Five-Phase Replication of Behavioral Health Integration in Pediatric Primary Care

Area of Science:

• Pediatric primary care
• Behavioral health integration
• Healthcare access

Background:

• Severe shortages of pediatric behavioral health specialists necessitate innovative solutions.
• Collaboration between pediatric primary care practitioners (PCPs) and behavioral health (BH) specialists can expand BH services.
• A previous study demonstrated the success of phase 1 of the Behavioral Health Integration Program (BHIP) in 13 pediatric practices.

Purpose of the Study:

• To assess the replication of increased access findings from phase 1 of BHIP over 4 subsequent implementation phases.
• To explore the practicality of broad dissemination of the BHIP model.
• To evaluate the impact of BHIP on access to pediatric behavioral health services.

Main Methods:

• BHIP was extended over 4 phases using a stepped-wedge design to 46 additional pediatric practices, totaling 59 practices.
• The program included BH education, consultation, and support for integrated practice transformation.
• Outcomes were assessed quarterly, pre- and post-program launch, across 7 implementation domains.

Main Results:

• BHIP was associated with increased primary care access to BH services, including screening, psychotherapy, and PCP BH visits.
• Psychotropic prescribing and emergency BH visits remained unchanged.
• The program demonstrated strong performance across acceptability, appropriateness, feasibility, fidelity, adoption, penetration, and sustainability.

Conclusions:

• Integrated care models like BHIP show significant potential for increasing access to BH services in pediatric primary care settings.
• The findings support the scalability and sustainability of BHIP for broader dissemination.
• This approach addresses workforce shortages and improves patient care by integrating BH into primary care.