Colorado is the second fastest-growing state in the United States, yet it is sparsely populated compared to its geographical size, ranking it 37th by population density. Like several western states, Colorado’s Rocky Mountain terrain and number of rural communities combined with a statewide shortage of behavioral health professionals present many challenges to mental health care access, particularly child psychiatry services.
The American Academy of Child and Adolescent Psychiatry reports that Colorado has a severe shortage of child and adolescent psychiatrists, with just 181 statewide to serve 1.2 million children in 2015. As a result, Coloradans are more likely to be seen by their primary care providers (PCPs) than by mental health practitioners. However, PCPs sometimes lack the necessary tools and resources to conduct mental health screenings or prescribe psychotropic medications, often resulting in missed opportunities for early identification and effective mental health treatment.
The Colorado Psychiatric Access and Consultation for Kids (C-PACK) program extends the reach of child psychiatry into primary care settings via expert telephonic consults and training, thereby expanding access to much needed psychiatric and behavioral health care. Enrolled prescribers can refer patients to the program regardless of their type of insurance.
Responding to the critical need for specialty behavioral health care for children across the state, C-PACK began under a Colorado Health Foundation grant in 2013. In January 2016, Beacon began managing the program, funded by Colorado Health Partnerships and covering 43 of Colorado’s 64 counties.
Beacon Vice President of Transformation Lisa Clements, PhD, oversees the program. Dr. Clements also manages innovative programs that address integrated care, long-term services and support, care coordination, care for persons involved in the justice system, and member and family affairs. Christine Andersen, Director of Integrated Care, manages the daily operations of C-PACK.
C-PACK offers an integrated approach to support PCPs in meeting the psychiatric and behavioral health care needs of child and adolescent patients. The program offers telephonic psychiatric consultation, behavioral health care coordination, and practice training to support PCPs in identifying and treating children with behavioral health issues. The C-PACK team also conducts provider training on children’s behavioral health, makes in-person clinic visits, and facilitates psychotropic medication training with the program teleconsultants.
How C-PACK’s Curbside Psychiatric Consultation Works
- Prescribers at enrolled PCP practices call the C-PACK Call Center to request a psychiatric consultation.
- The psychiatrist responds within 30 minutes or the consultation is scheduled at the caller’s request.
- The child psychiatrist provides real-time consultation on a variety of children’s behavioral health topics including, but not limited to: medication questions, screening tools, diagnoses, and treatment considerations.
- Beacon surveys the prescriber post consultation to determine satisfaction and that the services met their needs.
When prescribers obtain psychiatric consultation services, almost 88 percent of those cases remain with the primary care provider for continued treatment (with or without psychiatric medications). Only 12 percent are referred to a psychiatrist. It is important to note that the cases that remained with the primary care practice include patients that may not have psychotropic medications prescribed and the consultation may advise whether it is appropriate to start the medications.
How C-PACK’s Behavioral Health Coordination Works
- Beacon provides behavioral health and/or community referrals as requested through the PCP.
- The care coordinator works with the family directly to identify their needs and any specific requests for providers.
- The coordinator locates providers who fit the family’s needs, take the family’s insurance, and have openings for new patients.
- The coordinator then contacts the family and provides them with three provider options so the family can choose who best suits their needs.
Focus on El Paso County
Because local agencies often struggle with finding a Medicaid provider who accepts new patients and meets their specific needs, Andersen and her team work closely with the Department of Human Services to link children in the foster care system with integrated primary care practices and/or those who have enrolled in C-PACK.
This is particularly true in El Paso County, the Colorado county with the most residents and the highest volume of child welfare cases. Beacon meets biweekly with County staff on appropriate utilization of Medicaid benefits, allowing the County to use its funding for other services and best meet our members’ needs. We also collaborate with El Paso and Teller Counties to conduct Medicaid coding and billing practice trainings for those providers who treat the child welfare population.
Andersen explains that PCPs are frequently the first to address patients’ behavioral health concerns. “By educating and supporting them through C-PACK,” she says, “they are better equipped to meet the needs of our child and adolescent members.”
Therefore, when children need non-acute services, their case workers can refer them to these primary care practices rather than to the overburdened Community Mental Health Center. This way, Beacon helps increase engagement in needed services and minimize wait times for behavioral health support.
“I have a passion for the child welfare population because these youth have already experienced trauma in their lives and are dramatically underserved,” says Andersen. “Beacon brings all these resources together in a meaningful way, which helps the case worker, the child, and the family get the help they need, when they need it.”
Andersen further explains that supporting children in the foster care and child welfare systems is not solely the responsibility of the Department of Human Services. Rather, the entire delivery system shares responsibility for engaging this vulnerable population in much needed services because eventually, she says “These children will become contributing adults within our community.”
C-PACK by the numbers (2016)
|Estimated Service Area Youth Population||500,000|
|Number of Calls||714|
|Practices Enrolled FY16||67|
|Providers Enrolled FY16||137|
|Team Composition||1 Program Manager
1 Program Coordinator
1 Support Specialist
4 Contracted Teleconsultants
PSYCHline for Adult Patients
In addition, Beacon administers the PSYCHline, which started as a small pilot program in partnership with the Center for Mental Health on the western slope of Colorado. Similar to C-PACK, the PSYCHline offers psychiatric consult for rural PCP offices serving adults in six rural/frontier areas. Often, these patients drive more than an hour to visit their primary care setting; the PSYCHline offers them the opportunity to receive both physical and behavioral health care in one convenient visit.
What Providers Say
- “Great review (depression training) and new info and improved screening tools to help patient care.”
- “I was called back in about 15 minutes from my request for consult. It was an informative and helpful call.”
- “Consultation was awesome, very helpful for me as the treating PCP and for the family.”
- “As always, I am a huge fan of C-PACK and am very grateful for all of the help over the years.”
Hours of Operation
The C-PACK and PSYCHline call center is available Monday-Friday, 8 a.m. – 5 p.m. Callers can also leave a voicemail, with a guaranteed response the following business day. For more information about these programs, visit www.cpack.org.