The need for mental health care in children and adolescents has been surging; rates of suicide and self-harm are increasing, and, like hospitals, primary care practices are struggling with an influx of patients. Properly supported, these practices can provide behavioral health services to children and teens. But in a national study led by Alyna Chien, MD, research director in the Division of General Pediatrics at Boston Children's Hospital, more than 85 percent of multi-physician practices caring for children reported difficulty in obtaining advice and consultations.
The findings, published in the Annals of Family Medicine, draw on data from the National Survey of Healthcare Organizations and Systems (2017-2018).
"Behavioral health care needs have spiked during the COVID-19 pandemic, so these figures likely underestimate how frequently practices are experiencing difficulty delivering services today," says Chien, the study's first author. "I hope our findings will help people understand how hard it's been for pediatric primary-care physicians to fulfill their role on the frontline of behavioral health."
The survey identified 1,410 multi-physician practices that care for children (primarily family medicine practices) and asked them to rate their degree of difficulty in obtaining medication advice, evidence-based psychotherapy, and family based therapy. The survey response rate was 47 percent.
Overall, 86 percent of practices had difficulty obtaining medication advice, 87 percent had trouble obtaining psychotherapy, and 89 percent had difficulty obtaining family-based treatment.
Practices owned by health care systems experienced difficulty in obtaining pediatric behavioral health advice and services at the same rates as independent practices, even though system-owned practices tend to be larger with access to more physicians. However, practices with a Medicaid accountable care organization contract had somewhat less trouble obtaining medication advice (81 percent vs. 89 percent for non-ACO practices) and evidence-based psychotherapy (81 percent vs. 90 percent).
Finally, in adjusted analyses, rural practices had significantly more difficulty obtaining pediatric behavioral health advice and related services than their nonrural counterparts.
The numbers contrast with those of the most recent survey in 2004-2005, in which 67 percent of health care providers (combining pediatric and adult providers) reported trouble accessing behavioral health services.
"This study shows that even before the current COVID-19 pandemic, pediatric primary care practices struggled to get the therapeutic advice they needed to deliver behavioral health care to children," says Chien. "With the pandemic, the need for behavioral health reinforcements for pediatric primary care practices is even greater."
Ellen Meara, PhD, of the Dartmouth Institute for Health Policy & Clinical Practice (Lebanon, NH) and the Harvard T.H. Chan School of Public Health, was senior investigator on the study. The study was funded by the Agency for Healthcare Research and Quality (U19 HS024075-05).
About Boston Children's Hospital
Boston Children's Hospital is ranked the #1 children's hospital in the nation by U.S. News & World Report and is the primary pediatric teaching affiliate of Harvard Medical School. Home to the world's largest research enterprise based at a pediatric medical center, its discoveries have benefited both children and adults since 1869. Today, 3,000 researchers and scientific staff, including 10 members of the National Academy of Sciences, 25 members of the National Academy of Medicine and 10 Howard Hughes Medical Investigators comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's is now a 415-bed comprehensive center for pediatric and adolescent health care. For more, visit our Answers blog and follow us on social media @BostonChildrens, @BCH_Innovation, Facebook and YouTube.
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Journal
The Annals of Family Medicine
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