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New Jersey Minds the Gap Between Symptom Onset and Intervention

When behavioral and mental health treatment is delayed for children and adolescents, disorders become more difficult and costly to handle. Yet, the average delay between the onset of symptoms and intervention is eight to 10 years, in part because of a nationwide shortage of child and adolescent psychiatrists.1

To increase early identification and close the intervention gap, New Jersey is one of many states working to integrate mental health services with primary care.

Practicing Child and Adolescent Psychiatrists by NJ County“Our state, depending on which county you look at, has either a high shortage, a severe shortage, or no child and adolescent psychiatrists,” says Harriet Lazarus, MBA, Chief Operating Officer of the New Jersey Chapter of the American Academy of Pediatrics (NJAAP). “This problem is not going away anytime soon.”

With support from the New Jersey Department of Children and Families, the NJAAP collaborated with Hackensack Meridian Health, Cooper University Health Care, Atlantic Health Systems, and other partner hospitals to build the Pediatric Psychiatry Collaborative (PPC). The collaborative aims to:

  • Increase mental/behavioral health screening in primary care settings;
  • Provide pediatricians with quick access to psychiatric consultation and evaluations for patients when needed;
  • Assist pediatricians with care coordination; and
  • Refer families to community services as needed.

New Jersey AAP staff

“Pediatricians might not have the resources, time, or comfort level to screen or treat behavioral and mental health issues,” says Marcella Betzer, MPH, Program Director of NJAAP’s Mental Health Collaborative MOC Part 4 Program. “It’s often not something they learned in medical school. And many practices don’t have the ability to hire a child psychologist or a social worker.”

To implement the goals of the PPC, the partners established eight regional mental health “hubs” in 20 counties. A ninth hub, located in Essex County and managed by Rutgers University Behavioral Health Care, means that every county in New Jersey has access to an integrated child mental health delivery system.

“Hubs have two purposes,” says Lazarus. “They provide a direct service to children who have immediate behavioral or mental health needs, and they coordinate care for other children by connecting their families to appropriate community services.”

For example, a hub psychiatrist might provide a one-time evaluation of a child at no charge to the patient or assist a primary care pediatrician with diagnostic clarification or medication management.

To increase behavioral and mental health screening in primary care settings, clinicians who participate in a regional hub agree to conduct behavioral and mental health and substance use screenings at all well visits, submit a weekly screening log, and complete demographic surveys. They also are encouraged to view monthly webinars and participate in an optional, ABP-approved, Quality Improvement (QI) Maintenance of Certification (MOC) Part 4 program to support their continuing certification (see story).

“The PPC offers an efficient pathway for children to receive the behavioral or mental health services they need,” says Lazarus. “PPC participation increases the capacity of practices to provide care, and then families feel their primary care office is a trusted place where they can share their concerns.”

In the last four years, more than 500 pediatricians or pediatric clinicians have participated in the PPC by screening about 146,000 patients. Nearly 9,000 of those screened needed support from one of the hubs. 

1Workforce Issues. American Academy of Child & Adolescent Psychiatry website. Accessed December 3, 2019.
Photo: NJAAP staff attend a collaborative learning session. From left to right: Kyle Shupp, Harriet Lazarus, Marcela Betzer, Krista DeFilipo, Lindsay Caporrino, and Bethany Kondavaty. Photo by Andrew Miller Images.