O3212: Early Childhood Expansion of the Virginia Mental Health Access Program (VMAP)

Background: Developmental, behavioral, and social-emotional concerns are common in young children, yet there is a severe workforce shortage of developmental-behavioral pediatricians (DBPs), child and adolescent psychiatrists (CAPs) with early childhood (EC) expertise, and other mental health providers. The Virginia Mental Health Access Program (VMAP) is a statewide initiative founded in 2018 to address mental health access barriers for children through age 21 via tele-psychiatric consultation, care navigation, and provider education. In 2022, VMAP received support to expand services for children from birth through 5 years, including adding DBPs and CAPs with EC expertise to the consultation line, a specialized EC care navigator and licensed mental health professional, and targeted provider education opportunities focused on EC.

Methods: This is a descriptive study to evaluate VMAP EC expansion efforts for 2022-2024, including numbers of calls, primary concerns of callers, recommendations of consultants, and outcomes from provider education and training programs. Provider education and training included monthly meetings of Project ECHO cohorts focused on EC behavioral health clinical practices and connections to community services. In 2023 there was a new cohort that was accredited in Level 3 (primary care) Triple P (positive parenting program). Provider surveys were administered before and after each cohort to measure changes in knowledge, confidence and behavior related to EC screening, diagnosis, and referral to services.

Results: Since VMAP’s launch, 353 consultations and 465 care navigation referrals have occurred for children 0-5 years old. The proportion of calls for young children has increased since launching EC expansion, from 7.5% overall before 2023 to 10.8% in 2023. Calls regarding children 0-5 years have disproportionately been related to concerns about autism, disruptive behaviors, and child maltreatment, compared to concerns for older children. A majority of calls for EC have been for 4- and 5-year-olds (69%). Among participants in EC-focused VMAP education and training (n=70), 71.4% were physicians, and a majority (73-94%) in each cohort reported that the training was very or extremely helpful in increasing use of validated screening tools, improving ability to diagnose mental health symptoms in young children, and increasing knowledge about community systems. In the systems of care training cohort, 64.7% reported increased referrals of families to community services, and in the Triple P cohort, 89.5% of providers reported feeling confident or very confident to conduct evidence-based parent training.

Conclusion: VMAP is a statewide model that has built a sustainable tele-psychiatry program and expanded to include training for child-serving providers and specialized services for children from birth through age 5 years. Along with increases in calls for young children and positive evaluations from providers about trainings, it will be important to measure child- and family-level outcomes in future studies.