TMA Interim Testimony by Joyce Mauk, MD
House Committees on Public Education and Public Health
June 28, 2018
Chairman Huberty, Chairman Price, and Committee Members,
Thank you for the opportunity to provide testimony today. My name is Joyce Elizabeth Mauk, MD, and I am a neurodevelopmental pediatrician from Fort Worth, testifying on behalf of the more than 52,000 combined members of the Texas Pediatric Society, the Texas Chapter of the American Academy of Pediatrics, and of the Texas Medical Association.
We would like to thank Speaker Straus and these committees for their attention to the mental health needs of our children, especially in the wake of recent traumatic events. The pediatric physician community stands ready to aid our communities in building resilience in our young people and providing comfort and treatment to those struggling with mental health concerns.
The pediatric medical home is an ideal place to manage and coordinate the mental health care of children and adolescent youth.
Families know and trust their child’s primary care physician and are already in the habit of attending regular well-child visits each year. Primary care physicians know the developmental context of a child and can provide preventive care where needed. The American Academy of Pediatrics Bright Futures initiative recommends adolescents receive yearly screenings by their primary care physician for depression and other mental health concerns. Additionally, primary care pediatricians report that a main driver of acute visits in the adolescent population is for behavioral health concerns. Seventy-five percent of all children and youth with mental health disorders are seen in pediatric care settings. Furthermore, addressing mental health concerns in the primary care setting can help reduce stigma associated with accessing care.
Child Psychiatry Access Programs (CPAPs) are one unique solution to our current mental health workforce challenge.
As the prevalence of mental health concerns increases in our young people and the availability of behavioral health specialists remains stagnant or does not keep up with population growth , we must look for creative ways to better utilize the professional workforce we have. By fully using the potential of a state’s current behavioral health and primary care workforce, CPAPs allow for most children and youth with mental health concerns to be served earlier in the primary care setting while freeing up psychiatrists and other licensed mental health professionals to serve children with more severe needs.
Operating in nearly 30 states, CPAPs consist of a statewide network of regional hubs at academic medical centers staffed by child and adolescent psychiatrists, licensed mental health clinicians, and referral/resource specialists. These teams help pediatric primary care physicians meet the needs of children with behavioral health concerns. Services may include one or more of the following:
- Clinical consultation over the phone during business hours;
- Expedited psychiatric consultations, either face-to-face or via tele-mental health;
- Co-located behavioral health providers within pediatric settings to provide short-term, evidence-based treatment;
- Care coordination to help access community-based behavioral health resources including psychiatry; and
- Continuing professional education, via in-person networking meetings or webinars, that is tailored for a region’s primary care physicians to help them with clinical decisionmaking.
Under this model, primary care physicians over time become more adept at working with children with mental health concerns and rely on the hubs less or begin asking more sophisticated questions to care for more complex patients. Hubs also can begin to act as integrated behavioral health training environments for psychiatric residents and fellows creating a pipeline to increase our overall workforce.
Investing in a Texas Child Psychiatry Access Program could go a long way to alleviating the mental health workforce challenges in our state and ensure more children receive the right care, at the right time, in the right place.
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