A Multidisciplinary, Team-Based Teleconsultation Approach to Enhance Child Mental Health Services in Rural Pediatrics

ABSTRACT

Mental health services for rural youth are extremely limited, especially given the national shortage of child and adolescent psychiatrists (CAPs). Patient-centered primary care medical homes (PCMHs) are often their only available portal of care, yet high-quality PCMH integrated models of behavioral health that include a CAP are rare. This manuscript presents a unique multidisciplinary teleconsultation model wherein integrated behavioral systems consultation was employed to increase access to integrated behavioral health services. Common referrals included complex presentations outside of provider comfort range or medication and diagnostic clarification. Primary concerns were symptoms of ADHD, autism spectrum disorder, anxiety, and depression. Recommendations included referral to outpatient therapy, further coordination with the medical team, and follow-up with the CAP. Providers noted access to care, specialized quality of care, provider support, and enhancing principles of the PCMH as strengths of the teleconsultation. Challenges included patient engagement, scheduling/availability, challenges with the teleconsultation process, and provider-level barriers.

Additional information

Notes on contributors

Kate Margolis

Kate Margolis, PhD is an assistant clinical professor in the departments of psychiatry and pediatrics at the University of California San Francisco. She is a licensed clinical psychologist and pediatric psychologist, and serves as the Associate Director of Primary Care Behavioral Health, Pediatrics at Zuckerberg San Francisco General Hospital and Trauma Center. Dr. Margolis conducts research, systems-level advocacy, clinical service, inter-professional education and training, and consultation in the area of integrated behavioral health in pediatric primary care settings.

Kimberly Kelsay

Kim Kelsay, MD is a child and adolescent psychiatrist and associate professor in the Department of Psychiatry at University of Colorado and Pediatric Mental Health Institute, Children’s Hospital Colorado. She serves as the Training Director for Child and Adolescent Psychiatry, University of Colorado. Dr. Kelsay has a longstanding interest in integrated behavioral health care.

Ayelet Talmi

Ayelet Talmi, PhD is an Associate Professor of Psychiatry and Pediatrics at the University of Colorado School of Medicine and a Pediatric Psychologist at Children’s Hospital Colorado. Dr. Talmi is the Director of Integrated Behavioral Health at the Pediatric Mental Health Institute, the Co-Director of the Harris Program, and the Program Director of Project CLIMB, an integrated behavioral health services program. Her clinical and research interests focus on building sustainable service delivery systems for children and families, integrating behavioral health into primary care settings, and supporting young children with special health care needs and their families.

Heidi McMillan

Heidi McMillan, MD is a board-certified pediatrician and member of the American Academy of Pediatrics. She received her undergraduate degree from Georgetown University, and both her medical degree and her pediatric residency training at Pennsylvania State University. Dr. McMillan is the Physician Champion for the Pediatric Partners of the South West Integrated Behavioral Health Team.

M. Cecile Fraley

M. Cecile Fraley, MD is a board certified pediatrician and the Pediatric Partners of the South West Practice CEO. She received her undergraduate degree from Stanford University and her medical degree from Case Western Reserve University. Dr. Fraley also provides medical services to adolescents as the Medical Director of the Robert E. Denier Youth Detention Center.

John F. Fred Thomas

John F. “Fred” Thomas, PhD is the Director of Telemedicine at Children’s Hospital Colorado and the Executive Director of ECHO Colorado at the University of Colorado School of Medicine. Primary research interests are focused on the development of improved clinical care approaches through technology. He has designed and evaluated best practices for the implementation of telehealth models and have received numerous extramural grant awards to test their health and healthcare-related impacts.