Implementing the COPE Mental Health Program in Pediatric Primary Care

The COVID-19 pandemic worsened mental health needs of pediatric patients, with one in six children showing symptoms nationwide. Primary care providers lack training and resources for effective initial mental health care. Local Problem: In Utah, 20% to 27% of children have mental health disorders, and up to 72% do not receive treatment, revealing a significant healthcare gap. This project aimed to implement and evaluate COPE2Thrive (COPE), a Cognitive Behavioral Therapy (CBT) intervention, in primary care clinics for Utah pediatric patients aged 7-18 years with depression, anxiety, and stress. Methods: This project assessed the impact of the COPE program on participating pediatric focused nurse practitioners (NP) clinical practice using pre-implementation surveys, bimonthly implementation surveys, and post-program informal interviews. The pre-program survey identified existing practices and barriers in pediatric mental health care. NPs then received bimonthly surveys for ten weeks to evaluate the program's implementation. After the implementation period, informal interviews assessed the program's feasibility and usability. Results: A pre-intervention survey among NPs (n=11) unveiled challenges in addressing mental health concerns, with many expressing unease in promptly prescribing psychiatric medications and reluctance in offering in-office mental health interventions due to feelings of unpreparedness. While two NPs completed COPE certification, they did not integrate the program into their practice. Subsequent post-implementation interviews highlighted coordination challenges and operational uncertainties. Conclusion: The COPE program offers promise in addressing pediatric mental health challenges, though its implementation in clinical settings remains uncertain. Informal feedback from COPE trained NPs indicated positive outcomes in using the program with their children, enhancing emotional expression and coping skills. However, sustainability is in question, with logistical barriers and concerns over patient suitability. Challenges include time constraints in clinics and the cost of re-certification. Implementing the program over a longer timeframe may clarify its feasibility and sustainability.