Oregon Psychiatric Access Line Collaboration

OPAL-K development

The Oregon Psychiatric Access Line about Kids (OPAL-K) arose out of collaboration between the Oregon Pediatric Society (OPS) and the Oregon Council of Child and Adolescent Psychiatry (OCCAP) which began in 2006. At that time both groups recognized the need for better mental health access in the medical home.  

They sought to develop strategies to improve Primary Care identification and treatment of Developmental, Mental and Behavioral challenges. Key Pediatricians and Child Psychiatrists gathered around these issues and eventually formed the mental-health task force, incorporating a wider range of stakeholders including family groups, payors, state mental health leaders, educators and the full array of health care providers.

This group investigated programs, including the Massachusetts Child Psychiatric Access Program (MCPAP) and the Pediatric Access Line (PAL) in Washington State. Both of these state funded programs improved the primary care provider’s ability to provide psychiatric care in the medical home through the use of child psychiatry consultations via phone, education, and direct telemedical evaluations.

Following consultation with Barry Sarvet, M.D., the medical director of MCPAP, and Robert Hilt, M.D., the director of the PAL programs, the basic OPAL-K model was developed. Initial grant support came from Clackamas County MHO and Marion County IPA.

The 2013 Legislature with advice of Addictions and Mental Health (AMH), authorized new investments in Children's Mental Health, including pilot funding for OPAL-K. Addictions and Mental Health signed a contract to establish OPAL-K with the OHSU Division of Child and Adolescent Psychiatry in January of 2014. The OPAL-K program was formed over the ensuing six months and started taking calls in June of 2014.

The OPAL-K program is delivered by OHSU with significant ongoing collaboration with the Oregon Pediatric Society, Oregon Council of Child and Adolescent Psychiatry, Psychiatric Access Line at the University of Washington and with oversight by the Addictions and Mental Health Division of the Oregon Health Authority. 

Why is OPAL-K necessary?

The Problem

  •  Oregon children with serious mental health problems are not receiving treatment or are experiencing long delays before treatment is started
  • According to the U.S. Surgeon General, about 20% of children and adolescents have a mental disorder with functional impairment and only 20% of children and adolescents in need of treatment for mental illnesses receive it
  • Students with untreated mental health problems contribute to increased special education costs, school violence, bullying, and victimization by bullying. 
  • Many children with unidentified and untreated mental illnesses fail or drop out of school, fail to develop friendships and social skills, and have an increased risk of entering the juvenile justice system
  • Mental illnesses are implicated in 90% of suicides, the third-leading cause of death in US youth and second leading cause of death in Oregon youth ages 12-18

The Reasons

  • Shortage of mental health specialists: child psychiatrists, child psychologists, child therapists, particularly in rural areas
  • Ineffective models of care delivery: single clinician treatment, lack of coordination between clinicians, exclusion of primary care clinicians
  • Underutilization of primary care clinicians secondary to lack of consultative support and insurance barriers
  • Lack of collaboration between primary care clinicians and mental health providers

The Solution

  • OPAL-K can help reduce the number of children who do not receive treatment for their psychiatric disorders and eliminate or bridging long delays for treatment currently experienced by youth in both the private and public sectors
  • The OPAL-K model is based on proven programs presently used in other states (WA, MA, MN). Outcome data from these programs show clear benefit to both patients and their PCPs
  • OPAL-K builds a system to help the primary care provider provide the best mental health care possible, using resources available in the community now
  • OPAL-K promotes clinical teamwork through a  “biopsychosocial” understanding of children and knowledge of evidence-based treatments, not just prescription of medications or referral to inpatient care

OPAL-K collaboration

Oregon Psychiatric Access Line about Kids (OPAL-K) operates in collaboration with:

Oregon Health & Science University, Division of Child and Adolescent Psychiatry

Oregon Pediatric Society

Oregon Council of Child and Adolescent Psychiatry

Teri Pettersen, MD is the OPAL-K Consulting Pediatrcian