Most practices struggle to support kids with behavioral health needs

More than 85% of U.S. medical practices had trouble obtaining advice and services for pediatric patients who needed behavioral health care, survey data showed.

The national cross-sectional study is the first of its kind to evaluate the accessibility of pediatric behavioral health care, researchers wrote in Annals of Family Medicine. A 2004 to 2005 poll that did not differentiate between adult and child behavioral health services indicated that 67% of practices had difficulties helping patients secure behavioral health care.

“There is a lot of attention to emergency room boarding and hospital beds, but primary care physicians are typically the first stop when a child or teen is struggling with a mental health issue,” Alyna T. Chien, MD, MS, the research director for the division of general pediatrics at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School, told Healio. “If we can deliver the right behavioral health response at the right time, then patients and their families don’t have to wait for a bad situation to get worse before receiving attention.”

Chien and colleagues asked 1,410 practices with at least three PCPs on their staffs to rate the difficulty they experienced when seeking advice or therapy for pediatric patients with behavioral health needs.

According to the researchers, 86% of the practices had difficulty obtaining medication advice, 87% had difficulty obtaining evidence-based psychotherapy and 89% had difficulty obtaining family-based treatment. These percentages remained consistent among system-owned and independent practices but were lower among the Medicaid Accountable Care Organizations that participated in the study.

“The news is sobering — the challenge of providing behavioral health treatments for children is a hefty one, and much progress needs to be made,” the researchers wrote.

Some of the challenge may be met by establishing “strong collaborative relationships between primary care physicians, psychiatrists and therapists,” Chien said in the interview.

“We have to think and act very strategically about how to make sure that precious behavioral health resources are used to the greatest possible effect,” she said.

The study findings are even more relevant amid the COVID-19 pandemic, she added.

“Everything that was difficult before is even more difficult with COVID. That is why emergency rooms and hospitals are speaking up,” Chien said. “But perhaps the emergency rooms and hospitals would not be as overwhelmed if primary care practices did not find it so difficult to deliver behavioral health services to children.”