Collaborative care can help pediatricians take a larger role in children's mental health care

Expanding collaboration between pediatricians and child psychiatrists may help address gaps in children's mental health care as demand continues to exceed the available specialty workforce, according to John Walkup, MD, president of the American Academy of Child and Adolescent Psychiatry.

Walkup, who also chairs the Pritzker Department of Psychiatry and Behavioral Health at Ann & Robert H. Lurie Children's Hospital of Chicago, said addressing children's behavioral health needs will require participation from both specialties. Strategies include preserving the existing psychiatry workforce, providing pediatricians with accessible training, and creating systems that allow primary care clinicians to consult mental health specialists when needed.

Why are international medical graduates important to child psychiatry?

International medical graduates represent an important component of the child psychiatry workforce, particularly as communities across the country face limited access to specialists.

"So, this is a hot topic, and I think taking from the American Academy of Child and Adolescent Psychiatry, it's a workforce issue," Walkup said. "We need all hands on deck to address the behavioral health problem that we see, whether it's in urban areas, because there are some deserts, if you will, even in urban areas as well as in rural areas."

Walkup specifically emphasized the importance of maintaining a workforce that includes physicians who received their medical training internationally.

"We need all physicians to be engaged, particularly those from international training backgrounds. We need them here, and sadly, it's been kind of complicated to keep that workforce going and to build that workforce," he said.

What can collaboration between pediatricians and psychiatrists look like?

With insufficient numbers of child psychiatrists to independently meet demand, Walkup said collaborative care can provide pediatricians with both education and specialist support.

At Lurie Children's, the approach includes a collaborative care program as well as education and training for pediatricians throughout the Chicago area.

"So, our pediatricians know that we have their back, that they can call, that we will help them with complicated cases," Walkup said.

Local relationships between pediatricians and mental health professionals represent one model. Statewide psychiatric access programs provide another option, allowing pediatricians to obtain consultation even when a specialist is not directly integrated into their practice.

What makes a psychiatric access program effective?

Walkup described 2 general approaches to statewide consultation programs. Some emphasize ongoing education and training for pediatricians, whereas others focus primarily on providing telephone access to specialists for individual cases.

"I think the best programs are the ones where they really do the active education of pediatricians in the state, as well as provide that phone backup around particular cases," he said.

This combination can help pediatricians develop their own behavioral health skills while maintaining access to psychiatric expertise when a patient's needs become more complex.

How can pediatricians become more comfortable managing mental health?

Not every pediatrician begins with the same level of interest or confidence in behavioral health care, Walkup said. During 8 years of collaborative care at Lurie Children's, his team has observed clinicians who readily pursue mental health education as well as others who are more hesitant.

For pediatricians who are less comfortable, education needs to be accessible and accompanied by early collaboration with specialists.

"We've tried to provide education in such a way that is readily accessible to them, and also provide a ton of early kind of work, collaborative work with them to kind of get them over the hump," Walkup said.

He also acknowledged that some pediatricians entered the field without expecting behavioral health care to become such a substantial component of practice.

What is the next step for integrated pediatric mental health care?

Walkup said the challenge over the next several years will be developing systems that support pediatricians at different levels of readiness. That includes keeping clinicians who are already interested in behavioral health engaged, helping those who need additional support become more comfortable, and addressing barriers for pediatricians who struggle to incorporate mental health care into their practices.

"That for me is the challenge of the next 5 to 7 years," Walkup said. "Because we need all the pediatricians and all the child psychiatrists working together to address this mental health crisis."