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.