Faculty Bibliography

Objectives: This poster will evaluate the clinical outcomes related to implementing a collaborative care service providing therapy, mental health assessment, and medication management in an academic pediatric primary care clinic.
Method(s): A modified collaborative care model was developed and implemented in order to provide therapy and mental health services to pediatric patients while simultaneously providing education and clinical supervision to providers to increase their capacity to participate in the behavioral health care of their patients. Encounter data was collected from the start of the program in March 2018 until March 2021 using electronic medical record data on all patients utilizing collaborative care services to measure trends in referrals for and utilization of collaborative care counseling and psychiatric services.
Result(s): All measures of utilization of the program increased over time. In March 2018, the first month of implementation, 22 patient visits occurred, 169 monthly visits occurred in March 2019, 290 monthly patient visits occurred in March 2020, and 320 monthly visits occurred in March 2021. Of note, monthly patient visits dropped 25% in April 2020 (first full month of pandemic), but patient visits rebounded in May 2020 and have continued to increase. The average wait time from referral to collaborative care to scheduling the first appointment has consistently remained at 1 week. Prior to the start of the program, 2/12 (16.7%) of full-time pediatricians reported feeling confident enough with their behavioral health knowledge to manage psychiatric medications. In March 2021, 12/13 (92.3%) pediatricians were routinely managing the psychiatric medications of their patients.
Conclusion(s): The development of a modified pediatric collaborative care psychiatry program including integrated counseling and psychiatry services in combination with building behavioral health capacity among pediatric providers can provide mental health services to a substantial number of pediatric patients in the primary care setting. In addition, the time from referral to the first appointment is more rapid than the average wait time for an intake appointment in local mental health clinics. Lastly, the percentage of pediatric providers who reported feeling the confidence to provide psychiatric medication management to their pediatric patients increased significantly. CON, AC, PYI
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BACKGROUND:The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE:This study aims to describe the early changes implemented by 22 PCLPSs from the United States and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS:A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20 to April 28, 2020, and from August 18 to September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that were not dependent on predetermined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS:Twenty-two academic hospitals in the United States and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children's hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS:To our knowledge, this is the first multicenter study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multisite survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.