Alisa Perry
N717a-Context of Care


To: Veronica Nieva, PhD
From: Alisa Perry, RN, APRN Intern
Date: October 13, 2011-10-08
Subject: Enhancing the Ability of Primary Care Providers to serve Pediatric Patients with Mental Health Issues.

Recently I had the opportunity to spend time reviewing various AHRQ innovations related to pediatric care. The innovation that particularly peaked my interest was the innovation entitled “Regional Teams Enhance Ability of Primary Care Clinicians Throughout Massachusetts to Serve Children and Adolescents With Mental Health Issues.” This innovation was developed by the Massachusetts Child Psychiatry Access Project in 2005 and it received a moderate evidence rating. This innovation can be retrieved from the AHRQ website at

I received my undergraduate degree from Colby College in 2007 with a BA in Biology. After college I worked at Dana-Farber Cancer Institute in Boston, Massachusetts doing pre-pharmaceutical bio-chemical research in the pediatric hematology/oncology department. Currently, I am in my final year of graduate school at Yale University's School of Nursing studying to be a Nurse Practitioner with a specialty in pediatrics. I am interested in working in pediatric primary care and have had various experiences in pediatric primary care settings including a hospital based pediatric primary care clinic, a pediatric private practice, an elementary and high school school-based health center, and a summer camp health center.

Research has shown that 1 in 5 children and adolescents have a diagnosable mental health disorder that requires treatment and intervention (USDHHS, 2000). However, only one third of children with a diagnosable mental disorder get help (CDC, 2011). With such staggering statistics is it becoming more clear how imports it is for primary care providers to be able to identify and diagnose mental health issues as well as help their patients access adequate care. In practice, I have seen first hand the obstacles pediatric primary care providers face in adequately serving their patients with mental health needs. Primary care providers often feel that they lack the training, time and resources to sufficiently manage their patients with various mental health needs (Savet, 2010). Thus, an innovation such as this one, offers an excellent program which aids primary care providers in caring for such patients. As a future pediatric primary care provider I see how such an innovation can aide me in diagnosing and treating my patients with mental health needs.

In Connecticut, this innovation is not available and I have found myself in various instances where I felt unprepared in helping my patients with mental health needs. In a twenty minute visit it is often difficult to start delving into patients' mental health issues especially with a lack of formal training in mental health. Without being able to adequately indentify the patient's needs, it can also be very difficult to identify the right treatment and make the correct referrals. This innovation removes all of the above barriers by having an easily accessible mental health team to consult with, to make diagnoses, plans for treatments, referrals and who can coordinate appropriate care.

There are many aspects about this innovation that I like. I like that the initial consultation between the primary care provider and mental health team member happens over the phone. This allows for an easily accessible initial evaluation where an preliminary plan for the patient can be initiated or any clinical questions (i.e. about medication) can be addressed while the patient is still in the office. I also like that more involved and complex cases lead to an in-person meeting between the patient and mental health team member. This allows for a more complete evaluation of the needs of the patient so that an appropriate treatment plan can be made and the patient can be directed to the resources they need for effective treatment though their care coordinator. I believe that this multi-disciplinary approach in addressing mental health needs will foster better detection and treatment of pediatric patients with mental health needs and thus lead to better outcomes.

The negatives of this innovation involve the obstacles in implementing such a program in other states. The costs of establishing this program in Massachusetts was about 2.5 million dollars annually or about 2 dollars per child. This cost is significant and data has yet to be published about the cost-effectiveness of this program. I am confident that this program will prove to be very cost-effective, yet I also know that it will be difficult to get funding for such a program in other states without such data. This program was also able to establish mental health teams in the state's 6 major academic hospitals and recruit enough pediatric primary care practices so that 98% of the state's pediatric population had access to this program. These statistics are impressive; however, in order to establish this program in other states would require significant initiative, funding, coordination, and organization. Larger states with more rural setting might also have more difficulty in accessing the majority of their populations and find easily accessible resources for those more rural populations.

This innovation by the Massachusetts Child Psychiatry Access Project is truly a valuable program for all pediatric primary care providers. With this program, primary care providers will better serve the mental health needs of their patients by have the ability to collaborate with a mental health team who can support in creating a treatment plan for their patient as well as coordinate care for further services if needed. Pediatric patients will be better served by having increased rates of diagnosis identification, early intervention and having someone to coordinate their care and assist them in accessing the resources they need. I believe that this innovation will prove to be a very cost-effective and will prove to lead to better outcomes in pediatric patients with mental health needs. As a future pediatric primary care provider, I sincerely hope that I have access to a similar program so that I can better serve the mental health needs of my patients.


American Nurses Credentialing Center (ANCC ) ANCC certification renewal. Retrieved on 10/10/11 from

ARHQ, Regional Teams Enhance Ability of Primary Care Clinicians Throughout Massachusetts to Serve Children and Adolescents With Mental Health Issues. Retrieved online on 10/1/2011 from

Centers for Disease Control (CDC). Eliminate Disparities in Mental Health. Retrieved online on 10/10/2011 from

Executive Office of Health and Human Services (EOHHS). Retrieved online on 10/11/2011 from

National Association of Nurse Practitioners (NAPNAP). Retrieved online on 10/11/2011 from

Pediatric Nursing Certification Board (PNCB). Retrieved online on 10/11/2011 from

Phillips, S.J. (2010). 22nd annual legislative update: Regulatory and legislative successes for APNs. The Nurse Practitioner, 35(1), 24-47.

Sarvet B., Gold J., Bostic J.Q. (2010) Improving access to mental health care for children: the Massachusetts Child Psychiatry Access Project. Pediatrics. 126(6),1191-2002.

US Department of Health and Human Services (USDHHS) (2000) Mental Health: A Report of the Surgeon General. Retrieved online on 10/10/11 from

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