Child Psychiatry Consultation Program works to address psychiatrist shortage

Twenty percent of children age 13 to 18 live with a mental health condition, according to the National Alliance for the Mentally Ill.

Additionally, 50 percent of all lifetime cases of mental illness begin by age 14.

Many of these kids, however, will never get the help they need as there are simply not enough mental health providers.

Some children have to wait six to 12 months to see a child psychiatrist, a Milwaukee County Outpatient Behavioral Health Capacity Study found. Children’s Wisconsin does not book appointments beyond 90 days out, but if it did, they would be scheduled into 2018.

“There is a significant shortage of child psychiatrists not only in Wisconsin but across the country,” said Robert Chayer, MD. Chayer is the Chucker Aring Chair in Child and Adolescent Psychiatry at Children’s Wisconsin, the vice chair of Child and Adolescent Services at the Medical College of Wisconsin, and an associate professor in the Medical College of Wisconsin Department of Psychiatry and Behavioral Medicine.

Currently, 145 child psychiatrists work in Wisconsin, and each of the state’s 72 counties has some degree of a shortage, he said. In fact, in 2012, 48 counties in Wisconsin lacked an outpatient child psychiatrist, according to the Wisconsin Department of Health Services.

“Access is a huge issue for all providers,” Chayer said, adding that the adequate bare minimum number of psychiatrists would be more than 47 for every 100,000 children. “But most counties don’t even have one.”

To address the statewide shortage, Children’s Wisconsin has many initiatives underway, one of which is the Child Psychiatry Consultation Program (CPCP).

Launched in late 2014, the program offers primary care providers from all health systems and organizations who serve children access to expert pediatric psychiatric education and consultation services.

As many as 50 percent of pediatric primary care visits are said to be related to behavioral and emotional concerns, according to Pediatric Clinics of North America, yet Chayer said primary care pediatricians receive minimal training in the area during their pediatric residencies.

Thus, CPCP helps primary care providers who work with children address mild to moderate mental health issues in two main ways: 1) in-person and online educational sessions on topics like psychiatric medication management and screening tools and 2) consultation services delivered via phone or email.

CPCP recently delivered its 500th consultation. These consults cover a variety of topics, including diagnosis and treatment options and resource and referral support. Phone calls are returned within 15 to 30 minutes, and emails are responded to within one business day.

“The feedback on CPCP has been very positive,” said Tracy Oerter, MS, director of mental health services at Children’s Wisconsin. For instance, the program is supported by such organizations as the Wisconsin Chapter of the American Academy of Pediatrics and the Wisconsin Academy of Family Physicians.

“We just need to grow it. Doctors who don’t have access to it are asking for it, particularly in regions CPCP doesn’t serve yet,” Oerter said.

CPCP currently operates in 19 counties, with 165 providers enrolled in four counties in the Milwaukee area and 150 providers enrolled in 15 northern Wisconsin counties.

CPCP stems from a Medical College of Wisconsin pilot program called the Charles E. Kubly Psychiatry Access Project that enrolled Children’s Wisconsin primary care offices serving Kenosha, Waukesha and Ozaukee counties.

The program was funded by Dr. Mike and Billie Kubly in memory of their son who lost his battle against depression.

Due to the success of the pilot project — and later the endowed program of the same name — Chayer and other representatives from Children’s Wisconsin and the Medical College went to the Wisconsin State Legislature to seek funding for the CPCP state program.

2013 Wisconsin Act 127 subsequently created a continuing, biennial appropriation of $1 million that allowed the program to expand, and Children’s Wisconsin is hoping more investment can be made in the future for the program, so that child psychiatry consultation will be readily available across the state.

Approximately 30 states have programs similar to CPCP, including the Massachusetts Child Psychiatry Access Project, which served as the model for CPCP.

“This program is not the cure to solving the provider shortage,” Oerter said. “But it’s helping to get more children timely access to the mental health care they so desperately need.”