The PATHS program at Children’s of Alabama is helping connect patients with mental health providers more quickly.
The United States is experiencing a crisis regarding children’s mental health, with many emergency rooms overwhelmed with urgent mental health visits.1 Adding to the crisis, said Children’s of Alabama child psychiatrist Vinita Yalamanchili, M.D., is a severe shortage of pediatric psychiatrists and other mental health providers, particularly in rural areas.
“The mental health needs of children have increased exponentially,” she said. “There’s just no way we can match those needs.”
Pediatric Access to Telemental Health Services (PATHS) at Children’s is designed to address both issues. The program is dedicated to increasing primary care providers’ ability to diagnose, treat and manage mild-to-moderate behavioral health conditions in children and adolescents.
“It can take three to six months to see a therapist or psychiatrist,” Yalamanchili said. But waiting that long for treatment means kids in crisis are at risk of self-harm. With PATHS, they can get expert care from their primary care provider, often within 24 hours.
Primary care practices enroll with the program and receive access to the PATHS team, which includes child/adolescent psychiatrists and psychologists, psychiatric nurse practitioners, licensed clinical social workers and licensed professional counselors. In return, they agree to start behavioral health screenings for well-child visits and report results to PATHS; participate in one-hour, bi-weekly educational sessions on pediatric and adolescent mental health issues; and maintain ongoing responsibility for their patients’ behavioral health care and treatment.
Providers call PATHS when they have a patient who needs additional assistance. After an initial consult with a social worker, they are directed to the most appropriate team member to help. Yalamanchili, for instance, is usually the point person for medications. “I will tell the provider exactly how to prescribe the medicine and give them different options,” she said. For children who don’t need medication, the provider may talk to an early development specialist or a psychologist for information about topics like sleep training or behavioral management.
“You’re providing a consult for the provider to assist them in helping this child,” Yalamanchili said.
If the child needs more intensive care, they can interact directly with one of the PATHS specialists from their primary care office via telehealth. “This allows a patient not to have to come to Birmingham to see us,” she said. “It’s a really nice bridge until a local psychiatrist can see them.”
Initially founded to help rural practitioners, PATHS now works with providers throughout the state, even those just a few miles away. “They have the same waiting time of three to six months for psychiatric care,” Yalamanchili said. PATHS can continually extend its reach, she said, because as providers gain more education and confidence, they need fewer consults, freeing space for more practices.
“Because we also provide education, I think a pediatrician may not call me for a while because they’ll say, ‘Well, you’ve taught me enough that now I feel comfortable doing this on my own,’ ” she said.
The PATHS team also provides information about mental health specialists in the practice’s area.
“It’s actually one of my favorite jobs, because I am providing care very quickly to children,” Yalamanchili said. “And the pediatricians are just so grateful for these services.”
- Sorter M, Stark LJ, Glauser T, McClure J, Pestian J, Junger K, Cheng TL. Addressing the Pediatric Mental Health Crisis: Moving from a Reactive to a Proactive System of Care. J Pediatr. 2023 May 13:113479. ↩︎
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