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Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System

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Abstract

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system’s six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.

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Abbreviations

AAP:

American Academy of Pediatrics

CNHS:

Children’s National Health System

DC:

District of Columbia

DC-MAP:

DC Mental Health Access in Pediatrics

EMR:

Electronic medical record

PCP:

Primary care provider

PDSA:

Plan–Do–Study–Act cycle

QI:

Quality improvement

SDQ:

Strengths and Difficulties Questionnaire

References

  • Akinbami, L. J., Cheng, T. L., & Kornfeld, D. (2001). A review of teen-tot programs: Comprehensive clinical care for young parents and their children. Adolescence, 36(142), 381–393.

    CAS  PubMed  Google Scholar 

  • American Academy of Child & Adolescent Psychiatry (AACAP). (2016). Medical homes for children and adolescents with mental, developmental and substance abuse disorders. Retrieved November 5, 2016 from http://www.aacap.org/AACAP/Policy_Statements/2011/Medical_Homes_for_Children_and_Adolescents_with_Mental_Developmental_and_Substance_Abuse_Disorders.aspx.

  • American Academy of Pediatrics (AAP). (2010). Appendix S3: Mental health practice readiness inventory. Pediatrics, 125(Supplement 3), S129–S132.

    Article  Google Scholar 

  • Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L. (2015). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. JAMA Pediatrics, 169(10), 929–937. doi:10.1001/jamapediatrics.2015.1141.

    Article  PubMed  Google Scholar 

  • Bartels, S. J., Coakley, E. H., Zubritsky, C., Ware, J. H., Miles, K. M., Areán, P. A., … PRISM-E Investigators. (2004). Improving access to geriatric mental health services: A randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. The American Journal of Psychiatry, 161(8), 1455–1462. doi:10.1176/appi.ajp.161.8.1455.

    Article  PubMed  Google Scholar 

  • Beers, L. S., Godoy, L., & Biel, M. G. (2017). Using effective public private collaboration to advance integrated care. Child and Adolescent Psychiatric Clinics of North America. doi:10.1016/j.chc.2017.06.003.

    PubMed  Google Scholar 

  • Briggs, R. D., Stettler, E. M., Silver, E. J., Schrag, R. D. A., Nayak, M., Chinitz, S., & Racine, A. D. (2012). Social-emotional screening for infants and toddlers in primary care. Pediatrics, 129(2), e377–e384. doi:10.1542/peds.2010-2211.

    Article  PubMed  Google Scholar 

  • Brink, R. (2012). Improving the children’s mental health system in the District of Columbia. Washington, DC: Children’s Law Center.

    Google Scholar 

  • Chapa, T. (2004). Mental health services in primary care settings for racial and ethnic minority populations.

  • Chevarley, F. M. (2003). Statistical brief #12: Children’s Access to Necessary Health Care, Fall 2001. Rockville: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality. Retrieved from http://meps.ahrq.gov/mepsweb/data_files/publications/st12/stat12.shtml.

  • Child and Adolescent Protection - Children’s National Health System. (n.d.). Retrieved April 2, 2016 from http://childrensnational.org/departments/child-and-adolescent-protection.

  • Centers for Medicare & Medicaid Services, Center for Consumer Information & Insurance Oversight (CMS-CCIIO). (2016). The mental health parity and addiction equity act (MHPAE). Retrieved November 20, 2016 from https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html.

  • Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health. (2009). Policy statement—The future of pediatrics: mental health competencies for pediatric primary care. Pediatrics, 124(1), 410–421. doi:10.1542/peds.2009-1061.

    Article  Google Scholar 

  • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry: The Journal of Mental Science, 150, 782–786.

    Article  CAS  Google Scholar 

  • DC MAP-Mental Health Access in Pediatrics. (2017). Retrieved March 21, 2017 from http://www.dcmap.org/.

  • Ellingson, K. D., Briggs-Gowan, M. J., Carter, A. S., & Horwitz, S. M. (2004). Parent identification of early emerging child behavior problems: Predictors of sharing parental concern with health providers. Archives of Pediatrics & Adolescent Medicine, 158(8), 766–772. doi:10.1001/archpedi.158.8.766.

    Article  Google Scholar 

  • Foy, J. M. & American Academy of Pediatrics Task Force on Mental Health. (2010). Enhancing pediatric mental health care: Report from the American academy of pediatrics task force on mental health. Introduction. Pediatrics, 125(Suppl 3), 69–74. doi:10.1542/peds.2010-0788C.

