This March, Genesis Health Consulting will be writing about the current landscape of pediatric mental health including a discussion of why health care systems should think about the unique factors of pediatric mental health and some new models of care designed to improve outcomes.
Our previous blog post listed several reasons that pediatric mental health is unique and outlined the growing need for more access and treatment in the area of pediatric mental health. The American Academy of Pediatrics recognized the growing need for primary care physicians and practices to increase mental health services in 2009 with the release of The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care policy statement; however, surveys of pediatric generalists often list training in mental health as an area in which they felt underprepared. Integrated behavioral health models have grown out of this complexity to address these and other barriers to pediatric mental health care. In the examples below, integrated behavioral health refers to the incorporation of behavioral and mental health services into a primary care setting. It is important to note that other models incorporating primary care into mental health settings, or behavioral health into other community settings, such as schools, also exist.
A Model of Integration
Integrated behavioral health can be understood with the Pediatric Integrated Health Care 4-Quadrant Model Diagram below. In its simplest form, a primary care pediatrician does a routine screening for behavioral health needs and refers to a behavioral health professional either located in the same office, or available for telephonic consult. The behavioral health professional conducts additional assessments and can, together with the pediatrician, outline a plan of care from a very low acuity situation where the primary care provider is able to manage the child’s care, up to a high acuity situation, where the child needs referral to and care management by a mental health specialty provider.
Integrated behavioral health models also are a response to family recommendations. A survey of families conducted by NAMI about child mental health care listed co-location of primary care physicians and mental health providers as a service that families want.
Here are some examples of integrated behavioral health models in pediatrics:
Massachusetts Project LAUNCH
Project LAUNCH was designed to meet early social-emotional needs in children age 0-8 years old by embedding early childhood mental health clinicians and family partners into primary care medical homes. In this project, the family partner was a peer with lived experience in parenting a child with social-emotional or behavioral difficulties. Behavioral health screenings were deployed at well child visits, and based on the results, warm handoffs were made to the mental health clinician and family partner pair for inclusion into the program. Evaluations of the program not only measured social-emotional and behavioral changes in the children, but also depressive symptoms and stress of the parents. Measures on both improved in an evaluation of the program. More information can be found here.
Massachusetts Child Psychiatry Access Project (MCPAP)
The MCPAP project is an example of providing behavioral health services through telemedicine. The project enrolls primary care providers and offers a behavioral health resource for enrolled providers who are treating children with mental health problems. An initial phone consult is done and follow-up services, assessments or links to in-person psychiatric care or resources may be done based on the serve needed. The project employs six regional teams based in academic medical centers to be resources for primary care providers. This project does not provide care coordination services, rather of primary care providers’ resource and referral information needs. A very detailed description of the program as it was initially conceived, including barriers, outcomes, and financing can be found here. The program has evolved over its 13-year history to incorporate changes in health care, thus a comparison of the iterations of the project can be found here.
Michigan Child Care Collaborative (MC3)
Similar to MCPAP, the MC3 program provides psychiatric support to primary care providers via same-day phone consultations and remote psychiatric evaluations. The collaborative works with primary care providers to participate in the program in order to more appropriately and efficiently manage patients’ behavioral health concerns. More information on MC3 can be found here.
Finally, this query-based system provided by the American Academy of Child & Adolescent Psychiatry can help locate other pediatric-focused integrated behavioral health programs. Additional general resources about pediatric behavioral health integration include:
SAMHSA’s Integrating Behavioral Health and Primary Care for Children and Youth
National Alliance on Mental Illness Integrating Mental Health and Pediatric Primary Care: A Family Guide
Starfish Family Services One Location, One Visit: A Manual for Integrating Mental Health Services into Pediatric Practice
Genesis Health Consulting has deep experience in helping health systems think differently about pediatric health care. Please email us at info@genesishealthconsulting.com to learn more about our work in this area.