Oregon’s Psychiatric Access Line about Kids
A partnership of the Oregon Pediatric Society, Oregon Health and Sciences University, Oregon Council of Child and Adolescent Psychiatry and the Oregon Family Support Network.
What does OPAL-K do?
OPAL-K provides primary care physicians timely phone access to child psychiatric consultation for children and adolescents birth to age 18. OPAL-K serves of all Oregon’s children and adolescents, not just those who are eligible for Medicaid. Phone access will be accessible state-wide with telemedicine options for rural face-to-face consultation.
Psychiatric access phone line will be staffed by qualified mental health professional (QMHP) and child psychiatrists. Initial calls from primary care physicians are triaged for need and coordinated for call back with the “on-call” child psychiatrists before the end of the working day to the primary care physician. The OPAL-K QMHP can also arrange referrals and follow-up with community mental health agencies.
Face-to-face follow-up for child psychiatric consultation can be arranged in a timely manner as determined by the primary care physician and the child psychiatrist (goal within 2 weeks)
Why is OPAL-K needed?
Child Psychiatry Workforce Issues
- Estimated 1.6 child and adolescent psychiatrists per 1,000 children and youth nationally
- Oregon has 7.8 child psychiatrists per 100,000 children and youth, with poor geographic distribution
- No increase in number of child psychiatrists trained per year in the US between 1995 and 2006
Impact of untreated mental illness in community:
- Individual: suicide, community violence, delinquency, drug and alcohol abuse, involvement in the criminal justice system, restrictive levels of care and homelessness
- Family: Stresses related to caring for a child with mental emotional and behavioral challenges often lead to financial and emotional turmoil, family separation and divorce. The stigma of mental health issues often isolate families from the community.
- Society: long term economic impact for schools, state-run mental health services, emergency rooms and hospitals.
Why Focus on the Primary Care Setting?
- Often primary care providers are the first place families turn to, which provides an opportunity for early prevention and screening
- Primary care providers know the developmental and family context of symptoms
- Patients and families often feel comfortable and trusting of primary care providers
- For families with inadequate mental health coverage, often the only choice is the primary care provider
- Addressing psychiatric issues in primary care setting can reduce the stress associated with the stigma of having a child with a mental illness.
What are the expected outcomes of OPAL-K for primary care providers and families?
- Promotion of evidence-based practices through consultation and education maximizing the timeliness and quality of mental health treatment in the medical home.
- Increase early detection and intervention reducing the use of more restrictive and costly treatments later that deplete family and societal resources.
- Increase the primary care clinician’s confidence and competence to provide mental health treatment to children in their practice.
- Reduce inappropriate prescribing practices including unneeded psychotropic medication prescriptions for children in foster care.
- Same day consultation through phone calls or videoconferencing assuring timely information and service to their patient and family
- Referral information will help families find appropriate links to resources and supports in their community
- Telemedical evaluations will allow evaluations for families living in underserved areas of the state.
- Similar Programs have observed a decrease in inpatient interventions and substantial improvements in competence and confidence of primary care providers.
Examples of similar successful programs in other states
Oregon Pediatric Society
Keith Cheng, MD, OPAL-K Medical Director