Shared from the 5/27/2017 The Providence Journal eEdition


Mental health advice over the phone?

Across Rhode Island, phone consultations fill in for state’s lack of child psychiatrists


Dr. Mary E. Murray is a South Kingstown pediatrician who uses the PediPRN program. The patient in this photo was having a routine exam and is not a participant in the PediPRN program. [THE PROVIDENCE JOURNAL / BOB BREIDENBACH]

By the numbers

■ One in five Rhode Island children ages 6 to 17 — nearly 28,000 children — has a diagnosable mental health problem.

■ Rhode Island has about 40 child and adolescent psychiatrists, all but a handful of whom work full-time in hospitals and have waiting lists of two to three months or longer.

■ Hospitalizations of children with mental health disorders rose from 1,797 in 2005 to 2,744 in 2015 — a 53 percent increase.

Source: RI Kids Count; Bradley


SOUTH KINGSTOWN, — Pediatrician Mary E. Murray worries.

One of her patients — a teenager with good grades — has started skipping school. Another middle schooler feels anxious and depressed. And several others have a history of hurting themselves.

“I see plenty of kids who cut and some have had active suicidal ideation and plans,’’ Dr. Murray said. “General pediatrics has a lot of challenges that are very fixable. But mental health is sometimes not as easy... And it’s not what I trained for.”

Washington County has only two child and adolescent psychiatrists. One of them doesn’t accept insurance; the other visits the area to see patients for a half-day once a week.

The American Academy of Child and Adolescent Psychiatry in 2015 designated Washington County as among the counties with a “severe shortage” of child and adolescent psychiatrists. At the time, the county’s child adolescent psychiatrists numbered four.

In a state where the waiting list for an appointment with a child and adolescent psychiatrist is generally two to three months or longer, pediatricians and other primary-care providers are on the frontlines of mental health care.

“Sometimes they’re managing kids who have been released from hospitals on a multitude of medications,” said Dr. Rajvi Broker-Sen, a child and adolescent psychiatrist at Bradley Hospital in East Providence. “Then the kid is not doing well and they’re not sure where to go from there.”

To help primary-care providers manage the behavioral health needs of their young patients, Broker-Sen and her colleagues at Bradley Hospital have developed a new phone consultation network, the Pediatric Psychiatry Referral Network or PediPRN. The “PediPRN team’’ includes three child psychiatrists, a nurse practitioner, a care coordinator, a social worker and a psychologist.

The project is funded through a three-year federal State Innovation Model grant and private funding through the Van Beuren Charitable Foundation ($63,000) and the Rhode Island Foundation ($67,000). It’s modeled after a similar program in Massachusetts. More than 30 states in the nation struggling with shortages of child and adolescent psychiatrists now have created programs modeled after the Massachusetts Child Psychiatry Access Program, according to the program’s website.

“I probably call every other week for a patient,” said Dr. Elizabeth B. Lange, a pediatrician at Coastal Medical in East Providence who helped bring the program to Rhode Island. “And part of it is my own personal appreciation for what this program can do...It’s just nice to have someone with special training. We’re learning. They’re teaching us.”

Pediatricians often get to know their patients’ families over many years, she said, which can provide insight into the generational aspect of their health issues not available to other specialists. A mother whose daughter is having panic attacks, say, might comment, “I was just like that when I was in ninth grade.”

In the less than six months since the project was launched, it has enrolled 51 primary-care practices in Rhode Island with 320 providers, including pediatricians, family practitioners and nurse-practitioners.

If PediPRN can increase primary care providers’ knowledge and comfort with treating young people with “mild to moderate’’ behavioral health needs, Dr. Broker-Sen said, that also will free up child and adolescent psychiatrists to manage the more severe cases.

“Mental health disorders are on a spectrum,’’ said Dr. Karyn J. Horowitz, director of outpatient services at Bradley Hospital, who provides consulting for PediPRN. “And for some of the more mild cases I think it’s OK for pediatricians to treat them.”

Murray, the pediatrician at Narragansett Bay Pediatrics in South Kingstown, has called the PediPRN network for advice about a child with ADHD who was losing weight, a side-effect of the medication Adderall. The psychiatrist advised another medication to stimulate his appetite. And her colleague recently called for help with a patient who was suicidal. The psychiatrist helped get the patient admitted to a hospital.

“It’s been useful,” Murray said of the service, and then she sighed. She worries about some of her patients when she asks how they’re feeling. Are they telling her the truth? Or are they telling her what they think she wants to hear?

“I’d just rather a psychiatrist take care of them,’’ she said. “[But] I think this is going to continue to become part of the pediatrician’s responsibilities.”


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