Troubled by a shortage of psychiatrists who specialize in treating the mental health needs of children and adolescents, two organizations with often vastly different agendas have joined forces to issue a call for managed behavioral health care companies to make greater use of psychiatry residents.

In April the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Managed Behavioral Healthcare Association (AMBHA) issued a joint statement supporting the inclusion of more child psychiatry trainees in managed behavioral health care organizations, often referred to as carveouts.

"The compelling reason for this joint effort," the statement explains, "is the documented shortage of child and adolescent psychiatrists coupled with the knowledge that 21 percent of children and adolescents ages 9 to 17 have a diagnosable mental disorder."

The AACAP and the AMBHA point out that both child psychiatry trainees and managed care organizations will benefit by contracts between child psychiatry training programs and the mental health carveout firms. Such contracts, which would involve supervision by the training program and credentialing of residents by the managed care company, "will enable child and adolescent psychiatry residents to participate and gain experience in a managed care network," the two groups point out.

Including psychiatry residents who are receiving intensive training in treating children and adolescents in these networks will provide more children with "the opportunity to receive quality care," the statement says. It goes on to explain that these specially trained psychiatrists are learning the skills and knowledge "in behavioral and pharmacological interventions that are unique and critical to assess, evaluate, and treat children, adolescents, and their families."

The statement emphasizes that in accord with a child psychiatry resident’s training, supervision, and licensing status, "AACAP and AMBHA support [managed behavioral health care organizations’] use of child and adolescent psychiatry residents who are enrolled in accredited training programs." It points out as well that any decisions about which providers to use and credentialing requirements will remain "at the sole discretion" of the managed behavioral health care organization.

Explaining the genesis of the joint statement, Kristen Kroeger, director of clinical affairs for AACAP, told Psychiatric News that the two organizations had for several years contemplated collaborating on an issue of concern to both. In the fall of 1998, AACAP’s Work Group on Health Care Reform and Financing met with a small group of AMBHA’s board representatives. After several drafts, leaders of the two organizations agreed on a joint statement that explained the issue and its remedy to the satisfaction of both constituencies, Kroeger noted.

Pamela Greenberg, executive director of AMBHA, pointed out that the statement does not require AMBHA’s 10 member organizations to increase their use of child psychiatry residents as a condition of membership.

"The statement is a way of saying we’re supportive [of using child psychiatry residents in managed care organizations] and think this is a good idea; that is, that we are giving it our seal of approval." It is up to the managed care organization to decide how or if it will implement the suggested policy change, Greenberg noted.

She added that AMBHA and AACAP plan to collaborate on future issues of joint concern but have not yet decided on their next topic.—K.H.