"I am a PMHS"

Avis Johnson-Smith, DNP, APRN, CPNP-PC, FNP-BC, PMHS, CNS, FAANP is a certified PNP-PC and FNP-BC who owns a nurse practitioner clinic in Georgia, Healthy Kids and Families Wellness Center, LLC, and also serves as an academic professor and Family Nurse Practitioner Track Coordinator at Angelo State University in Texas.

How does PMHS certification benefit you, your patients, and FNP students?

The PMHS certification has been very beneficial thus far, but the full potential and the full benefit for me, my patients, their families, and my FNP students is still unfolding.  

From a clinician’s standpoint, even though the PMHS certification has provided evidence of my expertise and knowledge related to child/adolescent primary care mental and behavioral health issues, more importantly, it has provided an avenue for me to reach and serve more children, adolescents, and their families who have slipped through the mental and behavioral health care cracks. 

Simply put, my PMHS certification has helped to transform children, adolescents, and their families who struggle with mental and behavioral health issues from invisible to visible thriving individuals.

Unlike most FNP programs, we offer one standalone Mental Health course as part of the FNP curriculum because we understand the role primary care providers can play in helping to address mental health issues within their practice setting.  

From an educator’s standpoint, not only has the PMHS certification strengthened my transference of knowledge related to child and adolescent mental and behavioral health issues to the FNP students I teach, it has also increased the students’ level of awareness about the PMHS certification. My PMHS certification has helped enlighten FNP students to the fact that they can strive to become PMHS certified in order to make a greater impact on the mental and behavioral well-being of children, adolescents, and their families.

Jennifer Keller, DNP, CPNP, PMHS practices in a pediatric primary care clinic, part of the Children's Hospital of Philadelphia. The office consists of five medical physicians, two pediatric nurse practitioners (including herself), and their team of registered nurses and medical assistants. Together, they provide well and acute care to patients from birth to twenty-one years of age.

Tell us about the behavioral/mental health concerns you see in your practice.

When I started at the practice, I found that the preponderance of patients with mental health symptoms (depression, anxiety, panic disorder, PTSD, disordered eating, and self esteem issues) fell between the cracks and never received intervention or treatment; either due to lack of services, wait time, and/or insurance coverage. Due to challenges that nearly all primary care settings face, our office did not have a standard, evidence-based structure in place to foster well-organized mental health phone triage, appointments, treatment, management, and/ or referral.

How does being a PMHS enable you to improve access to care for children with these concerns?

As part of my DNP scholarly project, equipped with my PMHS certification, I challenged our existing patterns of outsourcing the majority of mental health care and implemented the Primary Care Behavioral Health model, structured by Dr. Strosahl, into our practice setting. The integrative model consists of the primary care provider (PCP) and the behavioral health consultant (BHC) functioning collaboratively to identify, assess, and manage mutual patients with mental health symptoms within the context of primary care. As a PMHS, I fulfilled the BHC role. I am available to the team for either brief consultations or patient referrals to take over the assessment and management of mental health care. I also established interprofessional relationships with other mental health providers throughout our community. This not only allowed our office to utilize resources that were previously unknown or unobtainable but strengthened the communication and consistency of care between each silo.

How do you feel about your PMHS achievement?

I wholeheartedly feel that this certification helped me identify myself as a nurse practitioner and become an essential part of my provider team. As I developed interprofessional relationships throughout the course of my project, the sharing of each other's educational background, clinical knowledge, and practice experience ultimately led to a mutual respect and admiration for one's professional role and functionality. Therefore, by obtaining this certification, integrating mental health services into the primary care setting was not the only practice change that transpired--these credentials became a catalyst for interprofessional understanding and unity.

Do you inform parents and patients that you hold PMHS certification and what that means? Do they feel reassured by that knowledge?

My PMHS certification is displayed on our practice's website and throughout our office. When a patient is triaged by the nursing staff for a mental health concern, they inform the family about my specialty and certification. If the provider team comes across symptoms during a visit, they also explain my background and experience. Both means of referral lead to the scheduling of a mental health consultation with me. Our patients are not only reassured but grateful for this element of care offered by our practice. I once had a family ask, "Why don't all primary care offices have a PMHS?" I replied, "That certainly is the goal!"

How do you feel earning PMHS specialty certification has impacted your day-to-day practice with patients?

Earning my PMHS specialty certification has greatly impacted my clinical practice. Viewing the patient as a whole, both physically and mentally, is the very essence of our nursing paradigm. The enhanced knowledge and experience behind this certification has further enabled me to provide patient-centered care according to my nursing roots.

How has your credential brought added value to your practice/clinic?

The value of the PMHS is not only functionally and financially advantageous to the practice but also to the patient. Since services are offered in the same setting, patients are able to access safe, timely, familiar, and cost appropriate mental health care. After seeing positive outcomes from my pilot project, I was able to justify the need and designate time in my schedule strictly for mental health consultation appointments.

How does your employer feel about your new certification?

I have received a lot of positive feedback and support from my practice team and overall macrosystem. The PMHS certification not only amplifies the value and versatility of the nurse practitioner role but also fulfills the absolute need for patient-centered and interprofessional care that our healthcare system now requires.

Teresa is a PMHS who works in a pediatric practice in rural Maryland, and we're proud to share her story:

Tell us about the behavioral/mental health concerns you see in your practice.

