Needs Assessment Key Findings - Wyoming Department of Health

The Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS) provided financial support for this publication. The award totaled $445,000.00, and provided 100% of total costs for the assessments. The contents are those of the author. They may not reflect the policies of HRSA, HHS, or the U.S. Government.

Introduction

Background

In 2023, the Maternal and Child Health (MCH) Unit launched two separate needs assessment projects to inform and guide activities under the Pediatric Mental Health Care Access (PMHCA) grant, which supports work to improve pediatric mental health care in primary and emergency care settings. One needs assessment sought to understand the barriers and facilitators to accessing mental health care for youth, as experienced by parents and youth. The second assessment sought to understand what barriers and facilitators primary care and mental health care providers experience in providing effective mental health care, including their perception of patients’ barriers to accessing care.

Wyoming Department of Health Investments in Mental Health

Ongoing Work

Implement the Behavioral Health Redesign, which prioritizes access to community-based mental health services for high-needs children and families, among other patient populations.
Continue investing in 988 and suicide prevention activities in local communities and statewide.
Maintain the Partnership Access Line (PAL), a teleconsultation resource for pediatric medical providers across the state to receive support delivering mental health care to children and youth.
Continue offering the Medicaid children’s mental health waiver, which provides access to high-fidelity wraparound services for youth with significant behavioral health concerns regardless of their insurance coverage.
Support telehealth efforts, including the Wyoming Telehealth Network.

PMHCA Grant Activities

Increase awareness and use of the PAL, including clarifying eligibility requirements and supporting providers to integrate PAL use into their daily workflow.
Facilitate medical provider access to high-quality, online pediatric mental health trainings and resources.

Title V MCH Projects

Focus on adolescent mental health as a Wyoming-selected national performance measure.
Continue adolescent suicide prevention efforts and partnerships.
Partner with Medicaid to increase awareness of and participation in the children’s mental health waiver.
Participate in the National Academy for State Health Policy’s Children’s Behavioral Health Policy Academy.

Key Findings

From Both Assessments

Families and providers who participated in the assessments see a role for schools in supporting youth mental health. Youth and families report schools as a primary resource to identify youth in need and refer them to mental health services. Primary care and mental health care providers maintain clinical relationships with school nurses and school mental health counselors and report schools as one of the key facilitators in their community for connecting youth and their families to mental health care options.
Youth reported stigma and concerns about approaching adults for help as major barriers, both in the survey and in focus groups. Parents/caregivers did not share stigma as a primary concern, which suggests that families may not always know when a teen they care about is struggling with mental health. Providers generally agreed with youth that stigma and a lack of family and community support present a major barrier specific to addressing youth mental health needs.
Many primary care providers reported low confidence in treating mental health care conditions in children.
Parents/caregivers and providers both recognized the lack of specialized mental health care providers in Wyoming as a barrier to effective care. Parents reported difficulty finding a provider that could meet their child’s specific needs. Providers reported difficulty finding specialists to whom they could refer pediatric patients when patients have more acute or severe needs or when more specific types of care are required.
Parents/caregivers and providers both reported the overall cost of accessing care as a major barrier. Cost considerations included issues with insurance coverage as well as incidental costs such as transportation to and from appointments and time away from work to attend appointments.
Providers report that the traditional process of managing referrals among primary care, mental health, and schools–placing the responsibility for following through on the referral fully on the family –often leads to no-shows and communication problems among providers and support services. Youth and family survey responses indicate that many people attempt to access services but are unsuccessful, and many families reported wait lists and wait times that resulted in an escalation of mental health symptoms before being able to access care. Taken together, this data suggests the need for formal care coordination and peer support for parents and families as they navigate care options, as well as the need for options such as telehealth, where appropriate, to minimize barriers to attending appointments.

Themes and Promising Directions

Themes

Families need structured, systemic support to effectively navigate the pediatric mental health care system.
Effective, coordinated pediatric mental health care relies on many individuals and organizations in a community beyond just families and providers.
Increasing and improving access to first-line (non-crisis) care may reduce the need for more expensive and time-intensive crisis care.
The true need for youth mental health care is likely unknown, due to youth experiencing stigma in asking for help from peers, parents, and trusted adults.
Telehealth may offer a cost-effective method to increase access for some families, but it is not appropriate in all situations.

Promising Directions

Support the development or existing implementation of a care coordination service to assist families navigating mental health care options for their children.
Work with education partners, with appropriate legislative direction, to implement new, effective strategies for schools to support families whose children exhibit behavioral and mental health concerns that affect educational outcomes.
Provide ongoing professional development opportunities and resources for primary care providers to address provider needs related to pediatric mental health care.
Support parents in recognizing when their adolescents may be struggling and in responding in ways that encourage open communication and improve mental health.
Support formal relationships among primary care providers, mental health care providers, and emergency medical services to support pediatric patients with mental health concerns.
Support families whose children are eligible for but not currently covered by Medicaid and Kid Care CHIP (Wyoming’s Children’s Health Insurance Program) with information and assistance to enroll if desired.

Methods

Data collection

The Department’s Institutional Review Board (IRB) reviewed and approved the methods for both assessments to ensure participants’ rights and welfare.

The youth and family needs assessments used a mixed-methods approach, collecting data through key informant interviews, online surveys, and focus groups. Health Management Associates completed this work on behalf of the Department between February and October 2023.
The provider needs assessment used a mixed-methods approach, collecting data through key informant interviews, online and paper surveys, and focus groups. Align and the Wyoming Survey and Analysis Center completed this work on behalf of the Department between April 2023 and January 2024.

Youth caregivers were asked about what helped and hindered access to mental health services for youth in their care. Youth ages 13 to 21 were asked the same questions about their own mental health care. Pediatric primary care providers and mental health care providers were asked what helped and what hindered their ability to provide effective, appropriate mental health care to youth.

Provider surveys were made available to all pediatric, family, and mental health providers actively licensed with the Wyoming Board of Medicine, the Wyoming State Board of Nursing, and the Wyoming Mental Health Professions Licensing Board.

Limitations

While youth and family surveys were made available to all eligible caregivers and youth in Wyoming, there are some limitations to consider. First, very few survey responses were from youth under the age of 18. The Department did not promote the survey directly to youth under age 18, instead relying on parents and guardians to share the survey with youth in their care. The low response rate from youth under 18 means youth feedback may not fully represent the experiences and needs of minors. Additionally, the vast majority of caregiver and youth survey respondents were in Laramie County. Those survey responses may not be representative of the experiences of families in more rural communities in the state.

Providers can be difficult to survey, and the response rate for the primary care provider survey (9.8%) is very good given this difficulty. Responses should not be interpreted as representative of all providers in the state, given the low rate of return, but do shed light on many current provider experiences.