NJ Expands Funding to Help Pediatricians Address Kids’ Mental-Health Issues

Andrew Kitchenman | August 6, 2015 | Health Care
Budget doubles spending on pilot program linking kids’ physicians with psychiatrists and other behavioral-health experts

Fran Gallagher, executive director of the state chapter of the American Academy of Pediatrics.
Pediatricians are often the first healthcare provider in a position to treat children with mental-health disorders, but are frequently unprepared for the task – which is why New Jersey doctors’ groups are praising the expansion of a program that connects pediatricians with psychiatrists and other behavioral-health providers.

The state budget includes $2.4 million for the Child Collaborative Mental Health Pilot Program, twice the amount budgeted for the fiscal year that ended in June.

While state officials haven’t said how the additional money will be spent, program advocates are hoping that the state will expand it beyond the five counties where it was launched in May: Burlington, Camden, Gloucester, Monmouth, and Ocean.

The state should be able to begin evaluating how effective the program has been by next spring, according to Dr. Stephen Kairys, a pediatrician affiliated with Meridian Health, which is operating the regional program center for Monmouth and Ocean counties.

Pediatricians who participate in the program regularly screen children for mental-health concerns, and are trained in how to interpret the results. The doctors can then turn to a program-funded regional care manager – a licensed clinical social worker or psychologist – who assists in determining whether the child should be referred to a psychiatrist or whether the pediatrician can treat the patient, either on his or her own or by coordinating with a social worker or psychologist. The program also pays for an initial visit with a psychiatrist, who can help deal with the immediate problem and help with planning the young patient’s future care.

There’s a shortage of child psychiatrists in the state – while there are about 1,700 pediatricians and 1,000 family doctors who treat children, New Jersey has only 130 child psychiatrists, Kairys said.

“Right now people are not being screened” in most of the state, Kairys said, noting estimates that as many as 30 percent of children who visit pediatricians have behavioral-health issues, but most aren’t screened. “They’re picked up late or not at all.”

“There’s a huge paucity of child psychiatrists and most of those don’t even take insurance these days because they don’t get paid enough,” Kairys said. “The number of kids with issues is overwhelming,” with attention deficit hyperactivity disorder, anxiety, depression, and autism spectrum disorder among the most pressing concerns.

For children with the most serious problems, the state Division of Children and Families has established the Children’s System of Care, a program designed to connect children with behavioral-health disorders with treatment.

While mental-health experts praised the system for helping children with the most serious issues, they said the pilot program could help pediatricians treat the majority of cases that don’t rise to the most serious level.

“We’re not asking them to deal with complicated stuff,” Kairys said, adding that most children have issues that can be treated without a psychiatrist.

Kairys said the program also connects pediatricians and family doctors with local mental-health specialists. He said that many primary-care doctors know local gastroenterologists or neurologists, but don’t know good local psychologists.

The program will measure how many children are screened, track the health status of all children whose cases are referred to the regional centers, and measure whether the children improve, as well as what medications the children are prescribed.

An early indication of interest in the program is the response from pediatricians – while 40 practices were expected to participate, more than 80 signed up.

Kairys said he hopes the program data helps build a case for insurers reimbursing primary-care doctors for mental-health services.

The program is based on a similar one based in New England, the Massachusetts Child Psychiatry Access Project (MCPAP), which was launched in 2004.

Dr. John Straus, a psychiatrist who designed the Massachusetts program, said that state has shifted from primary-care doctors saying that it was impossible for them to meet the needs of their patients to being well-prepared. He said roughly 30 percent of patients in the program wind up being referred to psychiatrists, while 70 percent are treated by the doctors, often in combination with counseling by a psychologist or social worker.

“Our consultation program really is an educational one that tries to teach (primary-care doctors) how to handle a behavioral health problem the same as you would if you came in and said my stomach hurts or my chest hurts,” he said. “It’s so great that New Jersey is beginning to do this.”

The program was praised by doctors, parent advocates, and legislators at a public forum held yesterday at Hackensack University Medical Center.

Fran Gallagher, the executive director of the state chapter of the American Academy of Pediatrics, said 65 percent of pediatricians write psychotropic prescriptions, but need more support for their patients.

“Mental health does not shelve well – you can’t put it aside and ignore it and not have secondary issues,” she said, adding that for children, mental-health problems can cascade, affecting family relationships and their ability to have friendships.

Dr. Gary Rosenberg, a psychiatrist, has been coordinating the effort to build the pilot program.

“Pediatricians will acknowledge that they didn’t get much training in psychiatry,” Rosenberg said, adding that the program offers primary-care doctors “advice on-the-spot – it helps them feel more confident and willing to prescribe medication.”

Rosenberg would like the state to expand beyond the two centers in the pilot program – at Meridian and Camden-based Cooper University Health Care – to six regional centers, beginning with adding centers this year through the additional funding.

Dr. Michael LaMacchia, a pediatrician affiliated with St. Joseph’s Regional Medical Center in Paterson, said the concept aligns well with broader changes in the healthcare system, in which groups of providers coordinate care to manage the health of populations of patients.

And Dr. Diego Coira, a psychiatrist at Hackensack University Medical Center, said the program should allow pediatricians to steer a middle course between over-diagnosing and under-diagnosing patients – both of which he said are problems.

“I think with this type of program, we can avoid both extremes,” as primary-care doctors learn more about mental health, Coira said. He added that he’s seen patients who were prescribed four or five different psychotropic medications based on diagnoses that are mutually exclusive.

Diana Autin, executive co-director of the Statewide Parent Advocacy Network, said it’s important that the program be expanded statewide. She said a well-trained pediatrician can prevent crises that require emergency-room visits. She added that while much of the focus is on adolescents, younger children can also benefit from the program.

Senate President Stephen M. Sweeney (D-Cumberland, Gloucester, and Salem) praised Sen. Robert M. Gordon (D-Bergen and Passaic) for sponsoring the bill that launched the pilot program.

“No parent wants to think that their child has a problem,” Sweeney said. “That’s why (it’s) the earlier, the better” when pediatricians address mental-health issues before they worsen.

Sweeney acknowledged that the state was “a little late to the dance,” in launching its program – some 20 other states have similar efforts – but now that the pilot program is underway, he’s interested in expanding it statewide. He said it may take five years to get there.

Massachusetts’ program costs $3.1 million annually for a state with 1.5 million children. New Jersey has budgeted $2.4 million and has 2 million children.

Gordon said the program reminds legislators “of why we entered public life – it is to try to have a positive impact on people’s lives.”

Assemblyman Joseph A. Lagana (D-Bergen and Passaic), the Assembly sponsor for the program, said he considered the $2.4 million to be an investment in our children” and in the state’s future.