Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
BMC Prim Care. 2024 Aug 14;25(1):300. doi: 10.1186/s12875-024-02538-7.
Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics.
The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider's ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care.
A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann-Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach.
Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage.
This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.
精神疾病在儿童中很常见，会对儿童时期以及以后的幸福感产生负面影响。然而，许多患有这些疾病的儿童无法获得所需的心理健康护理。威斯康星儿童精神病咨询计划（WI CPCP）的创建旨在通过为初级保健提供者提供转诊资源、获得行为健康咨询的机会以及有关心理健康主题的培训来减少获得护理的差距。
本研究的目的是 1）评估 WI CPCP 在密尔沃基县的有效性，提供提供者照顾儿童心理健康能力的具体见解，以及 2）确定密尔沃基初级保健提供者在为儿童患者提供精神保健方面面临的挑战，并将这些挑战置于医疗保健获取的概念框架中。
使用 2014 年至 2022 年期间在密尔沃基县参与该计划的提供者在线完成的基线和九个月随访调查的数据，进行了横断面混合方法二次数据分析。使用 Two-sample Wilcoxon rank-sum（Mann-Whitney）检验（基线与随访调查应答）和描述性统计（仅随访调查）对提供者提供精神保健的信心和技能进行定量分析。使用主题分析研究方法对提供者提供精神保健的挑战进行定性分析。
定量分析结果表明，从基线到随访，提供者治疗儿童焦虑和抑郁的信心和技能有所提高。定性分析的结果分为 WI CPCP 范围内和范围外的因素。在 WI CPCP 范围内，提供者报告缺乏转诊选择的知识、缺乏心理健康护理培训以及缺乏评估和治疗精神障碍的知识。尽管如此，许多精神保健服务获取的障碍仍然存在，这些障碍超出了 WI CPCP 的范围，例如长时间等待和缺乏保险覆盖。
本研究支持该计划改善儿童获得护理的效果。然而，需要采取额外的解决方案，例如为心理健康专业人员提供更好的报销和扩大保险覆盖范围。
