The development and implementation of a preventive integrated behavioral health program in two academic pediatric...

Academy of Pediatrics advocates for a preventive approach to children's mental health (MH) care and pediatric primary care providers (PCPs) are in a unique position to promote the emotional health of their patients, integrate systems for screening and assessment of MH conditions and provide MH intervention and ongoing clinical follow-up. Integration of a behavioral health service into pediatric primary care has the potential to increase the clinical confidence and MH competency of PCPs and improve patient health outcomes through increased access to and delivery of quality MH care in the primary care setting.

This article describes the step-by-step process of developing and implementing a custom integrated behavioral health (IBH) program into two different academic pediatric primary care clinics located in New York, NY and Chicago, IL. The process of developing each clinic's: IBH needs assessment, setting of IBH priorities and defining and implementing initial and subsequent targeted educational and clinical interventions are described in detail. Specific consideration of each IBH program's issues related to physical space, staffing, funding, and billing is also addressed.

Each clinic had different pre-existing strengths, challenges, resources, and priorities but both settings desired having an IBH program that would simultaneously improve patient access to clinic-based counseling and psychiatry services while building MH clinical capacity among pediatric residents and attending PCPs.

Specific IBH educational and clinical interventions described in this article differed between the two settings, however, both IBH models were developed to provide pediatric residents and attendings with a combination of in-person and asynchronous clinical education and consultation and opportunities for mental health clinical skill modeling and guidance while also creating increased patient access to clinic-based MH services. This detailed review will be of benefit to pediatric clinics considering development of a customized IBH program.