NEW YORK (Reuters Health) – Most multi-physician practices struggle to get help from mental- and behavioral-health professionals when they need advice or services for children, a new U.S. study finds.
The study, which included responses from more than 1,400 U.S. practices that care for children, revealed that 85% found it difficult to obtain help with evidence-based pediatric behavioral healthcare, researchers report in Annals of Family Medicine.
“If primary care was supposed to be the backbone of a robust behavioral healthcare system for children, it needs serious bracing,” said lead author Dr. Alyna Chien of Harvard Medical School and Boston Children’s Hospital.
There are several possible underlying causes, Dr. Chien told Reuters Health by email. “Stigma – some people still don’t think that behavioral-health problems are important medical problems or are treatable – workforce shortages – both too few and we may not use the experts that we have in the most strategic ways – and lack of reimbursement and misaligned incentives,” she added.
Dr. Chien and her colleagues conducted a national cross-sectional study that focused on 1,410 multiphysician primary and multispecialty care practices that care for children. The practices included had responded to the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS) questions regarding difficulty obtaining services for children with behavioral-health needs.
Dr. Chien and her team rated practices’ experiences on a four-point scale from “difficult” to “not at all difficult.” The researchers found that 85% of the practices found it difficult to some extent to obtain help. When they adjusted for practice attributes, the percentage experiencing difficulty was similar between system-owned and independent practices. But practices participating in a Medicaid accountable-care organization reported significantly less difficulty obtaining medication advice (80.5% vs. 89.3%), and evidence-based psychotherapy (81.0% versus 90.4%).
Can the problem be fixed?
“We discovered a hint – perhaps counterintuitively – practices that participated in value-based payment models from Medicaid had difficulty delivering behavioral-health services less frequently, but we don’t know if this was because the practices that took on such patients were different – more accustomed or skilled at providing pediatric behavioral-health care – or because the payment model was better aligned with needed care,” Dr. Chien said.
There is a “huge need for mental-health services,” said Dr. Tamar Mendelson, director of the Johns Hopkins Center for Adolescent Health, in Baltimore, Maryland. “This isn’t new, but it’s worsened during the pandemic. I’m hoping that these kinds of studies will spotlight some of the service reforms that would be helpful.”
While treatment is important, “we should be thinking of prevention as well,” Dr. Mendelson, who was not involved in the new research, told Reuters Health by phone. “I’m a big advocate for prevention. We need to reach out to communities and families before they need treatment. We have a lot of really good evidence-based approaches in schools and these include social-emotional-learning programs, mindfulness programs and restorative-justice approaches.”
If children are taught coping skills, especially those who have been exposed to trauma, some may not need treatment, Dr. Mendelson said.
SOURCE: https://bit.ly/3IHBAVU Annals of Family Medicine, online January 25, 2022.
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