The Partnership Access Line: evaluating a child psychiatry consult program in Washington State

Abstract

Objective: To evaluate a telephone-based child mental health consult service for primary care providers (PCPs).

Design: Record review, provider surveys, and Medicaid database analysis.

Setting: Washington State Partnership Access Line (PAL) program.

Participants: A total of 2285 PAL consultations by 592 PCPs between April 1, 2008, and April 30, 2011.

Interventions: Primary care provider-initiated consultations with PAL service.

Main outcome measures: The PAL call characteristics, PCP feedback surveys, and Medicaid claims between April 2007 and December 2009 for fee-for-service Medicaid children before and after a PAL call.

Results: Sixty-nine percent of calls were about children with serious emotional disturbances, and 66% of calls were about children taking psychiatric medications. Primary care providers nearly always received new psychosocial treatment advice (87% of calls) and were more likely to receive advice to start rather than stop a medication (46% vs 24% of calls). Primary care provider feedback surveys reported uniformly positive satisfaction with the program. Among Medicaid children, there was significant increases in attention-deficit/hyperactivity disorder and antidepressant medication use after the PAL call but no significant change in reimbursements for mental health medications (P < .05). Children with a history of foster care experienced a 132% increase in outpatient mental health visits after the PAL call (P < .05).

Conclusions: Primary care providers used PAL for psychosocial and medication treatment assistance for particularly high-needs children and were satisfied with the service. Furthermore, PAL was associated with increased use of outpatient mental health care for some children.