Navigating the complexities of pediatric healthcare can be particularly challenging when it comes to mental health. For primary care physicians in Rhode Island, “Ocean State Pediatrics Ri Doctors,” the need to address anxiety, depression, and ADHD in young patients is increasingly pressing. Imagine having immediate access to expert psychiatric consultation to confidently manage these cases. This is the reality provided by the Pediatric Psychiatry Resource Network (PediPRN), a vital hotline connecting Rhode Island’s pediatricians with child psychiatrists. However, the future of this crucial service hangs in the balance as its funding source nears expiration.
For doctors in primary care, the breadth of medical knowledge required is vast. While residency provides a strong foundation, specialized areas like pediatric mental health often require additional expertise. Consider a scenario: a young patient presents with symptoms that could indicate anxiety, depression, or another mental health condition. A primary care physician, dedicated to providing the best care, may feel uncertain about the most appropriate course of action.
This is precisely the gap that Bradley Hospital, Rhode Island’s leading psychiatric hospital for children and adolescents, sought to address with the creation of the Pediatric Psychiatry Resource Network (PediPRN) in 2016. PediPRN offers a direct line of communication between children’s primary care physicians (PCPs) and pediatric psychiatrists. This streamlined consultation process is invaluable, particularly when PCPs are considering prescribing psychiatric medications that may be less familiar to them.
Dr. Alison Manning, a child psychiatrist affiliated with Hasbro Children’s and Bradley Hospitals, is among the specialists who answer calls to the PediPRN hotline. “Certainly, we don’t want PCPs to feel uncomfortable and prescribe medications that they’re not familiar with,” Dr. Manning explains. “Our main role is to support them in prescribing things that they feel comfortable with.”
In 2022 alone, PediPRN extended its reach to 71 medical practices and supported 425 primary care pediatricians across Rhode Island, according to Lifespan, the health network encompassing Bradley Hospital. That year, the hotline facilitated 209 consultations initiated by 65 physicians. The most prevalent concern was anxiety, accounting for 51% of cases, followed by ADHD at 34%. Depression and autism spectrum disorders represented 20% and 12% of diagnoses, respectively.
Dr. Alison Manning is available to provide phone consultations with pediatric primary care physicians.
Dr. Manning notes that PediPRN primarily assists pediatricians in managing common conditions like anxiety, ADHD, depression, and autism spectrum disorders. This often involves guidance on medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) for depression and anxiety, or stimulant medications for ADHD.
Dr. Suzanne McLaughlin, a pediatric primary care physician within the Lifespan network in Providence, highlights the empowering effect of PediPRN. “This is a chance to know you’re responsible for it and feel like you’re doing it intelligently, competently,” she states. “It makes you much more likely to raise questions, if you’re not scared of the answers people are going to bring you. You have an idea of what you can do.” This support system builds confidence and competence among “ocean state pediatrics ri doctors” in addressing mental health needs.
The Urgent Need for Pediatric Mental Health Support in Rhode Island
The PediPRN service is particularly critical in the current landscape of children’s mental health. Data from KIDS COUNT in 2022 revealed that 19% of Rhode Island children aged 6-17 were facing a diagnosable mental health challenge. This underscores the significant demand for accessible and effective mental health services for young people in the state.
Both primary care and specialized psychiatric services in Rhode Island are facing strain. Between October 2021 and September 2022, Bradley and Butler Hospitals, the state’s major psychiatric facilities, provided outpatient care to 1,832 children and adolescents. Inpatient services saw 1,194 admissions during the same period, with the majority of stays lasting at least nine days. Partial hospitalization programs accounted for an additional 1,495 visits. These figures demonstrate the heavy burden on the existing mental health infrastructure.
Senator Alana DiMario, representing Narragansett, Rhode Island, is a strong advocate for PediPRN. “If you think about the logistics of how to service our population adequately, how many more full-time psychiatrists we would need to recruit and retain to work in Rhode Island to replicate this program’s level of access, it would be unbelievably difficult to do that,” she emphasizes. “And I don’t know that we could. I don’t know what the incentive program would need to look like to be able to make that happen.” Senator DiMario recognizes the efficiency and reach of PediPRN as a vital resource for “ocean state pediatrics ri doctors.”
Funding Uncertainty Threatens PediPRN’s Future
Senator DiMario’s enthusiasm is coupled with a concern: the potential disappearance of PediPRN. Since its inception, the program has relied on a patchwork of grant funding. While PediPRN is a free service for patients, it is not without cost to the state. In 2023, the Rhode Island Department of Health (RIDOH) secured a crucial grant from the federal Health Resources and Services Administration (HRSA), providing $850,000 annually through September 30, 2026. This funding lifeline ensures the continuation of the program for the immediate future.
However, the question remains: what happens when this grant funding expires? “As of right now, there is no source of sustainable funding when this grant cycle ends,” confirmed Joseph Wendelken, a RIDOH spokesperson, highlighting the precarious nature of the program’s long-term viability. This funding gap poses a significant threat to the continued availability of this essential service for “ocean state pediatrics ri doctors” and their patients.
Beyond the Hotline: Training and Collaboration for Pediatricians
PediPRN’s impact extends beyond the consultation hotline. The program also offers intensive training opportunities for physicians seeking deeper knowledge in pediatric mental health. These training sessions provide a valuable platform for primary care doctors to engage in expert-led discussions on best practices within this specialized field. Dr. McLaughlin was among the physicians who completed a year-long training cohort, attending monthly sessions to enhance her expertise.
Kelly Brennan, a spokesperson for Lifespan, noted the ongoing commitment to training, with a new cohort of primary care doctors commencing in January. “I think what is interesting is that this model is a partnership that everyone agrees is working! Which is rare, unfortunately,” Brennan stated, underscoring the collaborative and effective nature of PediPRN.
