Challenges and Opportunities of Pediatric Mental Health Practice in Rural America

Practicing medicine in Rural America is rich with opportunities and wrought with challenges. Practicing pediatric mental health care in rural communities further exacerbates these unique challenges. On one hand, pediatric clinicians are well-placed to care for their patients struggling with mental health concerns. The opportunity to understand complex psychosocial contributors only is known from caring for parents, extended families, and living within the social context of the community can certainly aid clinicians in assessing and managing mental illness. On the other hand, knowledge, comfort, and experience in managing pediatric mental illness remain significant barriers to patients receiving high-quality, evidence-based care. Though still lacking overall, resources are available to support rural pediatric clinicians in this endeavor. Programs that aim to build up existing rural clinicians and educate and attract new health care professionals to rural areas are critical to addressing the pediatric mental health crisis. However, PCPs need the support of highly specialized CAPs both for this education and for consultation when they feel out of their depth. Therefore, initiatives aimed at increasing CAPs and child and adolescent psychologists are necessary. Pediatric patients have complex inner-workings of mind and body and are highly affected by their environments. Care for youth should be family-centered, holistic, and team-based. These goals are at the heart of the CCBHC and FQHC models. To be successful though, care must be financially sustainable for clinicians and systems. Further, programs that support clinicians and systems must remain adequately funded until the gap in pediatric mental health care access and quality is closed.