MCW program expands treatment
Consultations address shortage of child psychiatrists
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When Delafield pediatrician Renee Szafir wants a second opinion on how to treat a child with depression or another mental health condition, she can draw on the expertise of a child psychiatrist or psychologist at the Medical College of Wisconsin.
They often will get back to her within 30 minutes — and always within 24 hours.
“It makes me more comfortable. It makes the family more comfortable,” Szafir said. “It’s been an invaluable resource for us as pediatricians.”
The Medical College’s Child Psychiatry Consultation Program was created to help address a severe shortage of child psychiatrists and now is available in Milwaukee, Waukesha and Ozaukee counties as well as 15 counties in northern Wisconsin.
“It’s a way to extend the reach of primary care,” said Jon Lehrmann, a professor and the chair of psychiatry and behavioral medicine at the Medical College of Wisconsin.
That’s become essential, given that physicians such as Szafir don’t have the option of immediately referring patients to a child psychiatrist.
It can take several months to get an appointment with a child psychiatrist, and as long as nine months depending on the severity of the child’s condition, Szafir said.
At the same time, primary care physicians often are uncomfortable diagnosing psychiatric illnesses in children and reluctant to prescribe drugs without consulting a specialist. That’s in part because children’s brains are developing, and less is known about how drugs used to treat mental illness affect them.
Szafir draws on the consulta-
tion program, for instance, when a diagnosis isn’t clear.
“I use them a lot to say, ‘Hey, I’ve got this kid in my clinic. What do you think?’ ” she said.
Gov. Scott Walker has proposed increasing funding for the program — now funded by a $500,000 grant from the state Department of Health Services — to $1 million a year and expanding it to other parts of the state.
The federal Centers for Disease Control and Prevention estimates that 13% to 20% of children have a mental, behavioral or developmental disorder.
Among the most common disorders are attention deficit hyperactivity disorder, mood and anxiety disorders such as depression, and disruptive behavioral disorders such as oppositional defiant disorder and conduct disorder.
Half of all mental illnesses, such as major depression and anxiety disorders, begin by the age of 14.
The Child Psychiatry Consultation Program, operated in partnership with Children’s Hospital of Wisconsin, has provided more than 1,250 consultations since 2015.
It is available to 375 pediatricians, family medicine physicians, nurse practitioners and physician assistants in the Milwaukee area and northern Wisconsin.
The program started as a pilot project funded with a $250,000 grant from Michael “Mike” Kubly and his wife, Billie Kubly, whose philanthropy has focused on reducing the stigma surrounding mental illness and on improving access to behavioral health care.
It also received a grant of $190,000 from the Milwaukee Health Care Partnership, which includes the four health systems in Milwaukee County.
The model was first adopted in Massachusetts, and 28 states now have similar programs, according to the National Network of Child Psychiatry Access Programs.
The Medical College of Wisconsin is using the same model for a new program, the Periscope Project, that will treat pregnant women and new mothers for behavioral health conditions, including postpartum depression, and substance-abuse disorders.
The new program, which will be launched next month in southeast Wisconsin, is being funded with a grant of $425,000 a year for three years from the United Health Foundation and a one-time grant of $200,000 from the Department of Health Services.
Behavioral health conditions, such as depression and anxiety, are the most common complication of childbirth, said Christina Wichman, a physician and associate professor of psychiatry and behavioral medicine and of obstetrics and gynecology at the Medical College.
Some patients also have behavioral health conditions or substanceabuse disorders when they become pregnant. (Physicians must report to the state pregnant women who are addicted to certain drugs, such as opioids.)
Yet physicians often are wary of prescribing medications, such as antidepressants, during pregnancy or when a mother is breastfeeding.
Wisconsin has only three perinatal psychiatrists. And Wichman said she often gets two or three calls a day from physicians — including, at times, other psychiatrists — asking for advice on how to treat a patient with a behavioral health condition who is pregnant or who recently had a child.
The Periscope Project and the Child Psychiatry Consultation Program each have resource coordinators to help physicians identify community resources, such as support groups, and websites with educational materials and tool kits on assessment and treatment.
“The value of this is just not in the consults,” Lehrmann said.
Tina Neuendank, a nurse practitioner with Ministry Medical Group, part of Ascension, in Wausau, has taken all of the online educational courses.
She also has drawn on the Child Psychiatry Consultation Program, particularly when she has a child and family in crisis or when she has a question on a medication. And Neuendank, like Szafir, said the program gives her more confidence when diagnosing and treating patients.
The shortage of child psychiatrists is the most severe in rural areas, which don’t have the population density to support many specialists.
There also is no hope that the shortage will end soon: Psychiatrists once again were the secondmost recruited physicians, behind family medicine physicians, in an annual survey by Merritt Hawkins, a physician recruiting company.
That’s why new models, such as Child Psychiatry Consultation Program, are considered essential. And the Medical College hopes to offer similar programs for addiction and geriatric psychiatry.
The model is not an answer to the psychiatrist shortage, Lehrmann said, but it is at least part of the solution.
“This is another way we are trying to improve access to behavioral health care,” he said.