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Five-Phase Replication of Behavioral Health Integration in Pediatric Primary Care
Heather J Walter1,2,3, Louis Vernacchio2,3,4, Emily Trudell Correa3
1Departments of Psychiatry heather.walter@childrens.harvard.edu.
Insights
Integrating behavioral health services into pediatric primary care significantly improved access to care. This collaborative model expands the behavioral health workforce, benefiting over 300,000 patients across 59 practices.
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.
Background And Objectives:
Because of severe and protracted shortages of pediatric behavioral health (BH) specialists, collaboration between pediatric primary care practitioners (PCPs) and BH specialists has the potential to increase access to BH services by expanding the BH workforce. In a previous study, we demonstrated that phase 1 of a behavioral health integration program (BHIP) enrolling 13 independently owned, community-based pediatric practices was associated with increased access to BH services while averting substantial cost increases and achieving high provider self-efficacy and professional satisfaction. The current study was undertaken to assess whether the initial access findings were replicated over 4 subsequent implementation phases and to explore the practicality of broad dissemination of the BHIP model.
Methods:
After phase 1, BHIP was extended over 4 subsequent phases in a stepped-wedge design to 46 additional pediatric practices, for a total cohort of 59 practices (354 PCPs serving >300 000 patients). Program components comprised BH education and consultation and support for integrated practice transformation; these components facilitated on-site BH services by an interprofessional BH team. Outcomes were assessed quarterly, preprogram and postprogram launch.
Results:
Across combined phases 1 to 5, BHIP was associated with increased primary care access to BH services (screening, psychotherapy, PCP BH visits, psychotropic prescribing) and performed well across 7 standard implementation outcome domains (acceptability, appropriateness, feasibility, fidelity, adoption, penetration, and sustainability). Emergency BH visits and attention-deficit/hyperactivity disorder prescribing were unchanged.
Conclusions:
These findings provide further support for the potential of integrated care to increase access to BH services in pediatric primary care.
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