    Article  Google Scholar 

  • Ginsburg, S., & Foster, S. (2009). Strategies to support the integration of mental health into pediatric primary care. Washington, DC: National Institute for Health Care Management Research and Educational Foundation.

    Google Scholar 

  • Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 38(5), 581–586.

    Article  CAS  PubMed  Google Scholar 

  • Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581–629. doi:10.1111/j.0887-378X.2004.00325.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gresenz, C. R., Blanchard, J. C., Timbie, J. W., Acosta, J., Pollack, C. E., Ruder, T., … Hair, B. (2010). Behavioral health in the District of Columbia: Assessing need and evaluating the public system of care. Arlington, VA: Rand Corporation.

    Google Scholar 

  • Hagan, J., Shaw, J., & Duncan, P. (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents. Elk Grove Village: American Academy of Pediatrics.

    Google Scholar 

  • Heath, B., Wise Romero, P., & Reynolds, K. (2013). A standard framework for levels of integrated health care. Washington, DC: SAMSHSA-HRSA Center for Integrated Health Solutions.

    Google Scholar 

  • Home - National Center for Medical-Legal Partnership. (n.d.). Retrieved April 2, 2016 from http://medical-legalpartnership.org/.

  • Horwitz, S. M., Storfer-Isser, A., Kerker, B. D., Szilagyi, M., Garner, A., O’Connor, K. G., … Stein, R. E. K. (2015). Barriers to the identification and management of psychosocial problems: Changes From 2004 to 2013. Academic Pediatrics, 15(6), 613–620. doi:10.1016/j.acap.2015.08.006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Huffman, J. C., Niazi, S. K., Rundell, J. R., Sharpe, M., & Katon, W. J. (2014). Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: A publication by the academy of psychosomatic medicine research and evidence-based practice committee. Psychosomatics, 55(2), 109–122. doi:10.1016/j.psym.2013.09.002.

    Article  PubMed  Google Scholar 

  • John, T., Morton, M., Weissman, M., O’Brien, E., Hamburger, E., Hancock, Y., & Moon, R. Y. (2014). Feasibility of a virtual learning collaborative to implement an obesity QI project in 29 pediatric practices. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care/ISQua, 26(2), 205–213. doi:10.1093/intqhc/mzu012.

    Article  Google Scholar 

  • Kaaya, S., Eustache, E., Lapidos-Salaiz, I., Musisi, S., Psaros, C., & Wissow, L. (2013). Grand challenges: Improving HIV treatment outcomes by integrating interventions for co-morbid mental illness. PLoS Medicine, 10(5), e1001447. doi:10.1371/journal.pmed.1001447.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. The American Journal of Psychiatry, 159(9), 1548–1555. doi:10.1176/appi.ajp.159.9.1548.

    Article  PubMed  Google Scholar 

  • Katon, W., Unützer, J., Wells, K., & Jones, L. (2010). Collaborative depression care: History, evolution and ways to enhance dissemination and sustainability. General Hospital Psychiatry, 32(5), 456–464. doi:10.1016/j.genhosppsych.2010.04.001.

    Article  PubMed  Google Scholar 

  • Kolko, D. J., Campo, J., Kilbourne, A. M., Hart, J., Sakolsky, D., & Wisniewski, S. (2014). Collaborative care outcomes for pediatric behavioral health problems: A cluster randomized trial. Pediatrics, 133(4), e981–992. doi:10.1542/peds.2013-2516.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kolko, D. J., & Perrin, E. (2014). The integration of behavioral health interventions in children’s health care: Services, science, and suggestions. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 43(2), 216–228. doi:10.1080/15374416.2013.862804.

    Article  Google Scholar 

  • Lieberman, A., Adalist-Estrin, A., Erinle, O., & Sloan, N. (2006). On-site mental health care: A route to improving access to mental health services in an inner-city, adolescent medicine clinic. Child: Care, Health and Development, 32(4), 407–413. doi:10.1111/j.1365-2214.2006.00620.x.

    CAS  Google Scholar 

  • Mark, T. L., Levit, K. R., & Buck, J. A. (2009). Datapoints: psychotropic drug prescriptions by medical specialty. Psychiatric Services, 60(9), 1167. doi:10.1176/ps.2009.60.9.1167.

