Examining Practice Change Among Primary Care Providers Using a Child Psychiatry Access Program.

Objective: Child Psychiatry Access Programs (CPAPs) address the mental health treatment access gap by providing training, consultation, and referral support to primary care providers (PCPs). Research has documented provider use of and satisfaction with CPAPs, but less work has examined how usage relates to provider practice change. This qualitative study examines PCPs' perceptions about the use of CPAP services (i.e., consultations, referral support, training) and resulting changes in their practice behaviors.

Methods: The population of CPAP users was purposively sampled based on variation in geography and frequency of use: frequent (N=16), moderate (N=10), and infrequent (N=11) users. Semi-structured interviews were conducted with 37 providers. PCPs were asked about their use of CPAP services, and if/how these services influenced patient care and practice change. Interviews were recorded, transcribed, and analyzed using content analysis.

Results: Regardless of frequency of CPAP use, all providers indicated medication management and need for patient referrals as primary reasons for calling the CPAP. All providers described practice change behaviors, with increased confidence/comfort in providing mental health care and medication management identified predominantly by frequent users. Providers consistently reported a positive attitude toward CPAP consultations.

Conclusions: Providers perceive CPAP services as helpful and related to improvements in their ability to address patient mental health needs. Providers reported making changes to their practice behaviors, regardless of their level of CPAP use. This study provides preliminary support that participation in CPAP services contributes to improved PCP practice in addressing child mental health concerns.