The number of children with new and ongoing behavioral health needs continues to increase, staffing shortages persist, and resources are inadequate.
At the 2021 Annual Leadership Conference, three experts described what integrated behavioral health is, what the challenges are and how children's hospitals can use this model to better meet the needs of their patients.
Children's hospitals continue to face a mental health crisis. While the crisis is multi-faceted, requiring changes across the entire health care delivery system, integrated behavioral health (IBH) is one model that children's hospitals and primary care practices can adopt to mitigate the demand.
What is IBH?
IBH is a multidisciplinary approach whereby physical and behavioral health care services are provided in the same physical space. It is about prevention and early intervention, bridging behavioral health and primary care. Ideally, IBH helps prevent the need for higher levels of care.
Through IBH, primary care providers (PCP) screen, assess and diagnose patients for behavioral health concerns and then provide brief interventions or triage higher acuity needs. IBH helps address urgent behavioral health needs without overtaxing other parts of the system, such as emergency departments.
IBH can improve physical and behavioral outcomes for patients by:
- Promoting the value of emotional and behavioral health.
- Reducing stigma.
- Delivering care in a convenient, trusted location where families are used to receiving care.
- Removing barriers to access.
- Closing the gap between those needing services and those receiving them.
- Reducing costs of care.
Challenges to IBH and some solutions
"The challenges facing IBH are similar, or the same, as those facing behavioral health care across the entire system," says Jessica McClure, Psy.D., medical director, Behavioral Health, HealthVine, Cincinnati Children's Hospital Medical Center.
1. Workforce shortages. There is a national shortage of behavioral health care providers. It's not a new problem, but when incorporating behavioral health care more consistently into primary care, it poses an ongoing challenge. Especially in rural communities that are disproportionately affected.
"How do we utilize the levels of care and the pediatric providers we have more efficiently?" asks Heather Hutszi, Ph.D., chief psychologist, CHOC Children's. "How do we reach rural communities and help patients and families access care? We need to redeploy our behavioral health workers into IBH so they're ready to be part of a multidisciplinary team, provide targeted interventions and train other staff." Additionally, PCPs have historically limited training in behavioral health care. They could learn new skills that allow them to offer families behavioral health management strategies that don't require the using higher levels of care, such as a trip to the emergency department. Training also gives PCPs the confidence to know when a behavioral health specialist is needed and what the right level of care is for their patient.
Other solutions to workforce shortages include broadening telehealth capabilities to reach rural families in need of behavioral health care and embracing IBH's flexibility to adapt to a primary care practice's existing model, patient needs and staffing limitations.
2. Financial strain. Payment for behavioral health care services vary from state to state. Most insurers don't adequately cover these services and oftentimes programs are funded by pilots and service grants. "For a long time we didn't focus on prevention and we didn't think of children's mental health," Hutszi says. "Because of that, the behavioral health care system is undervalued and underfunded." Solutions are often tied to advocacy efforts but include paying for ALL components of this model, bundling behavioral health benefits, finding designated funding, such as through the Health Resources and Services Administration, a commitment to pay for services across all states and payment parity.
For children's hospitals looking for a place to start with IBH, McClure suggests finding a primary care practice that would serve as a good partner. "Work together on practice readiness with scheduling, finding appropriate space, and while you're building that you're working together to decide what your model will look like. Find a shared vision and establish priorities. That also helps you get buy in from the whole medical team."
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