Pediatric Integrated Care is Key to Meeting Needs of Young Patients


Since becoming president of the American Academy of Child and Adolescent Psychiatry (AACAP) in 2015, Gregory K. Fritz. M.D., has made it his mission to educate child and adolescent psychiatrists about how best to collaborate with others in primary or specialty medical care. In the presidential symposium “Current Issues in Child and Adolescent Psychiatry” at APA’s Annual Meeting, Fritz outlined benefits and barriers to implementing pediatric integrated care.

“Child psychiatrists and psychologists are incredibly rare compared with the need,” said Fritz, who is a practicing psychiatrist in Providence, R.I., and professor and vice chair of the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University. “There is a huge reservoir of children with untreated mental illnesses, and limited access to mental health services has far-reaching consequences for them.”

To meet the needs of these young patients, pediatricians, primary care physicians, and mental health professionals must move toward greater pediatric integrated care. “Many child and adolescent psychiatrists may not want to adapt to the significant changes in practice this would pose,” said Fritz, who is also director of the Division of Child and Adolescent Psychiatry at Rhode Island Hospital. “Most haven’t received training on how to function in an integrated system, so they may feel uncomfortable doing it, like a fish out of water.”

Fritz described several different types of service models that primary care providers and psychiatrists could consider, including psychiatrists working as consultants to primary care providers, bringing psychiatrists in-house at pediatric practices, and the “hub model”—in which mental health services are provided in a central location with immediate access for pediatricians’ questions by phone or teleconferencing.

(APA has received a grant from the Centers for Medicare and Medicaid Services to participate in the Transforming Clinical Practice Initiative that is training 3,500 psychiatrists in the skills needed to support primary care practices that implement behavioral health programs. APA will offer both online learning modules and in-person training. Interested APA members should email san@psych.org.)

While Fritz acknowledged that the biggest barriers to pediatric integrated care remain the reimbursement of mental health care services, he noted that with mental health professionals’ consultation and backup, primary care providers can effectively manage many pediatric mental health problems, expanding the number of children who have access to care.

(Image: iStock/FatCamera)