Abstract

The North Carolina psychiatry access line (NC-PAL): A pediatric and perinatal behavioral health access and education program

Chelsea Swanson, MPH¹, Kendra Rosa, MPH¹, Alexis French, MS¹, Karen Burns, MSW², Naomi Davis, PhD¹, Nicole Heilbron, PhD¹, Nathan Copeland, MD, MPH¹, Alison Manning, MD¹, Marla Wald, MD¹, Marquise Eloi, MSW¹, Mary Kimmel, MD² and Gary Maslow, MD, MPH¹
(1)Duke University, Durham, NC, (2)UNC Chapel Hill, Chapel Hill, NC

APHA's 2020 VIRTUAL Annual Meeting and Expo (Oct. 24 - 28)

There is a significant shortage of behavioral health care services across many states, particularly in rural counties. In North Carolina, a largely rural state, 84% of counties are classified as Mental Health Professional Shortage Areas (NCDHHS, 2018). The access problem is pronounced for children and perinatal women, who typically need more specialized behavioral health services. Primary care providers (PCPs) fill the gap in providing behavioral health care, but often lack specialized training and resources to support meeting the behavioral health needs of these populations. With funding from the Health Resources and Services Administration, NC has implemented the NC-PAL Child and Perinatal Psychiatry programs to centralize and provide access to pediatric and perinatal behavioral health resources for PCPs.

NC-PAL offers PCPs real-time telephone consultation from specialized psychiatrists and behavioral health consultants around diagnostic clarification, medication management, referral support, and connection with resources. Our psychiatry team also offers one-time patient assessments, in person or via telehealth, as needed to support providers. Additionally, PCPs receive ongoing behavioral health education and practical tools to support their clinical care. Through these services, NC-PAL aims to increase provider confidence and improve the ability of PCPs to manage patients’ behavioral health needs.

Data evaluating PCP satisfaction, outreach, training and impact are collected on an ongoing basis. Between NC-PAL’s inception in October 2017 through January 2020, over 500 calls have been received by 104 unique providers. Data obtained after calls indicate PCP satisfaction with the consultation (100%), increased confidence in treating patients' behavioral health concerns (83%), and reduced need for higher levels of care (33%). Additionally, multiple mechanisms have been utilized to engage PCPs, including practice visits, in-person lectures, webinars, and e-newsletters.

Statewide partnerships have been formed to support NC-PAL’s implementation and will ensure success as the landscape for publicly insured health services transitions to a managed care model in NC. NC-PAL is one of several psychiatry access programs nationwide, and preliminary data suggest it is having a positive impact. As NC-PAL becomes part of the health system infrastructure, this model of consultation, resource/referral coordination, and training opportunities is poised to transform mental health care in North Carolina.

Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs