosed with a mental health condition. Nine out of 10 children receive regular medical care from a primary care provider but only one in three pediatricians report they have sufficient training to diagnose and treat children with a mental health condition, according to the U.S. Centers for Disease Control and Prevention.
North Dakota is no exception, especially with the rural nature of the state. Often the closest healthcare facility does not have providers trained appropriately to deal with mental health concerns. However, a state program is trying to change this for the benefit of the children and their families.
Pediatric Mental Health
The Center for Rural Health (CRH) is working with the North Dakota Health and Human Services (HHS) Behavioral Health Division on the state's Pediatric Mental Health Care Access (PMHCA) program. The program began in 2018 and is funded through the Health Resources & Services Administration and currently goes through September 2026.
The provider in rural North Dakota...can consult with a clinician, a psychologist, or psychiatrist, when a youth comes into their practice and presents with these symptoms or needs a medication change.
"The program is to expand telehealth behavioral services for children and youth in the state," said Sara Kapp, program administrator for North Dakota HHS Behavioral Health, "and promote behavioral health integration into those primary care settings by providing peer to peer tele-consults. The provider in rural North Dakota who may not have the behavioral health background can consult, through the consultation line, with a clinician, a psychologist, or psychiatrist, when a youth comes into their practice and presents with these symptoms or needs a medication change."
The PMHCA program has two goals:
- Increase the capacity of primary care providers to screen, diagnose, and treat children for behavioral health disorders in primary care settings.
- Develop and create capacity for telehealth programs in community-based settings by expanding partnerships within emergency departments and schools.
Training Opportunities
Providing training opportunities has been an important component of this program. The North Dakota HHS Behavioral Health Division has over 800 providers on their listserv they reach out to about these opportunities, such as the Project ECHOs that are held frequently.
Since 2021, CRH's Project
ECHO has offered a series of clinics on
pediatric mental health, through a partnership with
PMHAC, geared toward providing education and training to
providers on a wide variety of subjects including, but
not limited to:
- Pediatric suicide prevention
- Post-traumatic stress disorder
- School adjustments and accommodations
- Social anxiety, specific phobias, and selective mutism
- Pediatric obesity
- Pediatric persistent depressive disorder
TeleECHOs offer virtual educational opportunities to increase access to specialty treatment expertise in rural and underserved areas by providing front-line clinicians with the knowledge and ongoing support they need to manage patients with complex conditions. All sessions are archived and can be viewed online. Live sessions qualify for Continuing Medical Education credits.
Real-time Provider Support
Another facet of the program is providing real-time support for providers. Primary care providers can access a consult phone line that is monitored Monday through Friday, during business hours. A child and adolescent psychiatrist or psychologist will be able to provide free consultation for the provider that can impact the care within 24 hours and can include screening and diagnosis questions, medication management, and assistance with developing a treatment plan if needed.
Kapp explained, "It could be
early detection of a behavioral health condition,
learning what assessments can be utilized to diagnose a
child with a behavioral health condition or treatment, or
referral for the child that is in their care."
The program is even expanding into community-based settings, such as schools and emergency rooms, to provide even greater support. Through working with the North Dakota Critical Access Hospital (CAH) Quality Network, housed within CRH, staff are helping to spread awareness of the advantages and benefits of the PMHCA program. CAHs and the Rural Health Clinics throughout the state are eligible to utilize the consult line, thus providing support for what is often the first contact for a child experiencing a behavioral health episode.
The consult line for providers is:
(888) 522-9654
Monday – Friday
8:30 am – 4:30 pm Central
Care Coordination for Families
Care coordination is one more facet that families can use. Family Voices, a partner on the PMHCA program, can provide consultations and referrals to behavioral health providers in the patient's community or through telehealth. They are also able to provide support and resources working with schools and Individualized Education Program (IEP) plans.
The program, one of 25 in the country, continues to provide multiple benefits for the people of North Dakota.
Primary care providers can benefit from utilizing the program to help get the youth that they serve, the behavioral health support that best fits their needs.
"Primary care providers can benefit from utilizing the program to help get the youth that they serve, the behavioral health support that best fits their needs," Kapp shared. "Whether that be assessing the youth, or needing further treatment that may not be available in the local practice, providers can find out what options are available within the state. And the care coordination piece opens up a whole different level of supports for the family, in the school, the community, and the family home itself. It can provide continued support until the support is no longer needed."
is the communications manager at the Center for Rural
Health at the University of North Dakota School of
Medicine & Health Sciences in Grand Forks.
