Executive Director, Washington Chapter of the American Academy of Pediatrics
Proposed Expanded Partnership Access Line (PAL) for Moms and Kids
WCAAP had the privilege to work with Bachelor’s in Social Work intern, Elizabeth Purdy, fall quarter 2017, to conduct a secret shopper project to assess barriers to accessing mental health care for kids insured on Apple Health. Elizabeth gathered mental health provider names from Managed Care Organization (MCO) website searches, and access was defined as having an available mental health appointment for a child on Apple Health via their Managed Care Organization benefit with no waitlist. Elizabeth placed 79 calls to mental health providers in King, Benton, Franklin, and Grant counties to understand the availability of outpatient mental health care. Reasons for not having access included not accepting Medicaid, not providing mental health services, and not serving children. The major takeaway from this project was the inaccuracy of plans’ provider information and the difficulty finding appropriate providers with access.
- 15 of 61 mental health providers (24.6%) called had access
- 14 of 61 mental health providers (23.0%) called did not return the call
- 32 of 61 mental health providers (52.5%) called did not have access
- We would expect treatment would begin for King County children within 2-4 weeks of seeking care, on average.
- 9 of 14 mental health providers (64.3%) called had access
- 3 of 14 mental health providers (21.4%) called did not return the call
- 2 of 14 mental health providers (14.3%) called did not have access
- We would expect treatment would begin for kids in Benton/Franklin counties within 3-4 weeks of seeking care, on average.
- 3 of 4 mental health providers (75%) called had access
- 1 of 4 mental health providers (25%) called did not have access
- 4 of 4 providers (100%) returned the call or answered when called
- We would expect treatment would begin for kids in Grant county within 3-4 weeks of seeking care, on average.
How can we decrease these barriers for families seeking mental health care?
While there are many barriers for families to overcome to seek mental health care for their children, including stigma, time away from work/school, and transportation, one barrier we know we can overcome is the burden on families to find out who is qualified and available to serve their child. Finding accessible mental health providers for kids can be frustrating and opaque to families and providers alike.
The Partnership Access Line (PAL) is an existing child mental health consultation resource available to all primary care providers in our state. There is an opportunity to build upon the current PAL program to help to children, mothers and families negotiate the often challenging process of connecting with appropriate and available local mental health care providers, and to assist providers caring for mothers struggling with depression during pregnancy or after childbirth. This expansion opportunity is based on lessons learned from a similar program in Massachusetts.
Expanding the PAL to provide referral assistance by working collaboratively with parents would help get more youth into timely and appropriate care.
Increasing access to care for mothers is an equally important step in promoting child health. Depression during pregnancy and after delivery is common, occurring in about 1 in 7 mothers. Typically, maternal depression goes unrecognized and untreated, which is associated with serious consequences for both mothers and babies. Unfortunately, obstetric, family practice, and pediatric providers in our state have limited access to mental health providers skilled in diagnosing and treating mothers with mental health problems. An expanded PAL service could promote PCP and maternity care providers screening for maternal depression, give providers access to real-time phone consultation with a perinatal psychiatrist, and assist new moms with accessing their own treatment services.
The proposed PAL for Moms and Kids expansion would assist moms and dads with making mental health service connections for both themselves and their children, and expand providers’ access to real-time phone consultation with a perinatal psychiatrist, including:
1. Referral assistance services, providing linkages to community-based resources including mental health care and other resources to support the wellness and mental health of children and youth, as well as pregnant and new moms.
2. Same-day telephone consultation with a perinatal psychiatrist for maternity care, pediatric, primary care and psychiatric providers serving pregnant and new moms.
WCAAP is working with legislative champions this session to establish such services for Washington children and families. Stay tuned for action alerts to support this exciting possibility. To learn more, see our issue brief here or contact WCAAP Executive Director Sarah Rafton or WCAAP Trustee and PAL Director Robert Hilt.