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Integrating Behavioral Health in Pediatric Care: Successes and Challenges

This report highlights the significant achievements and ongoing challenges faced in integrating behavioral health services within pediatric care settings. Launched in July 2011, the Behavioral Health Pediatric Integrated Program (BHPIP) aimed to improve access, quality, and sustainability of services. Key outcomes include increased referrals from 18% to 63%, reduced wait times for services, and enhanced provider communication. Despite these successes, barriers such as financial concerns and patient preferences persist, indicating areas for further growth and exploration.

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Integrating Behavioral Health in Pediatric Care: Successes and Challenges

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  1. Bridging the gap Rachael Bowers, LICSW NandiniSengupta, MD April 3, 2013

  2. Why Integrate??? • Barriers to Access Behavioral Health Services • Financial Concerns • July 2011: Launch Behavioral Health Pediatric Integrated Program (BHPIP) • January 2012: Complete integration of all Pediatric BH Services into BHPIP

  3. Our Model – Who We Are

  4. Our Model – What We Do • Individual and Family Therapy • Psychiatry (weekly) • School-Based Behavioral Health Services • Consultation to PCPs during medical appointments

  5. Our Model – How We Do It • Strong Clinic Leadership Commitment to Integrate • Co-location • Warm Hand Off • Pediatric Social Worker • Shared EMR • Shared Administrative Staff • Primary Care Behavioral Health Consultation Training • Creative Access to Child Psychiatry Services

  6. Co-Location Fall 2013: Rate of referral = 16/month CONSTRUCTION BHPIP Moves across the hall at the end of November Rate of referral DROPS to 8.5/month Seasonal Variation? Not entirely: Winter 2012 ROR 13/month

  7. Warm Hand-off • Tracking began July 1, 2013

  8. Warm Hand-off CONSTRUCTION • July - November 2013: WH rate 53% • December 2013 – February 2014: WH rate 21%

  9. Bridging the gap

  10. Outcomes I - Access • Referrals to BH at Dimock increased from 18% to 63% • Wait time for Services reduced to 1-2 weeks • Why refer to other agencies? • 1. Language Needs • 2. Preference for School Based Services at a School Dimock does not serve • 3. Preference for Home-Based Services • 4. Distance

  11. Outcomes II - Quality of Care • COMPLIANCE WITH INTAKE: 67% • Rough estimate of compliance pre-integration: ~30%

  12. Outcomes III – Financial Sustainability • Cost Neutral by the end of second Fiscal Year • More streamlined/efficient use of Employee Time

  13. Outcomes IV - Morale • 1.Mutual Respect of Providers’ Disciplines • 2. Frequency and Quality of Communication • Leading to better understanding of patients (both MD and BH) and better compliance and tracking of patients within BH services • 3. Improved Access to Services and Access to Informationabout Treatment (for MD) • 4. Role of SW to facilitatethe process from both MD and BH perspectives • 5. Feeling of support and efficacy in role (BH)

  14. Expansion OBHI (Ob/Gyn and Behavioral Health Integration) Launched November 1, 2013 Funded by Children’s Hospital • Introduction of BH services at New OB appointment • MH Screening at prenatal and post-partum appointments • Access to BHPIP for services when needed or requested

  15. Where Next? Behavioral Health Consultations • 1. Increase: Could we reach more than 7% of Pedi patients? • 2. Billing???

  16. Where Next? Could we integrate care of chronic conditions?

  17. Where next? How do we redefine the “closed” BH case?

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