Regardless of the size, complexity, or location of a primary care pediatric practice, meeting the mental and behavioral health needs of patients and families presents a significant challenge. However, with challenges come opportunities to innovate and collaborate. Creative solutions can be a win for all stakeholders and should be encouraged. Kudos to the authors and all involved in “A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial,”1 who had the courage to think outside the box to solve a practice and community need.
Most pediatricians recognize the significance of mental and behavioral health concerns in the physical health of their patients. Although many practices are exploring opportunities to have colocated or fully integrated mental health models inside their practice walls, there can be significant challenges, including adequate space, privacy, and appropriate payment (especially when mental health insurance benefits are carved out and managed by a third party). The innovative model in this study combines a “soft hand-off” referral model and takes advantage of telehealth technology for implementation.
For those practices that are facing barriers to physical incorporation of mental health into their practice sites, finding appropriate community partners and a way to connect families to care is a viable alternative. Whether for physical health or behavioral health, pediatricians tracking referrals as part of family-centered medical home models have unexpectedly come to realize just how often families do not follow through with practice recommendations for outside care. Soft hand-offs, personal introductions, and making appointments directly within the medical home have all demonstrated positive impact. Adding a visual connection via telehealth and starting an engaged relationship can only have additional positive influence on visit completion.
As pediatricians, we have a unique opportunity to provide care to families who are digital natives. Barriers to effective use of telehealth solutions often reside more at the practice level than the patient and/or family levels. Connecting to others via virtual visualization is often a part of the fabric of our patients’ desire to connect to their extended family and community. As part of the family’s health care team, if we truly decide to put the patient and family at the center, pediatricians should examine their own hesitancy and trepidation regarding telehealth and technology-enabled communications and work to overcome them.
Screening for developmental, behavioral, and mental health is now incorporated into the Bright Futures Periodicity Schedule.2 At some point, if pediatricians want to have maximal impact on our patients’ lives, we will all have to find creative ways to identify concerns and either connect families to appropriate care in a way that results in appropriate care delivery and completion or provide comprehensive care within our medical homes. Even for those ambitious practices that are fully integrating mental health at the practice site, at some point there will likely be capacity challenges, and they may have to creatively incorporate community-based partners.
Regardless of the model, telehealth presents an opportunity to extend our medical home to meet mental and behavioral health needs. It may be by providing direct remote telepsychiatry or by connecting families to an appropriate community resource. Those practices that innovate to solve their problems by extending their medical home to include care teams outside their practice walls will likely see improved family satisfaction and, hopefully, improved outcomes.3 Get started on your practice journey. Your families are counting on you.
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
FUNDING: No external funding.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2018-2738.
POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.