The Virginia Mental Health Access Program (VMAP)

Abstract

Problem:

The mental health workforce shortage has led to an overwhelming demand for services that cannot be met by child and adolescent psychiatrists alone. By training PCPs, such as pediatricians, family medicine physicians, nurse practitioners, and physician assistants, we can help to provide better access to mental health care. VMAP has trained over a thousand providers with over 22,000 training hours, fielded over 4,000 calls, and reached millions of children through their primary care providers. Testimonials from across the state make it clear that this model is making a difference so that families can receive nearly real-time access to mental health care for their children and adolescents. Early promotion of healthy mental and emotional development is also key to prevention of morbidity and mortality from mental health disorders.

Goals and objectives:

• Goal 1: Expand the capacity of pediatric MH care through education to new and diverse providers.
• Goal 2: Enhance provider learning by expanding the scope and depth of content for advanced and specialized topics.
• Goal 3: Engage hard to reach providers through focused MH topics, skill building, and other educational opportunities.
• Goal 4: Provide medical education services that are culturally inclusive and addresses the needs of diverse populations.
• Goal 5: Develop a sustainability plan.

Key objectives of the Virginia Mental Health Access Program include:

1. Education and training of pediatric primary care providers on screening, diagnosis,
2. management, and treatment of child and adolescent mental health care;
3. Telephonic consultation between pediatric primary care and mental health providers;
4. Regional mental health teams (psychiatrists, psychologists, social workers, care navigators) to support PCPs and their pediatric patients with mental health concerns;
5. Care Navigation services to facilitate access to local mental health resources.

Methodology:

VMAP has been operational statewide since 2019 and has been successful with establishing central infrastructure and regional hubs. VMAP has used the current PMHCA funding to augment state funds to create an effective interagency, multi-stakeholder statewide program. This continuation application will complement and not duplicate other funding as the funds will be used for new services. Access to PMHCA funds will allow VMAP to reach new populations and reduce disparities to access, including the underserved and underinsured populations.

Coordination:

The VDH Division Director provides oversight, quality assurance and direction to ensure an integrated approach amongst unit leads who, in turn, provide oversight and foster coordination and collaborative approaches among staff and programs.

Partnerships with schools will create opportunities for engagement with medical providers working in school-based health settings. Children and adolescents spend most of their hours in schools and collaboration with school-based providers, such as nurses, is essential to successfully addressing the mental health crisis.

Expansion of provider education services to Emergency Departments (ED) clinicians. Having successfully piloted initial expansion to ED providers in one region with our PMHCA one-time expansion funds, we will now plan to expand these services to all five regions. Young people who are in the ED awaiting mental health care can experience long wait times and additional exposure to trauma. By expanding VMAP provider education on pediatric mental health to ED clinicians, ED providers will be better equipped to provide earlier intervention and assistance with discharge dispositions which can improve care and potential even reduce the cost of care as the focus moves further upstream towards ED diversion.

Evaluation:

Ongoing evaluation activities utilize quantitative and qualitative methods to measure changes in provider knowledge and behavior, as well as provider-level patient outcomes associated with increased engagement in VMAP. Dissemination approaches include quarterly meetings of the VMAP leadership team, bi-annual statewide stakeholder meetings, presentations at local, regional, and national conferences, and peer-reviewed publications in the medical and public health literature. The expansion also promotes the ongoing goal of creating a sustainable program through state support and innovative financing strategies.