Bringing mental health care into pediatricians' offices works, finds 5-year study

June 11, 2019

A five-year study at Boston Children's Hospital reports success with a program it started in 2013 to bring much-needed behavioral health services directly into primary care pediatricians' offices. As reported today in Pediatrics, the program improved children's access to behavioral health care, with only minor increases in cost, and got high marks from participating pediatric practices.

Based on the findings, Boston Children's Hospital is continuing to expand and evaluate the program, which currently reaches more than 70 of its affiliated pediatric practices in Massachusetts.

Meeting an unmet need

By late adolescence, up to 20 percent of children will have experienced functionally impairing anxiety, depression, and/or ADHD, the most common and treatable mental health conditions. But child behavioral health specialists are in chronic short supply with long wait lists, says Heather Walter, MD, MPH, a child/adolescent psychiatrist at Boston Children's Hospital and first author on the paper. Massachusetts, for example, has nearly 300,000 youths with at least one diagnosable psychiatric disorder -- but only about 400 to 500 practicing pediatric psychiatrists.

"Nearly a decade can elapse between when a child first shows symptoms of a disorder and when it is diagnosed and treated, which has major consequences in their academic, social, and family lives," Walter says. "There aren't enough child psychiatrists to offer this care alone, and we realized we needed partners. The obvious physician partners are pediatricians - they see children for years, know them well, are tuned into child development, and are highly trusted by patients and families."

Empowering pediatricians

Boston Children's Hospital's Behavioral Health Integration Program (BHIP) was designed to empower primary care pediatricians to head off or, if indicated, treat most cases of anxiety, depression, and ADHD, referring only the more complex cases to specialists. This would free up the limited number of child mental health specialists to focus on youths with more severe illness.

"If a child has schizophrenia or bipolar disorder, we'd want them to be cared for in a specialty setting," notes Walter.

The program has three components:5-year outcomes

The BHIP offered its services to primary care practices affiliated with the Pediatric Physicians' Organization at Children's, LLC (PPOC), on a first-come, first-serve basis. The study in Pediatrics looked at outcomes in the first 13 PPOC practices in Greater Boston to enroll in the program. These practices comprised some 105 primary care pediatricians serving some 114,000 children and youth.

"Our over-arching goal was to increase children's access to behavioral health services, without breaking the bank," says Walter.

Study findings included:"We were hoping for a big dip in emergency room utilization, because that's a big problem when mental health services are not widely available," says Walter. "But we need more data before we can make that claim."

The study did, however, find an overall 19 percent decrease in emergency room costs for behavioral health visits.

Although this Pediatrics study did not directly survey parents, pediatricians often reported high satisfaction among families who felt the arrangement was more convenient, less stigmatizing and in some cases more readily covered by insurance.

New initiatives

The BHIP now plans to extend the program to all of the PPOC primary care practices (current participation is 85 percent) and continue to research outcomes. Other recent and future initiatives include:"Providing top-quality behavioral health services to kids in the right setting at the right time will help millions of children receive the care they need and deserve," says David DeMaso, MD, psychiatrist-in-chief in the Department of Psychiatry at Boston Children's Hospital.
The BHIP was initially supported by Boston Children's Hospital's Provider-Payor Quality Initiative, a collaboration between Boston Children's Hospital, Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Tufts Health Care, and MassHealth. BHIP has received subsequent funding from MA Health Policy Commission, the Commonwealth of Massachusetts, the Children's Hospital Los Angeles Health Network, the Sydney A. Swensrud Foundation, Nancy Adams & Schott Schoen Family, Harvard Pilgrim Health Care, SAMHSA, and the Tommy Fuss Center for Neuropsychiatric Disease Research.

The study in Pediatrics was funded by the Boston Children's Hospital Payer Provider Quality Initiative. Glenn Focht, MD (now at Connecticut Children's Medical Center) was the study's senior author. Coauthors were Louis Vernacchio, MD, MSc, Emily Trudell, MD, Jonas Bromberg, PsyD, Ellen Goodman, MD, MSW, LICSW; Jessica Barton, MSW, LICSW; and Gregory Young, MD, all of Boston Children's and the PPOC; and David DeMaso, MD.

About Boston Children's Hospital

Boston Children's Hospital, the primary pediatric teaching affiliate of Harvard Medical School, is home to the world's largest research enterprise based at a pediatric medical center. Its discoveries have benefited both children and adults since 1869. Today, more than 3,000 scientists, including 8 members of the National Academy of Sciences, 18 members of the National Academy of Medicine and 12 Howard Hughes Medical Investigators comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's is now a 415-bed comprehensive center for pediatric and adolescent health care. For more, visit our Discovery blog and follow us on social media @BostonChildrens, @BCH_Innovation, Facebook and YouTube.

Boston Children's Hospital

Related Pediatricians Articles from Brightsurf:

Only a third of pediatricians fully follow guidelines on peanut allergy prevention
While 93 percent of U.S. pediatricians surveyed were aware of the national guidelines on peanut allergy prevention in infants, only 30 percent were fully implementing the recommended practices and 64 percent reported partial implementation, according to the study published in JAMA Network Open.

Despite burdens most pediatricians very supportive of national vaccination program
Despite bureaucratic hurdles, the vast majority of pediatricians want to keep participating in a national program that provides vaccinations at no cost to children who are on Medicaid, uninsured, or who are American Indian/Alaska Native, according to researchers at the University of Colorado Anschutz Medical Campus.

Visits to pediatricians on the decline
Commercially insured children in the US are seeing pediatricians less often than they did a decade ago, according to a new analysis led by a pediatrician-scientist at the University of Pittsburgh and UPMC Children's Hospital of Pittsburgh.

Empowering pediatricians to reduce preventable firearm injuries and deaths
A Children's National Hospital emergency room physician will participate in a symposium of surgeons, neurosurgeons and emergency medicine doctors during the American Academy of Pediatrics National Conference and Exhibition -- the first time these groups have come together to help reduce the number of kids hurt or killed by firearms.

Study shows pediatricians can help parents to quit smoking
An NIH-funded study published in JAMA Pediatrics has shown pediatricians can help parents quit smoking.

Bringing mental health care into pediatricians' offices works, finds 5-year study
A five-year study at Boston Children's Hospital reports success with a program it started in 2013 to bring much-needed behavioral health services directly into primary care pediatricians' offices.

Pediatricians and nurse practitioners report using strategies to improve HPV vaccination
Pediatricians and nurse practitioners report using several strategies to improve human papillomavirus (HPV) vaccination, yet also perceive barriers, according to a national American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) network study.

Survey of pediatricians and family physicians assesses HPV vaccine delivery practices
Current primary care practices and experiences with the delivery of HPV vaccine.

A 'compelling call' for pediatricians to discuss firearm safety
The Children's commentators point to the 'extremely dangerous' combination of 'the small curious hands of a young child' and 'the easily accessible and operable, loaded handgun' and suggest that pediatricians who counsel families about safely storing weapons tailor messaging to the weapon type and the family's reason for owning a firearm.

Influenza vaccine delays are a problem for pediatricians
Uptake of influenza vaccine among children is low compared to other childhood vaccines, and missed opportunities for vaccination play an important role in this low uptake.

Read More: Pediatricians News and Pediatricians Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to