By Ujjwal Ramtekkar, MD, MBA, CPE
Medical Director of Virtual Care, Department of Psychiatry and Behavioral Health at Nationwide Children's Hospital
Associate Medical Director, Partners for Kids
There are not enough psychiatric professionals to care for the children who need our help. Any number of peer-reviewed studies has shown this, and I know it from my personal experience in Ohio, where many counties don’t have a physical presence of pediatric psychiatrists. Young people are placed on waitlists to see specialists; some never get the treatment they should. This is a huge concern for equity in access to behavioral health services and barriers related to social determinants of health.
At Nationwide Children’s Hospital, we believe that some of the necessary behavioral health care can be provided by primary care providers. Those providers are often hesitant, however, because they don’t feel they have the adequate training they need, or they worry that they will encounter challenges after they start managing patients, including the absence of ongoing support.
So for the last few years, Nationwide Children’s has offered innovative, technology-enabled initiatives to empower community providers to help their young patients with behavioral health issues. Our primary goal is to improve local capacity so that access for these kids is not determined by their zip codes.
We’ve recently reached some milestones suggesting that not only are our models working, but they might work for other regions and health systems, too.
Project ECHO (Extension for Community Healthcare Outcomes) is a learning collaborative that uses a hub-and-spokes model for case-based group education. A multidisciplinary team of behavioral health and primary care professionals at Nationwide Children’s are the hub, and community providers are the spokes. Over the course of many weeks, community providers present cases from their own work, especially ones that continue to present challenges.
Their fellow providers and Nationwide Children’s experts discuss the cases, ask questions, and provide recommendations. A typical Project ECHO cohort has no more than 15 participants, so everyone participates and learns together.
Project ECHO began in 2019, and we have just launched our 21st ECHO cohort for primary care providers. In total, we have trained 120 community pediatric practices in 44 Ohio counties and four other states. Children in those areas now have better access to behavioral health services because their local providers can manage them.
This year, a new effort to help primary care providers began. Called Behavioral Health Treatment Insights and Provider Support, or BH-TIPS, it is a 5 day-a-week, on-demand, virtual consultation service for community providers. Nationwide Children’s psychiatrists are available for 15-minute windows to discuss everything from mental health screenings to prescription recommendations.
The initiative is built on the phone-based Child Psychiatry Access Projects that now operate in more than 20 states, but we have added a number of enhancements, including video. In just a few months, we have conducted 100 provider consultations in 16 Ohio counties. More than 90% of those consultations have allowed the community providers themselves to provide care without referring their patients to specialty child psychiatry services.
Project ECHO and BH-TIPS are part of an ongoing strategy for Nationwide Children’s Behavioral Health Services. We undertook an assessment to understand what providers need; we introduced ECHO so they could receive training; and we have launched BH-TIPS to address their case-by-case concerns. We envision other initiatives that will further empower them to manage behavioral health issues in their practices.
Some children need specialized behavioral health care, and my colleagues and I remain committed to them. But Project ECHO, BH-TIPS and other initiatives multiply what we are able to accomplish in the community – and they give confidence to primary care providers to address an unmet need in their practices.