You asked for a summary of the Massachusetts Child Psychiatry Access Project. You also want to know if other states have similar programs.

SUMMARY

The Massachusetts Child Psychiatry Access Project (MCPAP) is a regional system of children's mental health consultation teams that help primary care providers (PCPs) serving children with mental health conditions. Six regional teams, consisting of child psychiatrists, licensed social workers or psychologists, care coordinators, and administrative support staff, provide information and resources to PCPs serving children with mental health conditions, regardless of their insurance status.

The program was established in 2003 as a pilot and was implemented statewide the following year. It is administered by the Massachusetts Behavioral Health Partnership (the state's contracted Medicaid mental health and substance abuse provider) and is funded primarily by the Department of Mental Health (DMH) and also receives limited third-party insurance reimbursements for in-person visits (see below).

MCPAP's goal is to increase PCPs' familiarity with common psychiatric diagnoses and available public and private community-based mental health services. The program is free to all PCPs serving children, although providers must enroll to access services. The program's 422 participating primary care practices (consisting of 1,533 full-time PCPs) may call their MCPAP regional team for a consultation. If necessary, the team may request to meet the child for an in-person evaluation, refer the PCP to available community-based mental health services, or refer the child to the team's psychiatrist for evaluation or interim treatment.

In 2007, MCPAP administered a pilot program in six Western Massachusetts public schools in order to improve students' access to mental health services. These schools had access to the regional MCPAP hotline and were provided in-person and telephone consultations as well as care coordination. Participating schools found the program to be feasible, cost-effective, and clinically valuable. However, the state did not have funding to implement the program statewide.

According to the National Network of Child Psychiatry Access Programs, 23 other states have similar team-based children's mental health consultation programs. Connecticut does not have such a program.

MCPAP

Program Goals

MCPAP's goals are to:

1. improve treatment access for children with psychiatric conditions,

2. promote the inclusion of child psychiatry within the scope of primary care practice,

3. restore relationships between PCPs and child psychiatrists, and

4. promote the rational use of scarce specialty resources by the most complex and high-risk children.

Program History

MCPAP was created as a pilot in 2003, in response to concerns expressed among New England states over the increasing number of Medicaid children receiving multiple psychotropic medications, especially young children. The federal Centers for Medicare and Medicaid Services and MassHealth (the state's Medicaid program) provided a grant to UMass Medical School to develop the pilot program in the state's central region that provided consultation to pediatricians on child psychiatric conditions, including medication prescription.

The Massachusetts Behavioral Health Partnership implemented the program statewide in 2004. The program receives $2.5 million from DMH and $100,000 in third-party insurance billing for in-person visits.

MCPAP Regional Teams

MCPAP consists of six regional teams, one each in the southeast, central, northeast, and western regions and two in the Boston region. Each regional team consists of child psychiatrists, licensed social workers or psychologists, care coordinators, and administrative support staff. Some teams also have registered clinical nurse specialists.

Teams provide ongoing consultation and education to PCPs treating children with mental health issues. A PCP enrolled in the program may call for a telephone consultation with a child psychiatrist regardless of the child's insurance status. Telephone consultations are provided on weekdays within 30 minutes of request. PCPs may call with a general or patient-specific question regarding (1) diagnosis and treatment of a mental health disorder, (2) use of certain medications or mental health screening tools, or (3) available community resources.

Depending on the situation, a team member may (1) request to meet the patient for an in-person evaluation in order to answer the PCP's question, (2) refer the PCP to community-based services, or (3) recommend that the patient see the team's psychiatrist for evaluation or interim treatment.

OTHER STATES' PROGRAMS

According to the National Network of Child Psychiatry Access Programs, 23 states have consultation programs similar to MCPAP, which are listed in Table 1.

Table 1: State Child Psychiatry Access Programs

Table 1: -Continued-

Source: National Network of Child Psychiatry Access Programs website, http://nncpap.org/members/current-programs/.

ND:ts