Table 6.

Representative quotes for changes in PCP relationships with MH specialists and perceived impact of TEACH on patient outcomes.

Theme	Representative quotes
Changes in PCP relationship with MH specialists	A lot of times the [telephone] consultation [with TEACH] will end up with my finding out some new resources and some people available locally to be able to send somebody to for help in managing it -- usually, you know, either a psychologist or a social worker… [and] not having to find a psychiatrist to help with the medication, but for me to be able to work with an ancillary provider. I do feel definitely more confident in co-managing, in making suggestions, in identifying what’s working and what’s not working. And also, looking at side effects in a better way. I personally love the CAP PC {telephone} line, as I said. But I think we need access to better mental health facilities in the city…, And I certainly think many of these patients need more than I can provide. I can certainly be their first stepping stone in prescribing Prozac, but I think they need counseling as well. And it’s remarkably difficult to find counseling for kids in the city. I feel better able to be part of the treatment team in terms of understanding what to expect from a particular medication or therapy approach and that I can help parents feel supported in that.
Perceived impact on patient outcomes	…then they get discharged {as psychiatric inpatient}, and they get two weeks worth of medications, but they may not see the psychiatrist for six weeks, and what happens then? They come to see me. I have to refill their meds. I think that’s wrong. I don’t know how they’re doing. And then, guess what? 50% of the time, or better, probably 80% of the time, I don’t get a discharge summary from the {psychiatric} hospital. Without consult service it was frustrating for us, a feeling that we don’t have an access to child psychiatrists and we would have sent them to adult psychiatrist. Or the patient might get worse and end up in the emergency room. Or if they’re a behavioral problem they may end up you know with the conduct problems and may end up somewhere that you don’t want to…caught by the police or accident or in the juvenile facilities because sometimes the ADHD kids or who have other comorbidities might get into trouble with the law too. In the absence of the consult service, I would still be banging my head against the wall along with the parent and the kid. I think that the first week of school he would have gotten kicked out again. …I certainly think many of these patients need more than I can provide, and I can certainly be their first stepping stone in prescribing Prozac, but I think they need counseling as well. And it’s remarkably difficult to find counseling for kids in the city. When you talk about a two or three month delay in seeking care, a lot can happen in the life of a family and the life of a child in that time frame and it was just so awful feeling like there was nothing I could do except say, “Hang on and wait for your appointment.” There is only so much apologizing you can do for the system.

Theme

Representative quotes

Changes in PCP relationship with MH specialists

A lot of times the [telephone] consultation [with TEACH] will end up with my finding out some new resources and some people available locally to be able to send somebody to for help in managing it -- usually, you know, either a psychologist or a social worker… [and] not having to find a psychiatrist to help with the medication, but for me to be able to work with an ancillary provider.
I do feel definitely more confident in co-managing, in making suggestions, in identifying what’s working and what’s not working. And also, looking at side effects in a better way.
I personally love the CAP PC {telephone} line, as I said. But I think we need access to better mental health facilities in the city…, And I certainly think many of these patients need more than I can provide. I can certainly be their first stepping stone in prescribing Prozac, but I think they need counseling as well. And it’s remarkably difficult to find counseling for kids in the city.
I feel better able to be part of the treatment team in terms of understanding what to expect from a particular medication or therapy approach and that I can help parents feel supported in that.

Perceived impact on patient outcomes

…then they get discharged {as psychiatric inpatient}, and they get two weeks worth of medications, but they may not see the psychiatrist for six weeks, and what happens then? They come to see me. I have to refill their meds. I think that’s wrong. I don’t know how they’re doing. And then, guess what? 50% of the time, or better, probably 80% of the time, I don’t get a discharge summary from the {psychiatric} hospital.
Without consult service it was frustrating for us, a feeling that we don’t have an access to child psychiatrists and we would have sent them to adult psychiatrist. Or the patient might get worse and end up in the emergency room. Or if they’re a behavioral problem they may end up you know with the conduct problems and may end up somewhere that you don’t want to…caught by the police or accident or in the juvenile facilities because sometimes the ADHD kids or who have other comorbidities might get into trouble with the law too.
In the absence of the consult service, I would still be banging my head against the wall along with the parent and the kid. I think that the first week of school he would have gotten kicked out again.
…I certainly think many of these patients need more than I can provide, and I can certainly be their first stepping stone in prescribing Prozac, but I think they need counseling as well. And it’s remarkably difficult to find counseling for kids in the city.
When you talk about a two or three month delay in seeking care, a lot can happen in the life of a family and the life of a child in that time frame and it was just so awful feeling like there was nothing I could do except say, “Hang on and wait for your appointment.”
There is only so much apologizing you can do for the system.