Project links pediatricians, child psychiatrists

There’s a large and unmet need for children whose behavioral health is “a little more complicated” than what most general pediatricians can handle.

Those children often don’t have access to many psychiatrists in the area, said Dr. Stacey Fox, a general pediatrician for Beacon Pediatrics in Rehoboth Beach.

She described the frequency of children needing behavioral health help as “all day.”

“And much more now with COVID,” she said. “We have tons of kids who are experiencing anxiety, panic attacks, depression. It’s really starting to hit everybody, with what’s been going on with COVID and the changes in school and everything. We have a lot more kids. So even more unmet need.”

It was mostly this reason that paved the way for the Delaware Child Psychiatry Access Program, a project under the mantle of the Delaware Department of Services for Children, Youth and their Families. The program links pediatric primary care providers with free psychiatry consultations and assistance to streamline behavioral health care for children and youth.

“Well, the biggest shortage area in medicine right now is child psychiatry,” said Dr. Richard Margolis, DCPAP project director and medical director for the state Division of Prevention and Behavioral Health Services. “There is a recent article published in the American Academy of Child and Adolescent Psychiatry, which estimates that there are only about 20% of the child psychiatrists that we need. So a lot of the burden of treating children with behavioral disorders falls on the primary care practitioners. I’m a child psychiatrist, and there are not enough of us to go around.”

Many behavioral health issues present themselves in the primary care setting, said Mindy Webb, a licensed clinical social worker and behavioral health care coordinator for the program.

“That’s the patient’s medical home. That’s where they’re having services most often, as opposed to taking specialized services for behavioral health needs that they may not know they have or are not treating for a number of reasons,” she said. “It could be access, insurance, transportation, knowledge of where to go or what services are available.”

Because of that, DCPAP connects pediatricians with child psychiatrists who offer consultations, continuing medical education and behavioral coordination.

The consultations are private, with the consultants not knowing patients’ names or any personal information, Dr. Fox said.

“They’re there to provide support to us and to give us advice as providers, but there’s no concerns about privacy issues at all,” she said.

Patients are able to be treated at their primary care office, with the input from DCPAP’s consultation.

“It improves accessibility, and we’re also looking to improve the skill and knowledge base of primary care practitioners in the area of behavioral health,” Dr. Margolis said.

When he and Joseph Hughes, project manager, first wrote the grant — which is for five years — they had estimated connecting with 150 primary care providers in Delaware. But since beginning to register providers in September 2019, they’ve exceeded that, with 175 pediatric primary care practitioners working with the program, said Mr. Hughes.

There are more than 800 providers registered with the Medical Society of Delaware, and DCPAP is in the process of reaching out to those, with the goal of gaining 300 to 400 registrations to their program, he said.

In the past, Dr. Fox said practitioners at Beacon could handle the “basic stuff,” such as stimulants and antidepressants. If the patient needed something beyond that, however, they would be referred to one of the few psychiatrists in the area and would have to wait until they could be seen, she said.

“Now that we have the DCPAP, we can manage a lot more,” she said. “We can go to the next step, and, if we’re struggling at all, instead of just referring and crossing our fingers that the child will get the care they need — and know that they often won’t — we can provide that care, with the support of the DCPAP.”

Beyond working with the practitioners through consultations, DCPAP is offering training sessions through the fall and early next year, which will grapple with youth suicide, bipolar disorders, trauma, PTSD and autism spectrum disorder.

Interested providers, including pediatricians, family physicians, nurse practitioners and physician assistants caring for patients up to age 21, can register for DCPAP by calling 513-0929 or by emailing dscyf_dcpap@delaware.gov. Enrolled providers will also have access to a newsletter, information and webinars.

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