“What we were finding was that psychiatry, especially in this community, is difficult to access for pediatric clients,” Stute said.
Child and adolescent psychiatry is one of the most under-served specialties in medicine nationwide, said Dr. William Klykylo, director of the Child and Adolescent Psychiatry Division at the Wright State University School of Medicine.
Most estimates show that between 7,500 and 8,000 child psychiatrists practice in the United States each year, he said. That’s far short of the need.
“In any given day, there are between 12 million and 15 million or so kids who could see us,” Klykylo said.
Some psychiatric services are available for patients in Champaign County, Stute said, but many patients who could benefit face barriers such as transportation and long waiting lists.
The telepsychiatry program, which started here in November, allows Well Child patients who qualify to sit at a computer screen and receive psychiatric appointments through a video feed with Nationwide Children’s Hospital in Columbus.
The participating sites can usually schedule eligible Medicaid patients to see a psychiatrist within two to four weeks, said Mina Chang, chief of health services research and program development for the Office of Medical Assistance.
“Prior to the program’s launch, practice sites had indicated wait times have been up to two months in length,” Chang said.
It’s estimated that between 20 and 30 eligible children statewide will participate in the study this year. The research won’t be finalized until the end of the year.
Once qualified patients are evaluated and it’s determined they would benefit from psychiatric care, Stute said the next step is a consultation with a psychiatrist at Nationwide. Although the majority of the follow-up appointments are conducted over a computer screen, the initial consultation is conducted in person.
Under the pilot program, Stute said she works with both the family and hospital to eliminate anything that could prevent them from receiving treatment or making it to appointments on time, such as transportation problems.
Follow-up sessions with the psychiatrist are conducted in a small room at Mercy Well Child, in which patients and the psychiatrist interact over a computer screen. Follow-up appointments typically take about 30 minutes, and Stute said she works closely with the psychiatrist to review each case throughout the week.
Patients are sometimes skeptical about conducting an appointment through video, but they usually adjust quickly.
“People get comfortable with the screen about five minutes into it,” Stute said.
There are still some drawbacks to telemedicine in general, Stute said. For example, the equipment could malfunction or it may be more difficult for a physician to pick up on the emotional signals of a patient. But overall, it benefits patients who otherwise might not have easy access to care.
“This makes access a lot better,” Stute said.
Mercy Well Child’s staff includes a nurse practitioner, a pediatrician, nurses and other support staff. It offers pediatric services ranging from sick care to nutritional care to screenings for autism and depression.
Along with Mercy Well Child, medical offices in New Lexington and Athens are also participating in the program, according to information from the Office of Medical Assistance and the Ohio Department of Mental Health. Wright State was selected through a competitive bidding process to evaluate the project and provide technical assistance.
In Springfield, the Rocking Horse Community Health Center hasn’t had to face similar challenges, said Dr. James Duffee, medical director for the center. The center, which provides services ranging from behavioral medicine to chronic disease management and dental services, at times has as many as five child psychiatrists on staff at once.
However, Duffee said few child psychiatrists are available statewide when compared to the number of patients who could benefit from the service. Instead, the brunt of mental health work often falls on family practice offices and pediatricians who typically don’t have the same level of expertise in dealing with the behavioral and emotional needs of adolescents.
“Child psychiatry is very poorly distributed throughout the state,” Duffee said.
Several reasons account for why so few are in the profession, Klykylo said.
Little funding is available for training in the field, and despite the extensive training needed, the pay is typically lower than many other medical specialists. After years of education, it’s not unusual for a new professional to face between $170,000 and $250,000 in debt.
The pilot program is one of several recent attempts to find more cost-effective and efficient ways to provide care to patients who might not receive it otherwise, he said.
“We’re trying to integrate behavioral health and physical health, which is probably the way health care will be delivered in the future,” Stute said.
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