The first child psychiatry access project pilot in the United Stateswas formed in 2002. A consortium of New England states under Centers for Medicare and Medicaid Services (CMS) leadership of Ron Preston (former health and human services secretary) met to discuss concerns around the number of children insured by Medicaid who were receiving psychotropic drugs at young ages and children of all ages who were receiving multiple psychotropic drugs. In 2003, based on these concerns, CMS and MassHealth provided a grant to Dr. Ronald Steingard at UMass Medical School to develop a pilot program in Central Massachusetts (TCPS- Targeted Child Psychiatric Services) providing consultation to pediatricians around child psychiatry problems, including the prescribing of psychotropic medications. Targeted Child Psychiatric Services provided a collaborative model that would provide outpatient psychiatry services to stabilize patients before returning them to primary care for follow up and maintenance. The utilization results of this pilot was described in an article by DF Connor et al, “Targeted Child Psychiatric Services: A New Model of Pediatric Primary Clinician-Child Psychiatry Collaborative Care” (Clin Pediatr (Phila). 2006 Jun;45 (5):423-34 16891275).
In 2004, the Massachusetts Behavioral Health Partnership (MBHP), with significant stakeholder input, adapted the UMass pilot into a program design that would allow statewide rollout. Pediatrician John Straus, MD designed this model to address the shortage of child mental health professionals across the Commonwealth of Massachusetts. Dr. Straus’s vision was that mild to moderate mental health issues could be diagnosed and treated within primary care with the support of statewide telephonic child psychiatry consultation service and care coordination. The idea was that mild to moderate cases treated in primary care would free up specialists’ slots for the more severe and complex cases. This vision became the Massachusetts Child Psychiatry Access Project (MCPAP). With legislative approval, the Department of Mental Health funded MBHP to contract for a statewide rollout of six regional teams in 2004-2005. Child psychiatrist, Barry Sarvet, MD, as medical director for MCPAP, was instrumental in creating the first regional team under the new model at Baystate Medical Center. The Massachusetts Child Psychiatry Access Project (MCPAP) became the first statewide child psychiatry access project in the US. MCPAP participation and utilization results over the course of three and a half years was published in an article by Barry Sarvet et al, “Improving Access to Mental Health Care for Children: The Massachusetts Child Psychiatry Access Project” (Pediatrics) 2010 December; 126; 1191-1200.
Because of MCPAP’s success, variations of the MCPAP model have been replicated in over 20 states, and MCPAP staff has often been asked to provide technical assistance to support the development of the model in other states. Current members of the National Network of Child Psychiatry Access Programs will reflect the number of programs there are nationwide. This list may be found at http://nncpap.org/members/current-programs.
In their work with developing programs, MCPAP administrative staff noticed that many of these programs were addressing similar issues relating to implementation, financing, sustainability, evaluation, outcomes, and quality – the same issues that MCPAP has faced since its inception in 2005. With so many states on the same path, MCPAP staff realized that there was great opportunity for programs to learn from each other, combine resources to achieve common goals, and together further progress toward effective integration of mental health and primary care for children. As a consequence, MCPAP staff – working with a core group of dedicated national leaders in pediatrics and child psychiatry – started the National Network of Child Psychiatry Access Programs (NNCPAP) in 2011.
Today, the National Network of Child Psychiatry Access Programs (NNCPAP) is an all-volunteer organization that benefits child psychiatry access programs all over the country. We now have the mechanism we need to communicate with each other. We have had telephone conference meetings to discuss topics of mutual interest, and we provide technical assistance to each other on an informal basis.
Our ability to fulfill our mission is curtailed by the fact that we are an unfunded all-volunteer organization.
Our next step is to form a membership organization and work on obtaining funding to provide organized technical support to new upstarting programs and administrative support to keep our Network organized and updated on the activities of all of our membership.
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