Pediatric Telephonic Psychiatric Consultation to Primary Care Providers Caring for Young Adults

Background/Significance: In response to limited access to child and adolescent psychiatrists (Stein et al, 2019), Children’s Telephonic Psychiatric Consultation Service (TiPS) provides real-time consultation to primary care providers (PCPs) for pediatric patients with behavioral health concerns. Pediatricians are increasingly providing care beyond childhood, however the role that child psychiatry access lines play in young adult care is not well known.

Methods: Chart review identified telephonic consults for patients aged 18 and over during a 6 month period (January 1-June 30, 2021).  Basic demographic information (age, gender, foster care status, insurance type), reason for consult, diagnosis, and services provided were collected.

Results: One hundred seven young adult consults were completed, comprising 11.9% of total consults. Average age was 19.06 years (range 18-25), with a female predominance (64.7%). 47.2% of the sample had Medicare/Medicaid as primary insurance. Anxiety was the most common diagnosis (79/107; 73.8%), followed by depression (68/107; 63.6%), substance use (34/107; 31.2%), and trauma (17/107; 15.9%). Most common reasons for consult were: medication question (61/107, 57.5%) and resources/community access (30/107; 28.0%). Common services provided included: medication recommendations (63), education to PCP (63), direct care coordination to patient/family (33), recommendation for PCP to encourage patient to seek mental health services (19), resources to PCP (18), and formal psychiatric evaluation by our service (15). In only 4 cases, recommendation was made for dual diagnosis services, and in one case parental support for a young adult's substance use was recommended.

Discussion: TiPS provides a substantial number of telephonic consults for young adult patients. Common consultations include medication recommendations, resources to the family and PCP, and directions to PCP for next steps in care. While substance use was noted in over 30 percent of cases, in only 5 cases the substance use was specifically addressed, highlighting an area for future intervention.

Conclusions/Implications: Pediatricians frequently provide care for young adult patients with mental health and substance use issues. Telephonic consultation by child psychiatrists is a strategy to address the mental health concerns of these patients in shortage areas. Treatment recommendations should include asking questions about substance use and making referrals for substance use treatment when appropriate.

References:
Stein, B. D., Kofner, A., Vogt, W. B., & Yu, H. (2019). A National Examination of Child Psychiatric Telephone Consultation Programs' Impact on Children's Mental Health Care Utilization. Journal of the American Academy of Child and Adolescent Psychiatry, 58(10), 1016-1019.