Now how to ensure hotline connecting children’s primary care doctors and psychiatrists continues after funding ends?

This story was originally published in Rhode Island Current, a publication partner of Ocean State Stories.

Let’s say you’re a doctor. A doctor who’s anxious about treating a kid who might also be anxious. Or is your patient depressed? Is it something else entirely? 

A primary care residency taught you many things. But not everything.

Now imagine you could pick up the phone, and talk to another doctor — one who knows mental health.

That’s why Bradley Hospital, Rhode Island’s psychiatric hospital for children and adolescents, created the Pediatric Psychiatry Resource Network, or PediPRN, in 2016. The service connects children’s primary care physicians (PCPs) to pediatric psychiatrists, streamlining the process for prescribing common psychiatric drugs that may still be unfamiliar to primary care docs.

Alison Manning, a psychiatrist who works at Hasbro Children’s and Bradley Hospitals, might pick up the phone when a doctor calls.

“Certainly, we don’t want PCPs to feel uncomfortable and prescribe medications that they’re not familiar with,” Manning said. “Our main role is to support them in prescribing things that they feel comfortable with.”

PediPRN served 71 medical practices and 425 primary care pediatricians in 2022, according to figures from Lifespan, the health network to which Bradley Hospital belongs. A total of 65 doctors made 209 phone calls to the consultation hotline. Anxiety was the most common diagnosis that year, comprising 51% of cases. ADHD placed second at 34%. Depression and autism spectrum disorders were 20% and 12% of diagnoses, respectively.

Dr. Alison Manning is a psychiatrist at Hasbro Children’s and Bradley hospitals who is available to provide phone consultations with pediatric primary care physicians who see young patients who present mental health concerns. (Michael Salerno/Rhode Island Current)

Manning said PediPRN consulting doctors mostly support pediatricians in managing anxiety, ADHD, depression and autism spectrum disorders with medications such as antidepressants known as SSRIs (Selective Serotonin Reuptake Inhibitors) or stimulant medications.

“This is a chance to know you’re responsible for it and feel like you’re doing it intelligently, competently,” said Suzanne McLaughlin, a pediatric primary care physician for Lifespan clinics in Providence. “It makes you much more likely to raise questions, if you’re not scared of the answers people are going to bring you. You have an idea of what you can do.”

Dr. Alison Manning – Michael Salerno/Rhode Island Current

Funded through federal fiscal year 2026

The service exists at an opportune time. Data from policy organization KIDS COUNT reported that 19% of Rhode Islanders aged 6-17 had “a diagnosable mental health problem” in 2022.

Both primary care and inpatient psychiatry are overtaxed in Rhode Island. Bradley and the state’s other main psychiatric hospital, Butler, provided outpatient care to 1,832 kids and teens between October 2021 and September 2022, according to data from the two hospitals. That same timespan saw 1,194 juvenile inpatients enter hospital grounds, and most stayed for at least nine days. Partial hospitalizations, or when patients come to the hospital to receive medication on site, comprised another 1,495 visits.

Sen. Alana DiMario, a Narragansett Democrat, is a big fan of PediPRN. “If you think about the logistics of how to service our population adequately, how many more full-time psychiatrists we would need to recruit and retain to work in Rhode Island to replicate this program’s level of access, it would be unbelievably difficult to do that,” she said. “And I don’t know that we could. I don’t know what the incentive program would need to look like to be able to make that happen.”

DiMario isn’t just enthusiastic about the program. She’s also concerned it might disappear.

Since its inception, PediPRN has been funded by a careful juggling of grants. It’s free to patients, but not to the state. Most recently, the Rhode Island Department of Health (RIDOH) had to refill the program’s coffers in 2023. RIDOH successfully received a grant from the federal Health Resources and Services Administration (HRSA) for a second time, netting $850,000 in funding annually through Sept. 30, 2026. 

What happens when those funds dry up?

“As of right now, there is no source of sustainable funding when this grant cycle ends,” Joseph Wendelken, a RIDOH spokesperson, confirmed in an email.

‘Painfully watching at the sidelines’

With the next few years funded at least, PediPRN continues to operate as normal. Aside from the hotline, there’s also more intensive training for interested physicians, giving them front row seats to 90-minute, expert discussions on the best practices of an unfamiliar and often tricky discipline. McLaughlin was one of the doctors who completed these courses, meeting monthly for one year.

Kelly Brennan, a spokesperson for the Lifespan health network, said a new training cohort of primary care doctors started the second week in January. 

“I think what is interesting is that this model is a partnership that everyone agrees is working! Which is rare, unfortunately,” Brennan said via email.

Institutions have often found it hard to structure or even coordinate mental health care, both historically and recently. The fragmented and expensive nature of psychiatry is intimately linked to the development of psychopharmacology —  treating mental health with drugs.

“Prevention is better than cure,” the philosopher Erasmus once wrote, and that sentiment might be doubly true in psychiatry, where true cures do not exist — but treatments do. PediPRN is not really designed to accommodate the overflow from psych hospitals. Nor is it meant to introduce stronger medicines like antipsychotics to a wider audience.

‘Certainly, we don’t want PCPs to feel uncomfortable and prescribe medications that they’re not familiar with. Our main role is to support them in prescribing things that they feel comfortable with.’

