The Partnership Access Line: Evaluating a Child Psychiatry Consult Program in Washington State.
Hilt, Robert J. Romaire, Melissa A. McDonell, Michael G. Sears, Jeanne M. Krupski, Antoinette. Thompson, Jeffery N.
Published: Published online December 2012
Archives of Pediatrics and Adolescent Medicine
American Medical Association
515 N. State Street
Chicago, IL 60610
Tel: 312-464-4466 800-621-8335
Objective: To evaluate a telephone-based child mental health consult service for primary care providers (PCPs). Design: Record review, provider surveys, and Medicaid database analysis. Setting: Washington State Partnership Access Line (PAL) program. Participants: A total of 2285 PAL consultations by 592 PCPs between April 1, 2008, and April 30, 2011. Interventions: Primary care provider-initiated consultations with PAL service. Main Outcome Measures: The PAL call characteristics, PCP feedback surveys, and Medicaid claims between April 2007 and December 2009 for fee-for-service Medicaid children before and after a PAL call. Results: Sixty-nine percent of calls were about children with serious emotional disturbances, and 66% of calls were about children taking psychiatric medications. Primary care providers nearly always received new psychosocial treatment advice (87% of calls) and were more likely to receive advice to start rather than stop a medication (46% vs 24% of calls). Primary care provider feedback surveys reported uniformly positive satisfaction with the program. Among Medicaid children, there was significant increases in attention-deficit/hyperactivity disorder and antidepressant medication use after the PAL call but no significant change in reimbursements for mental health medications (P < .05). Children with a history of foster care experienced a 132% increase in outpatient mental health visits after the PAL call (P < .05). Conclusions: Primary care providers used PAL for psychosocial and medication treatment assistance for particularly high-needs children and were satisfied with the service. Furthermore, PAL was associated with increased use of outpatient mental health care for some children. (Author abstract)
mental health services; foster children; Washington; program evaluations; Medicaid; psychotropic medication