Thinking Outside the Box to Stretch Resources

The collaboration between psychiatrist Judith Koontz, M.D., and the pediatric practice at PeaceHealth in Bellingham, Wash., has parallels elsewhere, but not enough, according to child psychiatrists (see Pediatricians Gain 'Safety Net' Through Psychiatric Consults).

“This is a common practice today, but we'd like it to be more common,” said Kristin Kroeger Ptakowski, director of government affairs and clinical practice at the American Academy of Child and Adolescent Psychiatry in Washington, D.C., in an interview.

As examples, she cited a model in North Carolina in which psychiatrists and primary care physicians work out of the same office, a Massachusetts program that places child and adolescent psychiatrists from the state's medical school on call for phone conversations during the workday, and several programs in Minnesota.

At St. Cloud Hospital/CentraCare in St. Cloud, Minn., for instance, child psychiatrists are developing an electronic screening program for introduction in January. Initially, the program will be used at well-child visits. The age range of children handled by the program will be expanded until eventually adults are included as well, said child psychiatrist and pediatrician L. Read Sulik, M.D., the hospital's medical director. Sulik also holds regular consultations with pediatricians in the hospital.

The same hospital has adopted a program called DART—Diagnostic Assessment for Referral and Triage—run by therapists who can decide which patients need a more comprehensive evaluation and can schedule them into protected blocks of time held open each week. She sees 300 to 450 patients a year, and only 20 percent need to see the child psychiatrist.

“In the past, all of them would have gone on a waiting list, so now we are using our time much more efficiently,” said Sulik. “The triage therapist is critical. Many patients can be referred back to the pediatrician with recommendations for treatment, but they can also refer back to us if needed.”