It all began with a simple goal:
While the ultimate goal of the National Network of Child Psychiatry Access Programs (NNCPAP) is to support Child Psychiatry Access Programs (CPAPs) to increase children’s access to mental and behavioral health services, the initial goal that led to the first child psychiatry access program was much simpler. According to John Straus, M.D., the Massachusetts Child Psychiatry Access Program (MCPAP) founding director, “The initial goal was to help primary care providers prescribe psychotropic medications appropriately.”
A 2004 startling report by the center for medicaid services (CMS) revealed a significant increase in psychotropic medication prescriptions (Lopez-Leon, 2004 ). Urgent to address this issue, the New England division of CMS called for a conference to aid primary care providers in prescribing medication more appropriately. The University of Massachusetts (UMass) proposed a pilot program to support primary care doctors through consultations. This initiative garnered a Medicaid contract for UMass to develop the Massachusetts Child Psychiatry Access Project (MCPAP), which doctors soon found invaluable.
Recognizing the program’s potential, Ron Preston, then Secretary of Health in Massachusetts, proposed expanding the consultation program statewide with the help of the Massachusetts Behavioral Health Partnership (MBHP). MBHP developed the MCPAP program to support the efficient diagnosis and treatment of mild to moderate mental health issues within primary care.
“If you give a hungry man a fish, you feed him for a day, but if you teach him how to fish, you feed him for a lifetime”
-Lao Tsu
Designing the MCPAP Model
When designing the model for the statewide program, the directors recognized early the efficiency of educating primary care providers. The model was built on the principle expressed by Lao Tsu: “If you give a hungry man a fish, you feed him for a day, but if you teach him how to fish, you feed him for a lifetime.” Instead of referring patients with mild to moderate mental health concerns to psychiatrists immediately, contributing to a backlog of patients waiting to see a specialist, the model optimizes the limited workforce supply of psychiatrists to provide education and consultation to primary care clinicians. The child psychiatry access program model has three components: child psychiatry consultations (via telephone line or face-to-face), care coordination (community resources and referrals), and training and education. The program operates a consultation line, five days a week, 9:00 AM to 5:00 PM and participation in the program is at no cost to the practice. This array of services allows primary care clinicians to better meet the growing behavioral health needs of their patient panels. Through increased confidence and competence clinicians are able to offer more comprehensive and appropriate behavioral services in the patient’s medical home.
“We can get someone seen for a consultation within a couple of weeks when in the general community it would take a couple of months”
-John Straus, MD
Director John Straus played a key role in working with advocates and stakeholders to secure an earmark for the program’s funding. The program also focused on creating regional teams in medical institutions across the state to prioritize the education of primary care providers and ensure the efficient recruitment of psychiatrists. With legislative approval, the Massachusetts Department of Mental Health (DMH) provided funding to the Massachusetts Behavioral Health Partnership (MBHP) to establish six regional teams across the state in 2004-2005. Thus, MCPAP was born as the first statewide child psychiatry access consultative program in the United States.
Helping Families One Call at a Time
“When you call, you get more than an answer. Callers have the opportunity to be heard, learn and ask questions ...it is an educational exchange”
-John Straus, MD
Child psychiatrist and MCPAP medical director, Barry Sarvet, M.D., published a study in the journal Pediatrics that highlighted the positive response and engagement of primary care clinicians during the first few years of MCPAP's operation (Sarvet et al., 2010). Later, in collaboration with Dr. John Straus, MCPAP's founding director, Dr. Sarvet published a follow-up paper in Health Affairs. Their findings showed that MCPAP now covers 95% of the youth in Massachusetts (Straus & Sarvet, 2014). All at the mere cost of $2.33 per child per year.
Beginning in 2008 after the Massachusetts class action lawsuit, Rosie D. et al v. Patrick et al. primary care clinicians were mandated to offer formal standardized behavioral health screening to children and adolescents under the age of 21 who received medicaid benefits at all well-child visits. The behavioral health screening mandate led to a noticeable increase in calls to the program. MCPAP (and other CPAPs as well) encourage doctors to regularly screen for mental health issues and engage in conversations with patients about these concerns. This creates an environment in the pediatric office that signals to families and children that they can openly discuss these issues with their pediatricians. This approach helps to destigmatize mental health and to employ preventative screening practices.
The success of the MCPAP model has led to its expansion beyond pediatric primary care. In 2014 MCPAP for Moms was created after the findings that women in the perinatal period face mental health challenges and their obstetric providers are unequipped to help treat them. Thirteen states have adopted similar programs to address perinatal mental health and substance use, while programs focused on adult addiction and chronic pain are now operational in three states. The model continues to evolve as it is deployed to aid a variety of mental health workforce challenges.
Creating the Network
Presentations at the annual meetings of the American Academy of Child and Adolescent Psychiatry and American Academy of Pediatrics mobilized many physicians and health care professionals interested in finding a solution for the growing mental health needs in their state. Similar programs began in Washington, Illinois, Connecticut, Oregon, and Pennsylvania etc. The network organically developed as programs were eager to share their program design and accomplishments with peers in the field. Informal networking meetings to provide support and guidance subsequently followed. Ultimately, in 2011, a core group of national leaders dedicated to pediatrics and child psychiatry established the National Network of Child Psychiatry Access Programs to support existing and emerging child psychiatry consultation programs and further national progress toward effective integration of mental health with primary care.
This association officially incorporated on October 20, 2014 as the National Network of Child Psychiatry Access Programs, Inc. (“NNCPAP” or the “Organization”), a Massachusetts 501(c)3 nonprofit organization, in accordance with Chapter 180 of the Massachusetts General Laws. In carrying out its charitable mission, NNCPAP serves as a clearinghouse of resources for child psychiatry consultation programs across the country; facilitating relationships and effective communication among mental health and psychiatry access programs designed to address the mental health needs of children and adolescents within the primary care setting. NNCPAP was incorporated to form an official membership organization, provide organized technical support to new programs, and administrative support to organize and monitor program activities. Currently, NNCPAP does this and more.The organization fulfills its charitable mission through the generous support of the American Academy of Pediatrics and the Health Resources and Service Administram’s (HRSA) Organization’s Technical Assistance and Innovation Center.