RIDOH data from 2023 on PediPRN and MomsPRN, which facilitates psych care for postpartum and pregnant women, show the two programs together have logged 4,061 phone calls from 3,032 patients, across 877 doctors and 329 doctors’ offices, since 2016.

The number of child psychiatrists, meanwhile? There are currently five psychiatrists who pick up the phone at PediPRN when a primary care doctor calls, each of them a specialist of child or adolescent psychiatry. Per data from the American Academy of Adolescent and Child Psychiatry, Rhode Island had only 81 child psychiatrists in 2018. That number seems small, but in per-capita density, Rhode Island had 39 psychiatrists for every 100,000 kids — a number that outpaced even New York, where there were 29 psychiatrists per 100,000 kids. Overall, Rhode Island ranked third in its child-psychiatrists-to-children ratio, outpaced only by Vermont, with 40 psychiatrists for every 100,000 kids, and Washington, D.C., with 65 psychiatrists for every 100,000 kids.

PediPRN tries to instead leverage existing doctors across specialities. A pediatrician’s familiar face might offer “a level of trust” not easily accessed with a new doctor or referral, McLaughlin said. Families “feel like it’s someone they’ve worked with, who’s paying attention to their child, and has done that for years. … A lot of people are very reasonably worried about medications with children.”

Any primary care doctor can refer someone to a psychiatrist, but referrals can amount to a kind of limbo, with patients waiting up to six months to see their new doctor, McLaughlin noted: “I can start that child’s treatment and therapy well before I would have ever been able to do it.”

The alternative, she said, is “painfully watching at the sidelines.” 

Rather than wait, any doctor whose practice is registered with PediPRN can pick up and call the hotline.

“The consultation is available to any primary care provider in the state of Rhode Island, regardless of if they’ve taken the [training] course. Many of them call our line,” Manning said.

Anxiety was the most common diagnosis for pediatric patients who were the subject of consultations with Bradley Hospital doctors in 2022, comprising 51% of cases. ADHD placed second at 34%. Depression and autism spectrum disorders were 20% and 12% of diagnoses, respectively. (Canva photo)

Massachusetts leads way

A 2021 article in the journal Pediatrics confirms that PediPRN didn’t set a trend, but followed one: Rhode Island was the 32nd state to create a psychiatric resource network (PRN) for kids. The trendsetter was just over the border in Massachusetts, where the Commonwealth’s equivalent, the Massachusetts Child Psychiatry Access Program (MCPAP), was introduced in 2004. It was the first nationwide, Manning noted, and 45 good-natured copycats have since followed.   

But “funding uncertainty is not unique to Rhode Island,” the Pediatrics article stated.

Grants, contracts or annual budgets are common means of structuring these resource networks, which makes them “highly vulnerable to discontinuation. … Several programs lost funding when grants were not renewed.”

According to its website, MCPAP is “funded primarily by the Massachusetts Department of Mental Health and in part by major commercial insurances in Massachusetts.”

DiMario suggested PediPRN could operate much like MCPAP does in Massachusetts. “One of the really cool things about this model is that, the way we have it set up in this bill, is that it’s funded similar to how we fund pediatric vaccinations,” DiMario said. “Which is just a really small assessment on private health insurance policies. So this is not money that comes out of the state budget. This is a very, very nominal assessment on every private insurance policy.

“The private insurance companies are in favor of this, but it’s accessible to anybody regardless of their insurance,” DiMario said. “If you have a child who’s on Medicaid, their pediatrician can still access their hotline. They don’t have to be encumbered by the limitations of whatever [that] person’s insurance plan is.”

Rich Salit, a Blue Cross & Blue Shield of Rhode Island spokesperson, said the health insurer started funding PediPRN with annual contributions of $45,000 in 2019. As of 2023, their five-year contribution totaled $225,000.

This year, $170,000 will come from the Executive Office of Health and Human Services, a 20% match for the federal government’s sizable — and expiring — gift of $850,000, said RIDOH spokesperson Wendelken

In the Senate’s last session, only two sponsors backed the bill to make PediPRN permanent: DiMario, and Maryellen Goodwin, the former Senate majority whip who died in April 2023.

“One of the biggest focuses of her work was always on expanding access to health care, especially for women and children,” DiMario said of Goodwin.

In theory, “expanding access” means reducing inequity. But how about in practice? Does PediPRN help address inequities in psychiatric care?

“I feel like it does. I actually emphatically think that,” McLaughlin said. “We have extraordinary resources, and they’re still not enough to meet the needs.”

Said Manning: “The children’s mental health crisis has been increasing. … Providers that left training 10 or 20 years ago, they didn’t experience this level of distress in their patients and they weren’t trained for it.”

So DiMario wants to keep the lines at PediPRN ringing. On Jan. 12, she and nine other senators introduced a bill to amend state health care funding and create a dedicated “PRN account” for PediPRN and MomsPRN, as well as any future resource networks. The House introduced its companion bill on Jan. 17, with Rep. Mary Ann Shallcross Smith, a Lincoln Democrat, leading the effort. It wasn’t entirely a partisan bill, thanks to the support of a Cranston Republican, Rep. Barbara Ann Fenton-Fung. 

But the House is also where the same bill died last year. The Senate had passed it, yes, but the House’s version stagnated in the House Finance Committee — the legislative version, you could say, of waiting at the doctor’s office. Forever.