It’s like finding the Holy Grail! For pediatricians, successfully integrating behavioral health (BH) in a busy pediatric practice is an aspirational goal that isn’t always easy to achieve. The barriers to successful behavioral health integration include space, billing, and often finding mental health providers willing and able to co-locate with a pediatrician. In this month’s Pediatrics, Dr. Heather Walther and colleagues from Massachusetts provide us with the first results of their statewide Behavioral Health Integration Program (BHIP) which are quite promising (10.1542/peds.2018-3243).
BHIP was formed in 2013 and created a statewide support network to provide integrated BH services in independent pediatric practices. They signed up 400 doctors and 84 practices statewide. Each practice committed to: 1) designate ≥1 PCPs (physicians/nurse practitioners) to attend the education component and serve as BH “champion” for the practice; 2) utilize the consultation component as needed; 3) engage in integrated practice transformation including creating a BH team comprised of PCPs, BH clinicians (BHCs [psychologists/social workers/counselors]), and care coordinators (CCs); and 4) provide on-site clinical BH services. Using a learning collaborative model, the group provided education on managing behavioral health conditions as well as practice management (e.g, how to bill), real time phone support for providers seeing children with behavioral issues, and an onsite behavioral health service. This first paper highlights the outcomes at year 5 for the first 12 practices enrolled in the program.
The outcomes demonstrated in the 5-year quality improvement program included increased practice-level BH integration, psychotherapy and medical BH visits, and guideline congruent medication prescriptions for anxiety/depression and attention deficit/hyperactivity disorder. Additionally, while ambulatory BH spending increased 8%, emergency BH spending dropped 19% suggesting a shift of services to the practice setting. Participating providers reported high self-efficacy managing BH issues.
The work done in Massachusetts is another great example of the power of multi-practice learning collaboratives. Prior learning collaboratives have been used to improve asthma care, developmental screening, and obesity among other topics. Many statewide collaboratives are coordinated through NIPN – the National Improvement Partnership Network hosted at the University of Vermont. The American Academy of Pediatrics has also supported these types of improvement methods through the Quality Improvement Network (QUINN). In my opinion, these collaboratives offer the best methodology to actually improve and transform practices as well as quality outcomes.
Most importantly, the BHIP program offers a “real-life” tested and now evidence-based way states can improve BH services to resource limited areas. What most astounds me is that this was the first paper demonstrating outcomes, since other states (like Maryland) have also adopted the BHIP model and embraced providing support to practices to help alleviate the challenges faced by pediatricians in communities with inadequate mental health resources. Link to this important study to learn more.