The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings

      In 2011 the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) released their landmark report, Future of Nursing 2020, calling for nurses to serve as “full partners” in shaping the future of the healthcare system and laying out a series of goals for the profession to obtain by the year 2020 (
      • Institute of Medicine (IOM)
      The future of nursing: Leading change, advancing health.
      ). In a time of rising rates of childhood mental health disorders (
      ), including an increase in youth suicide (
      • Hedegaard H.
      • Curtin S.C.
      • Warner M.
      Suicide rates in the United States continue to increase NCHS Data Brief, no 309.
      ), the need for strong nursing leadership and innovation in healthcare is not only a professional obligation, but a moral one. In this paper, we reflect on the ways that psychiatric-mental health nursing has yet to achieve the Future of Nursing 2020 goals as they apply to child and adolescent mental health, and offer a starting point for conversation about what goals need to be set for the decade ahead. Namely, we focus on recommendation 1 (remove scope of practice barriers), recommendation 2 (expanding opportunities for nurses to lead and diffuse collaborative improvement efforts), recommendation 3 (implement nurse residency programs), recommendation 7 (prepare and enable nurses to lead change to advance health), and recommendation 8 (build an infrastructure for the collection and analysis of inter-professional health care workforce data). We propose that Psychiatric-Mental Health Nurse Practitioners (PMHNPs) in particular should play a more active role in increasing access to more “advanced” level mental health care in pediatric primary care, and should align their professional, educational, and legislative goals towards that end.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. American Association of Child and Adolescent Psychiatry (AACAP) (2019). Clinical care and quality improvement. Retrieved from:

        • American Association of Nurse Practitioners (AANP)
        Use of terms such as mid-level provider and physician extender.
        (Retrieved from)
      2. American Psychiatric Nurses Association (APNA) (2019). Expanding mental health care services in America: the pivotol role of psychiatric-mental health nurses. An informational report prepared by The American Psychiatric Nurses Association. Retrieved from on September 26, 2019.

        • Beck A.
        • Page C.
        • Buche J.
        • Rittman D.
        • Gaiser M.
        Mapping supply of the U.S. psychiatric workforce.
        University of Michigan Behavioral Health Workforce Research Center, Ann Arbor: MI. UMSPH2018
        • Borrell-Carrio F.
        • Suchman A.
        • Epstein R.
        The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry.
        Annals of Family Medicine. 2004; 2: 576-582
        • Burns B.
        • Costello J.
        • Angold A.
        • Tweed D.
        • Stangl D.
        • Farmer M.
        • Erkanli A.
        Children’s mental health service use across service sectors.
        Health Affairs. 1995; 14: 147-159
        • Chattopadhyay A.
        • Zangaro G.
        • White K.
        Practice patterns and characteristics of nurse practitioners in the United States: Results from the 2012 national sample of nurse practitioners.
        The Journal for Nurse Practitioners. 2015; 11: 170-172
        • Child and Adolescent Health Measurement Initiative
        National Survey of Children's Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB).
        (Retrieved from)
        • Cummings J.R.
        • Wen H.
        • Druss B.G.
        Improving access to mental health services for youth in the United States.
        JAMA. 2013; 309: 553-554
        • Hedegaard H.
        • Curtin S.C.
        • Warner M.
        Suicide rates in the United States continue to increase NCHS Data Brief, no 309.
        National Center for Health Statistics, Hyattsville, MD2018
        • Heisler E.
        • Bagalman E.
        The mental health workforce: A primer. Congressional Research Service, 7-5700. R43255. CRS Report prepared for members and committees for congress.
        (Retrieved from)
        Date: 2013
        • Health Resources and Services Administration (HRSA)
        National projections of supply and demand for selected behavioral health practitioners: 2013–2025.
        (Retrieved from)
        • Institute of Medicine (IOM)
        The future of nursing: Leading change, advancing health.
        The National Academies Press, Washington, D.C.2011
        • Kalieb K.
        Expanding our reach: Integrating child and adolescent psychiatry into primary care at federally qualified health centers.
        Journal of the American Academy of Child and Adolescent Psychiatry. 2017; 56: 907-909
        • Kaye L.
        • Warner L.
        • Lewandowski C.
        • Greene R.
        • Acker J.
        • Chiarella N.
        The role of nurse practitioners in meeting the need for child and adolescent psychiatric services: A statewide survey.
        Journal of Psychosocial Nursing. 2009; 47: 35-40
        • Mercado M.
        • Holland K.
        • Leemis R.
        • Stone D.
        • Wang J.
        Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 2001–2015.
        JAMA. 2017; 318: 1931-1933
        • Miles J.
        • Espiritu R.
        • Horen N.
        • Sebian J.
        • Waetzig E.
        A public health approach to children’s mental health: A conceptual framework: Expanded executive summary.
        Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health, Washington DC2010
        • National Center for Health Workforce Data
        HRSA Health Workforce. Behavioral health workforce projections, 2016–2030: Psychiatric nurse practitioners, psychiatric physician assistants.
        (Retrieved from)
        • National Council of State Boards of Nursing
        Consensus model for APRN regulation: Licensure, accreditation, certification, and education.
        (Retrieved from)
        • Nationwide Children'’s Hospital
        Child and adolescent psychiatric nurse practitioner fellowship.
        (Retrieved from:)
      3. O’Connell M. Boat T. Warner K. Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. National research council and institute of medicine. The National Academies Press. The National Academies Press, Washington D.C.2009 (Retrieved from)
      4. Pediatric Nursing Certification Board. The pediatric care mental health specialist (n.d.). Retrieved from

        • Perou R.
        • Bitsko R.
        • Blumberg S.
        • Pastor P.
        • Ghandour R.
        • Huang L.
        Mental health surveillance among children—United States, 2005–2011.
        MMWR. 2013; 62 (Retrieved from): 1-35
        • Skokauskas N.
        • Fung D.
        • Flaherty L.
        • Klitzing K.
        • Puras
        • Guerrero A.
        Shaping the future of child and adolescent psychiatry.
        Child and Adolescent Psychiatry and Mental Health. 2019; 13 (Retrieved from)
        • Stiffman A.
        • Stelk W.
        • Horwitz S.
        • Evans M.
        • Outlaw F.
        • Atkins M.
        A public health approach to children’s mental health services: Possible solutions to current service inadequacies.
        Administration and Policy in Mental Health. 2010; 37: 120-124
        • Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Integrated Health Solutions
        Integrating behavioral health and primary care for children and youth: Concepts and strategies.
        SAMHSA, Washington, D.C.2013
        • The Institute (The National Council Medical Director’’s Institute)
        The psychiatric shortage: Causes and solutions.
        The National Council for Behavioral Health, 2017 (Retrieved from)
        • Tyler E.
        • Hulkower R.
        • Kaminski J.
        Behavioral health integration in primary care: Considerations and opportunities for policymakers, planners, and providers.
        Milbank Memorial Fund, 2017 (Retrieved from)
        • Vanderhoef D.
        • Delaney K.
        National organization of nurse practitioner faculties: 2016 survey of psychiatric mental health nurse practitioner programs.
        Journal of the American Psychiatric Nurses Association. 2017; 23: 159-165
        • Wissow L.
        • Brown J.
        • Fothergill K.
        • Gadomski A.
        • Hacker K.
        • Zelkowitz R.
        Universal mental health screening in pediatric primary care: A systematic review.
        Journal of the American Academy of Child and Adolescent Psychiatry. 2013; 52 (1134–1147.e23)
        • World Health Organization (WHO)
        Mental health action plan 2013–2020.
        World Health Organization, 2013 (Retrieved from)