Behavioral and mental health disorders have surpassed physical health problems as the leading causes of extremely chronic illness and death in children and teens. But less than 25 percent of the 15 million affected children and youth receive any treatment because of the severe shortage of child psychiatrists and other mental health care providers, including child-family psychiatric and mental health nurse practitioners (CFP/MHNPs), according to the American Psychological Association (APA).

The ASU College of Nursing & Healthcare Innovation has launched an innovative educational program to help meet this critical health care need.

The Healthcare Resources and Services Administration (HRSA) has funded a nearly $1 million, three-year project at the ASU College of Nursing & Healthcare Innovation to establish the 16th family psychiatric nurse practitioner program in the nation, consisting of three online educational options, says Bernadette Melnyk, dean of the ASU College of Nursing & Healthcare Innovation, who is the project director.

According to American Association of College of Nursing data, child family psychiatric nurse practitioners comprise the smallest group of nationally certified psychiatric mental health advanced practice nurses in the United States, with just 487 in comparison to the other psychiatric advanced practice nursing specialties, including adult psychiatric clinical nurse specialists (CNS), 7,023; child psychiatric CNS (990), and adult psychiatric NP (1,501). Child psychiatric clinical nurse specialists and family psychiatric nurse practitioners comprise 14 percent of all nationally certified psychiatric nurse practitioners. In Arizona, there are 2,624 active NPs, of which 165, or 6 percent, are psychiatric NPs.

Because of the inadequate numbers of child mental health providers, pediatric primary care providers (PCPs), such as pediatric nurse practitioners and pediatricians, are having to assess and manage common behavioral and mental health disorders in children and teens. PCPs typically report inadequate knowledge and skills in these areas, which creates an urgent need to prepare more CFP/MHNPs, PNPs and family nurse practitioners (FNPs) with advanced skills so they can be more effective in screening for and implementing early evidence-based interventions for youth with common mental health disorders.

Needs of children and teens in Arizona

Arizona is experiencing tremendous growth, including children age 19 and younger. Its Hispanic population is one of the largest in the nation, which presents multiple challenges for the health care infrastructure. The psychiatric physician-to-population ratio in Arizona is 12 child psychiatrists per 100,000 members of the population, compared to the U.S. ratio of 16.5 per 100,000. In 2004, there were 134 child psychiatrists practicing in Arizona. Seventy-six percent of Arizona child psychiatrists practice in its two largest counties, creating a disparity of care in rural areas. Five of 15 counties have no child psychiatrists. Substantial health disparities also exist in the receipt of mental health services, with a disproportionate number of Hispanic and African-American children affected.

ASU nursing answers need

To address the gap in mental health services for children and teens, the ASU College of Nursing & Healthcare Innovation has established three new enhanced online educational paths. The three online offerings include:

• A 15-credit child and adolescent mental health intervention graduate and post-master’s degree certificate.

• A 44-credit post-master’s degree to Doctor of Nursing Practice CFP/MHNP program (fall 2009 admission).

• An 84-credit post-bachelor’s degree to Doctor of Nursing Practice as a Child-Family Psychiatric Nurse Practitioner.

“The first educational option, the graduate certificate, is designed to attract an interdisciplinary pool of health care professionals, including PNPs, FNPs, pediatricians and other related practitioners, who desire enhanced mental health assessment and intervention skills for use in their current primary care practices,” says Michael Rice, an associate professor of nursing and the psychiatric nurse practitioner program coordinator.

The last two programs will prepare CFP/MHNP candidates for national certification as family psychiatric nurse practitioners. The programs will be offered starting this fall. The post-master’s program is one of the advanced practice specialty tracks in the college’s new doctor of nursing practice program.

Besides Rice, project co-directors include Ann Guthery, a clinical assistant professor of nursing, and Maureen Campesino, an assistant professor of nursing.

Primary care: A natural point of contact

In 2006, the APA released a report that acknowledged the pressing need for further mental health training of health care professionals in mental health screening and intervention. Among the recommendations from its working group on psychotropic medications for children and adolescents were calls for continuing education for child and adolescent practitioners, as well as training for faculty in evidence-based strategies in the treatment and management of childhood disorders.

Extensive findings from research emphasize that evidence-based and early intervention services are essential to reduce the national and global epidemic of psychiatric disorders. Studies also have indicated that the provision of evidenced-based treatments is associated with better outcomes, including a decrease in symptoms and disabilities and improvement in school performance.

“Primary care settings represent a significant and natural point of contact for children and their families,” Melnyk says. “As such, pediatric primary care providers (PCPs) are in a unique position to identify and manage common mental health problems and disorders in children and adolescents, as approximately 75 percent of children with mental health disorders are seen in primary care settings. PCPs report inadequate knowledge of screening and early interventions for these problems, along with a strong desire to gain these skills, as they are often faced with treating children with these disorders as a result of a serious gap in mental health services in the current health care system.”

The ASU College of Nursing & Healthcare Innovation plans to conduct a national symposium on child and adolescent mental health in Phoenix this year. The symposium will focus on providing continuing education that enhances the mental health screening and early intervention practices of primary care nurse practitioners and interdisciplinary health care providers who care for children, adolescents and families.