    Article  PubMed  Google Scholar 

  • Merikangas, K. R., He, J.-P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125(1), 75–81. doi:10.1542/peds.2008-2598.

    Article  PubMed  Google Scholar 

  • NICHQ Vanderbilt Assessment Scale. (2002). American Academy of Pediatrics and National Initiative for Children’s Healthcare Quality.

  • Ojikutu, B., Holman, J., Kunches, L., Landers, S., Perlmutter, D., Ward, M., … Hirschhorn, L. (2014). Interdisciplinary HIV care in a changing healthcare environment in the USA. AIDS Care, 26(6), 731–735. doi:10.1080/09540121.2013.855299.

    Article  PubMed  Google Scholar 

  • Omar, H. A., Fowler, A., & McClanahan, K. K. (2008). Significant reduction of repeat teen pregnancy in a comprehensive young parent program. Journal of Pediatric and Adolescent Gynecology, 21(5), 283–287. doi:10.1016/j.jpag.2007.08.003.

    Article  CAS  PubMed  Google Scholar 

  • Ost, J. C., & Maurizi, L. K. (2013). District of Columbia youth risk behavior survey surveillance report. Washington, DC: Office of the State Superintendant of Education.

    Google Scholar 

  • Parent Navigator Program - Children’s National Health System. (n.d.). Retrieved April 2, 2016 from http://childrensnational.org/choose-childrens/deciding-on-care/support-for-families/parent-navigator-program.

  • Quality Improvement. (n.d.). Retrieved November 7, 2016 from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/index.html.

  • Sheldrick, R. C., Merchant, S., & Perrin, E. C. (2011). Identification of developmental-behavioral problems in primary care: A systematic review. Pediatrics, 128(2), 356–363. doi:10.1542/peds.2010-3261.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA, 282(18), 1737–1744.

    Article  CAS  PubMed  Google Scholar 

  • Squires, J., Bricker, D., & Twombly, E. (2015). Ages & stages questionnaires: Social-emotional, second edition (ASQ:SE-2). Baltimore: Brookes Publishing.

    Google Scholar 

  • U.S. Department of Health and Human Services, Health Resources Service Administration (DHHS-HRSA). (2016). Retrieved November 7, 2016 from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/index.html.

  • Weitzman, C., Wegner, L., Section on Developmental and Behavioral Pediatrics, Committee on Psychosocial Aspects of Child and Family Health, Council on Early Childhood, Society for Developmental and Behavioral Pediatrics., & American Academy of Pediatrics. (2015). Promoting optimal development: Screening for behavioral and emotional problems. Pediatrics, 135(2), 384–395. doi:10.1542/peds.2014-3716.

    Article  PubMed  Google Scholar 

  • World Health Organization, [WHO]. (2008). Integrating mental health into primary care: A global perspective. Geneva: World Health Organization.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Child Health Advocacy Institute, Children’s National Health System, 2233 Wisconsin Ave, Suite 317, Washington, DC, 20007, USA

    Leandra Godoy & Lee Beers

  2. Division of General and Community Pediatrics, Children’s National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA

    Leandra Godoy, Melissa Long, Donna Marschall, Stacy Hodgkinson, Hope Rhodes, Mark Weissman & Lee Beers

  3. Division of Adolescent and Young Adult Medicine, Children’s National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA

    Brooke Bokor

  4. Reach Out Therapy, LLC, 845-Q Quince Orchard Blvd., Gaithersburg, MD, 20878, USA

    Howard Crumpton

Authors
  1. Leandra Godoy
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  2. Melissa Long
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  3. Donna Marschall
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  4. Stacy Hodgkinson
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  5. Brooke Bokor
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  6. Hope Rhodes
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  7. Howard Crumpton
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  8. Mark Weissman
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  9. Lee Beers
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Corresponding author

Correspondence to Leandra Godoy.

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Conflict of interest

Leandra Godoy, Melissa Long, Donna Marschall, Stacy Hodgkinson, Brooke Bokor, Hope Rhodes, Howard Crumpton, Mark Weissman, and Lee Beers declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This study does not contain any studies with human participants or animals performed by the authors. Information reported in this article was considered exempt by the Children’s National Health System Institutional Review Board.

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Godoy, L., Long, M., Marschall, D. et al. Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System. J Clin Psychol Med Settings 24, 245–258 (2017). https://doi.org/10.1007/s10880-017-9509-8

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