Behavioral Health Integration in Pediatric Primary Care

Background: Pediatric behavioral health problems are a significant issue in healthcare. Over 15 million children are diagnosed with behavioral health problems in the United States. The cost of managing behavioral health in pediatric patients is estimated to be 40 billion dollars. Access to behavioral health care in the pediatric population is a significant challenge, including the difficulty of navigating the healthcare system, wait times for behavioral health treatment, and a shortage of behavioral health providers. Primary care providers and behavioral health providers continue to note dissatisfaction with managing pediatric behavioral health. Methods: A quality improvement project was developed to improve provider satisfaction with managing pediatric behavioral health and improve pediatric behavioral health outcomes by integrating a behavioral health provider into a private pediatric primary care clinic. In collaboration with a behavioral health clinic, a licensed social worker was at the private pediatric primary clinic for one month to provide access to behavioral health services onsite. Primary care providers and behavioral health providers completed a pre-intervention survey and a post-intervention survey to evaluate the effectiveness of the intervention and evaluate if the intervention improved provider satisfaction with behavioral health management in pediatric patients. Baseline and post-intervention PHQ9 and GAD7 scores were obtained to determine if the intervention improved behavioral health outcomes in the pediatric population. Results: Primary care providers referred 35 patients to the onsite licensed social worker during the intervention, and n=25 (71%) were seen on the same day as the referral reducing the gap from referral to initial behavioral health contact. There was a 50% increase in primary care providers reporting not burdensome or slightly burdensome with managing behavioral health after the intervention. Conclusions: Behavioral health integration into pediatric primary care appears to improve access to initial behavioral health contact and improved primary care provider satisfaction in managing behavioral health. Replication of this quality improvement is needed with a longer duration to determine if it will improve pediatric behavioral health outcomes.