Integrating Behavioral Health for Better Outcomes

Integrating Behavioral Health for Better Outcomes

This children’s hospital initiative seeks to erase barriers to care by aligning behavioral health with primary medical homes.
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For Monica Barreto, it’s the type of story that further validates the work she and her colleagues are doing.

“I had a patient who was coming in to see her doctor with a persistent cough, but she was healthy—all medical tests were fine,” says Barreto, Ph.D., clinical director of behavioral health for primary care at Nemours Children’s Health in Orlando, Florida. “It turned out to be a small tick; anxiety was starting to develop. We had four sessions, taught her some skills and now she's good to go—the cough has gone away.”

It’s a scene Barreto has seen play out often since Nemours Children’s implemented its Integrated Behavioral Health (IBH) model. The goal is to enhance access to care and improve outcomes by making behavioral health a part of a patient’s primary medical home.

To accomplish those objectives, Nemours Children’s:

  • Embeds licensed therapists in its primary care locations to provide in-person and telehealth visits.
  • Conducts behavioral health screenings within medical visits to facilitate direct referrals and early intervention by pediatric psychologists.
  • Includes behavioral health professionals in medical home health care teams to streamline communication and collaboration.

Nemours Children’s began rolling IBH out to its primary care centers in May 2022, but the health system had been building toward that launch years earlier. The work began in response to the rise in frequency and severity of behavioral health issues among pediatric patients and accelerated in the wake of the pandemic. For primary care physicians, IBH is a shift in the care paradigm.

“This is a totally different scenario because I can connect to my counselor right there in the office—we work together,” says Tom Lacy, M.D., medical director for primary care at Nemours Children’s. “Everything existed in such silos in the past and there were so many instances when patients didn't complete therapy. We're trying to change that, so it’s integral that Dr. Barreto and her team are really part of our team taking care of the kids.”

Eliminating common hurdles to care

Perhaps one of most impactful aspects of IBH, according to Barreto and Lacy, is how the initiative removes barriers to behavioral health care for children in the community. Nemours Children’s completed nearly 1,300 behavioral health patient encounters from May to November in 2022 during the program’s initial rollout. That rate is expected to grow in 2023 as the health system plans to expand IBH to more primary care centers—it’s currently live in 13 of its 20 facilities.

The enhanced access to behavioral health care is instrumental in improving long-term outcomes and is a result of the program’s progress against several traditional barriers to care, including:

  • Availability. Amid a national shortage of behavioral health care professionals, leveraging primary care providers to screen for issues and refer patients in-house for early intervention maximized available resources.
  • Distance. Accessing behavioral health care in their primary medical care home increases the likelihood patients will seek—and continue—treatment. “Most people's pediatrician is relatively close to where they live, so we are bringing mental health care to the patient in that respect,” Lacy says. “Mom's not having to take off a half day from work to take somebody across town to see the therapist.”
  • Payment. Reimbursement is often a major obstacle in funding behavioral health care programs, but Lacy credits a large corporate donor with seeding the IBH initiative. Nemours Children’s is now signing contracts with “forward-thinking” payors to ensure the program’s sustainability.
  • Stigma/fear. “They don't see it as if they're going to the mental health place down the street—they're going to their pediatrician's office,” Lacy says. “We're not a scary place; we're a comfortable, familiar place to go.”

By breaking down these barriers, Barreto says patients and their families are more willing to seek help early and address potential problems before they become crises. “Sometimes getting help leads to so many other stressors that they just don't get the help,” Barreto says. “They shove it down, move on and deal with it when they have that really big overwhelming moment—that's the case for many families.”

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