Funded Projects

Problem:

A factor contributing to the gap between identifying and treating children's behavioral health disorders is the need for more services or treatment options in Guam. There is a lack of growth in the workforce for child psychiatrists, developmental-behavioral pediatricians, advanced practice nurses in psychiatry or mental health, and child psychologists. The outlook for these professionals and their availability in Guam is even more dire. There are no locally based developmental-behavioral pediatricians or advanced practice nurses in psychiatry or mental health. The U.S. currently has 9.75 child psychiatrists per 100,000 children aged 0 to 19, a rate considerably lower than the recommended 47 child psychiatrists per 100,000. Guam continues to prioritize the recruitment of psychiatrists for Guam. However, recruitment for clinical professionals has historically been challenging within the territory and recently exacerbated by the COVID- 19 pandemic. Healthcare access and barriers are also relevant to understanding and addressing mental and behavioral health in Guam. In particular, the island's geographical isolation may limit expedient access to specialty mental healthcare and other specialty care essential for detecting and addressing risk drivers. While mental healthcare services are available in Guam (SEOW, 2021), local media reports have indicated concerns regarding the need for more psychiatric providers in Guam. For specialty healthcare offered outside of Guam (e.g., via telehealth or in-person), healthcare providers may be unfamiliar with cultural considerations germane to effectively providing care. Moreover, cultural norms (e.g., respect for older adults), attitudes (e.g., stigma), and beliefs (e.g., religious) regarding mental health may pose additional barriers to accessing services. The Guam Pediatric Mental Health Care Access Project will work to address this multi-faceted issue.

Goals and Objectives:

Goal 1: Establish and develop infrastructure to conduct behavioral health teleconsultation service for pediatric primary care providers. Goal 2: Conduct relevant pediatric behavioral health trainings for primary care providers, including trainings on referral pathways. Goal 3: Monitor, evaluate and engage in continuous quality improvement activities.

Methodology:

The Guam Pediatric Mental Health Care Access Program (GPMHCAP) will build upon existing infrastructure to promote behavioral health integration into pediatric primary care. This program will be implemented by the island's Department of Public Health and Social Services (DPHSS) in partnership with Guam Behavioral Health and Wellness Center (GBHWC). The goal will be to reduce healthcare disparities by creating greater accessibility to meaningful training and consultative information on pediatric behavioral health for primary care providers. This GPMHCA proposal seeks to establish and develop the capacity to provide pediatric primary care providers with synchronous and asynchronous pediatric behavioral health consultation and training resources via telecommunications mechanisms. To accomplish this goal, the GPMHCA program will develop a startup and implementation plan at the direction of an established Advisory Board. The Advisory Board shall consist of DPHSS, GBHWC, community clinics, and private pediatric primary care physicians. A collaborative committee will facilitate Program planning and implementation involving DPHSS, including related Title V program staff, GBHWC, related psychiatrists, or other children behavioral health provider staff. DPHSS is the State Health Care Authority and key stakeholder responsible for existing telehealth and telecommunications infrastructure. GBHWC is the State Mental Health Authority and key stakeholder responsible for overseeing the implementation of behavioral health services on the island.

Coordination:

To address the challenges in under-identification and treatment access for children with mental or behavioral concerns, the project team will work to address developing clinic policies to standardize screening and treatment options and referrals, provider training and consultation needs, and expand capacity for case management and/or service coordination for children identified.

Evaluation:

The GPMHCAP has adopted the conceptual model recommended by the Centers for Disease Control and Prevention (CDC) which shows 6 iterative steps that govern effective program evaluation.