Usually parents are concerned about negative behaviors that are affecting daily living of the child and the family. Some common issues are depression, anxiety, ADHD, and ODD.

How does being a PMHS enable you to improve access to care for children with these concerns?

I am currently in the process of establishing a solo practice where I will concentrate on these concerns. I live in a rural area that has a 3- to 5-month waiting list to be seen by a psychiatrist. Also, many therapists do not accept insurance so finding interventions can be a challenge. The additional certification helps my colleagues be more comfortable in referring patients to me.

How do you feel about your PMHS achievement?

It gives me an extra boost of confidence.

Do you inform parents and patients that you hold PMHS certification and what that means? Do they feel reassured by that knowledge?

Yes, when it fits in the context of the visit. Parents know if you are knowledgeable in the subject matter by how you help with the issues.

How do you feel earning PMHS specialty certification has impacted your day-to-day practice with patients?

For me, it has helped tremendously because I am focusing on mental/behavioral health in the child/adolescent population.

How has your credential brought added value to your practice/clinic?

It helps the community have another resource without a long waitlist, and I am working under a non-profit tax ID number. I am able to help families cope, understand and teach about the diagnosis. Also, I have been able to collaborate with a case management organization, mental health clinics, and a therapist in the community. I have been able to access specialty care quicker and easier.

How does your employer feel about your new certification?

The executive director appreciates my additional certification and expertise in the field. She has established many opportunities for me to speak to local organizations about what I do.

Deborah is a PMHS who owns and operates a specialty clinic in Oregon, and we're proud to share her story:

Tell us about the behavioral/mental health concerns you see in your practice.

I see children from birth to late adolescence with a variety of developmental and behavioral concerns. I use a family approach, so I also see parents of these children and help parents with parenting skills, accessing services and resources, and understanding their rights as parents of children with special needs. The most common diagnoses I see include children with Attention Deficit Disorder with and without hyperactivity and impulsivity, Autism Spectrum Disorders, depression, anxiety, mood disorder and dysregulation, Posttraumatic Stress Disorder, and adjustment disorders. I also see several adolescents struggling with drug addiction.

How does being a PMHS enable you to improve access to care for children with these concerns?

Being a PMHS helps by letting my clients and families know that I have furthered my own knowledge base to become a specialist in pediatric mental health. This certification helps separate me from PNPs that focus on primary health care alone, and helps other professionals know more about what I do and what my specialty area is.

How do you feel about your PMHS achievement?

I love being a PMHS. I have worked in the field of developmental and behavioral pediatrics for over 20 years, and feel this certification reflects that experience.

Do you inform parents and patients that you hold PMHS certification and what that means? Do they feel reassured by that knowledge?

I inform parents and patients every day that I hold PMHS certification. I have my certification framed and displayed with my other diplomas and certifications. I feel this really helps parents and clients know that I have the background to help them with their challenges.

How do you feel earning PMHS specialty certification has impacted your day-to-day practice with patients?

The primary way earning the PMHS specialty certification has impacted my day-to-day practice is by being able to include this certification in my description to patients and parents about my practice, and my qualifications behind that practice. I believe parents understand more about the role of PNPs and the role of a specialist within this field.

How has your credential brought added value to your practice/clinic?

One value that was unexpected is I have found I receive more respect from other professionals through the region. By adding PMHS after my name, I have had more referrals from physicians and other mental health professionals. I have also been asked to serve on more teams within the community as the mental health specialist. I own and operate my own clinic, and work with five other providers. As the owner of the clinic, I feel all providers should work towards specialty certification.

Sheree is a PMHS who works in a pediatric practice in rural Pennsylvania, and we're proud to share her story:

Tell us about the behavioral/mental health concerns you see in your practice.

I work in a large, rural pediatric practice. We focus on patient education, as well as biological, physical and social health promotion. Specifically in regards to mental health, we evaluate and treat Attention Deficit/Hyperactivity Disorder, depression, anxiety disorders, tic disorders, Asperger's Disorder, and perform safety assessments. We initiate treatment for new onset bipolar/psychotic disorders, as well as autism. I also provide both pharmacotherapy and brief psychosocial interventions.

How does being a PMHS enable you to improve access to care for children with these concerns?

It communicates added expertise to patients, families, colleagues, and other mental health professionals.

How do you feel about your PMHS achievement?

Very proud! This credential communicates my unique expertise as a primary care provider with added expertise in the evaluation and treatment of mental health disorders, as well as more comprehensive health promotion.

Do you inform parents and patients that you hold PMHS certification and what that means? Do they feel reassured by that knowledge?

Yes and yes! Families are more comfortable with a primary care provider with added expertise in mental health care versus conventional mental health professionals.

How do you feel earning PMHS specialty certification has impacted your day-to-day practice with patients?

This credential has increased patient and family confidence in the mental health care provided.

How has your credential brought added value to your practice/clinic?

I am now able to easily communicate my unique expertise. I am both an FNP and CNS in mental health, so my role in primary care is unique. This credential best describes my role as a primary care provider with advanced knowledge in the evaluation and treatment of mental health concerns in the pediatric population.

How does your employer feel about your new certification?

It helps my employer better describe my expertise in the treatment of children and adolescents with mental health concerns.