The historical challenges in structuring and coordinating mental healthcare are well-documented. PediPRN represents a successful model of collaboration, leveraging the expertise of child psychiatrists to support primary care physicians. While not designed to replace specialized psychiatric care or address severe cases, PediPRN plays a crucial role in early intervention and management of common mental health conditions within primary care settings.
“Certainly, we don’t want PCPs to feel uncomfortable and prescribe medications that they’re not familiar with. Our main role is to support them in prescribing things that they feel comfortable with.” – Dr. Alison Manning, Child Psychiatrist
RIDOH data from 2023, encompassing both PediPRN and MomsPRN (a similar program for postpartum and pregnant women), reveal the significant reach of these initiatives. Together, they have facilitated 4,061 phone consultations involving 3,032 patients, across 877 doctors and 329 physician offices since 2016.
Despite the relatively small number of child psychiatrists directly staffing the PediPRN hotline – five specialists in child and adolescent psychiatry – Rhode Island demonstrates a strong per-capita density of child psychiatrists. Data from the American Academy of Adolescent and Child Psychiatry indicated that in 2018, Rhode Island had 39 child psychiatrists per 100,000 children, ranking third nationally in child-psychiatrist-to-child ratio.
PediPRN’s strength lies in its ability to leverage the existing network of primary care physicians. Dr. McLaughlin emphasizes the importance of the established patient-physician relationship. Families often feel more comfortable discussing sensitive mental health concerns with a familiar pediatrician. “A lot of people are very reasonably worried about medications with children,” she notes, highlighting the trust placed in primary care doctors.
While referrals to psychiatrists remain an option, the wait times can be substantial, often extending to six months. PediPRN empowers “ocean state pediatrics ri doctors” to initiate timely interventions. “I can start that child’s treatment and therapy well before I would have ever been able to do it,” Dr. McLaughlin explains, contrasting it with the alternative of “painfully watching at the sidelines.” Any physician registered with PediPRN can readily access the hotline for consultation, regardless of prior training participation. “The consultation is available to any primary care provider in the state of Rhode Island, regardless of if they’ve taken the [training] course. Many of them call our line,” Dr. Manning confirms.
Learning from Massachusetts: A Model for Sustainable Funding
Rhode Island is not alone in recognizing the value of psychiatric resource networks. A 2021 article in the journal Pediatrics highlighted that Rhode Island was the 32nd state to implement such a network, following the lead of Massachusetts. The Massachusetts Child Psychiatry Access Program (MCPAP), established in 2004, served as the pioneering model, with numerous states subsequently adopting similar programs.
However, the Pediatrics article also points out a common challenge: “funding uncertainty is not unique to Rhode Island.” The reliance on grants and short-term funding mechanisms leaves these programs vulnerable to discontinuation when grants are not renewed.
Massachusetts offers a potential solution. MCPAP is primarily funded by the Massachusetts Department of Mental Health, supplemented by contributions from major commercial insurers in the state. This diversified funding model provides greater stability and sustainability.
Senator DiMario proposes a similar approach for PediPRN, drawing inspiration from the funding mechanism for pediatric vaccinations in Massachusetts. “One of the really cool things about this model is that, the way we have it set up in this bill, is that it’s funded similar to how we fund pediatric vaccinations,” Senator DiMario explains. “Which is just a really small assessment on private health insurance policies. So this is not money that comes out of the state budget. This is a very, very nominal assessment on every private insurance policy.”
This proposed funding model has garnered support from private insurance companies, recognizing the value of PediPRN in improving healthcare access and outcomes. Crucially, access to PediPRN would remain universal, regardless of insurance status. “If you have a child who’s on Medicaid, their pediatrician can still access their hotline. They don’t have to be encumbered by the limitations of whatever [that] person’s insurance plan is,” Senator DiMario emphasizes, highlighting the equity-focused design of the funding proposal.
Rich Salit, spokesperson for Blue Cross & Blue Shield of Rhode Island, confirmed their ongoing financial support for PediPRN, with annual contributions since 2019 totaling $225,000 by 2023. This year, an additional $170,000 is allocated from the Executive Office of Health and Human Services, supplementing the federal grant.
Senator DiMario, along with nine other senators, introduced a bill on January 12th to amend state healthcare funding and establish a dedicated “PRN account” for PediPRN, MomsPRN, and future resource networks. A companion bill was introduced in the House on January 17th, demonstrating bipartisan support for securing the future of PediPRN.
The legacy of the late Senator Maryellen Goodwin, a strong advocate for healthcare access, particularly for women and children, is also interwoven with this effort. Senator DiMario notes that expanding access to healthcare was a central focus of Senator Goodwin’s work.
PediPRN’s impact extends to addressing inequities in mental healthcare access. Dr. McLaughlin emphatically believes in its role in promoting equity. “I feel like it does. I actually emphatically think that,” she states. “We have extraordinary resources, and they’re still not enough to meet the needs.”
Dr. Manning emphasizes the increasing demand for mental health support for children. “The children’s mental health crisis has been increasing. … Providers that left training 10 or 20 years ago, they didn’t experience this level of distress in their patients and they weren’t trained for it.”
Ensuring the continued operation of PediPRN is a critical step in addressing this growing crisis. The bill introduced by Senator DiMario and her colleagues represents a vital effort to secure sustainable funding for this essential resource, ensuring that “ocean state pediatrics ri doctors” can continue to provide comprehensive and timely mental healthcare to the children of Rhode Island. The future of PediPRN, and the mental wellbeing of countless children, now rests on securing this stable funding stream.
