Skip to main content

West Virginia Targets Crowded ERs With New Pediatric Behavioral Health Program

Analysis  |  By Eric Wicklund  
   August 24, 2023

Coordinated by Community Care of West Virginia and Aetna Better Health for West Virginia, the program will provide on-demand emergency psychiatric care and care coordination for children and adolescents within 24 hours.

A new program being launched in West Virginia aims to give children access to in-person or virtual emergency psychiatric evaluations within 24 hours.

The Critical Access to Pediatric Psychiatry (CAPP) WV program is being launched by Community Care of West Virginia, a federally qualified health center serving some 50,000 patients across 17 community health centers, 51 school-based healthcare sites and seven pharmacies, along with Aetna Better Health of West Virginia, part of the CVS Health portfolio. Aetna Better Health of West Virginia is providing $1.5 million to support the new program.

The program aims to reduce the number of children and adolescents seeking emergency behavioral healthcare in ERs—a significant care gap affecting health systems not only in West Virginia but across the country—and direct children to the right resources within the state. West Virginia's health department is currently under a federal mandate to improve services for at-risk children, including those in foster care, following a Justice Department investigation that found more than 300 children in group residential care and psychiatric facilities outside the state, due in part to a shortage of in-state resources.

“We’re always working to improve access to essential pediatric psychiatric assessments for children and families in West Virginia, regardless of their location,” Kathy Szafran, executive director of Aetna Better Health of West Virginia's Mountain Health Promise program, said in a press release. “Due to limited availability of adolescent psychiatrists, children experiencing a behavioral health crisis can spend significant time in the emergency room waiting to be evaluated."

"With the coordination between Community Care and Aetna, we can now offer a virtual pediatric psychiatric evaluation anywhere in West Virginia usually within 24 hours," she added. "In conjunction with the Aetna care coordination team and Critical Access to Pediatric Psychiatry, the needed assessment and care coordination for ongoing services can be available throughout the state for under-resourced children. The goal is to get children assessed, level of care identified, and appropriate services coordinated as soon as possible. Our current outcomes are promising, keeping children with family and with the services needed.”

Along with in-person and telehealth-based care, the program will also establish a mobile mental health clinic that can be dispatched as needed to underserved communities.

CAPP WV could be a model for many states and healthcare organizations that have been dealing with a surge in ER traffic since the pandemic. Roughly half a million children are evaluated for behavioral health concerns in emergency departments each year, according to the American Academy of Pediatrics, and as little as 20% are getting the help they need, including adequate follow-up care and the right medication.

CAPP WV addresses four key pain points. As described by officials, they are:

  • On-demand access for Aetna members to specialized pediatric psychiatry services. The program will work with pediatricians and primary care providers to provide on-demand behavioral health services for Aetna members.
  • Timely psychiatric evaluations in emergencies. In situations where in-person psychiatric care is unavailable, the program will expedite psychiatric evaluations within 24 hours, including through virtual care.
  • Support for small rural healthcare providers. The program will offer ER consults and follow-ups for small rural healthcare providers who lack access to their behavioral health and/or pediatric specialists, giving them access to the resources they need to treat more of their patients instead of directing them elsewhere.
  • Ensuring connected care. For children and adolescents with medication needs who are placed on waitlists, the program will coordinate care management with established behavioral health providers to continue the care pathway.

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.


KEY TAKEAWAYS

Health system ERs have been inundated with young patients in need of emergency behavioral healthcare services since the pandemic, and many of those patients aren't getting the care they need.

A West Virginia FQHC is teaming up with a payer to create a program that meets those needs within 24 hours, either in-person or through telehealth.

The program could serve as a model for other states and healthcare organizations looking to address the care gap for children and adolescents, improving both access and care management.


Get the latest on healthcare leadership in your inbox.