Behavioral Health Integration Program

The current delivery model for addressing behavioral health issues in pediatric primary care is failing to meet the needs of children and families with behavioral health concerns. In 2013, the PPOC, in partnership with the Department of Psychiatry at Boston Children’s Hospital, launched the Behavioral Health Integration Program (BHIP) as an innovative model of behavioral health care that creates sustainable capacity to deliver integrated, evidence-based, behavioral health services into the pediatric medical home, with coordination of care at its core.

BHIP addresses three foundational issues head-on, to create and support a more capable medical home team in the following ways:

  • Delivering education and skills training to improve PCP competence in behavioral healthcare
  • Integrating behavioral health providers into the medical home team
  • Providing rapid response, case-focused, consultative support from child psychiatrists and substance use specialists

The program places clinical psychologists, clinical social workers, and mental health counselors, licensed for independent practice in Massachusetts, in the pediatric medical home to provide diagnostic evaluation, evidence-based treatment, consultation to PCPs, and to support behavioral health care coordination.

The program seeks to improve the following in the pediatric medical home:

  1. Increase rates of screening for behavioral health issues
  2. Increase rates of diagnostic evaluation for children that screen positive
  3. Increase rates of referral to behavioral health services for children with behavioral health diagnoses
  4. Increase coordination of care, and bi-directional communication with community providers,  for children referred outside the practice
  5. Decrease the time to a first appointment for children referred outside the practice for specialized behavioral health services
  6. Decrease emergency room utilization for behavioral health conditions
  7. Decrease inpatient psychiatric hospitalizations

Integrating Substance Use and Addiction Care in the Medical Home

Given the negative consequences of substance use and addiction, and the prevalence of co-occurring substance use in adolescents with behavioral health problems, increasing the medical home’s capacity to manage these issues is a high priority.

In a collaboration enabled initially by a grant from the Blue Cross Blue Shield Foundation, the PPOC partnered with the Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s Hospital. In this new multidisciplinary model, specially trained clinical social workers are integrated within the primary care team, to consult with medical staff, conduct evaluations and brief interventions, support the medical team in implementing substance use screening, and helping PCPs deliver brief interventions.  The program aims to address all forms of substance use in children and teens, from the initiation of nicotine and alcohol use, to regular use of marijuana, cocaine, and opioids.

An important part of this effort, has been preparing pediatricians to provide medication assisted treatment for patients with opioid use disorders.  Fewer than 2% of adolescents receiving treatment for opioid use disorders (OUDs) are prescribed medication, in spite of its efficacy, and the recommendations of the American Academy of Pediatrics (AAP).  Currently, pediatricians make up less than one-percent of physicians dispensing this life-saving care.

A team of pediatric addiction medicine specialists from ASAP will support each practice participating in this program.  In 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded a grant to fund the expansion of this substance use integration project to an additional 20-25 practices over the next five years. This award will dramatically bolster our network’s capacity to address substance use and addiction in primary care. 

The program offers the following components:

Comprehensive Substance Abuse Evaluation – Initial evaluation to determine the best treatment plan for the patient, encouraging parental/caregiver involvement when possible and with patient permission.

Provider Education – Sessions focused on increasing the understanding around the impact that substance use has on the developing body and brain, as well as how addiction develops.

Substance Use Intervention – Evidence-based substance use intervention can help patients explore their use, and how it may affect their lives. Depending on patient goals and needs, these visits may focus on making changes, developing coping skills, and other areas that patients want help with.

Parent/Caregiver Guidance – Patients may present for a confidential evaluation without their parent or guardians. Because substance use is often a source of family stress, patients may invite their parents to take advantage of parent guidance that focuses on increasing the understanding of adolescent substance use and strategies for reducing the risks associated with substance use,

Medication-Assisted Treatment (MAT) – Pediatricians who prescribe medications for opioid use disorders are rare, inspite of the efficacy of this potentially life-saving treatment.  The PPOC is committed to training pediatricians to offer medications such as buprenorphine (Suboxone®) and naltrexone (Vivitrol ®) to treat opioid and alcohol disorders as part of this work.  This treatment combines pharmacotherapy with behavioral intervention in a family-centered, primary care setting, making it easier for youth to access developmentally appropriate services close to home.

Referral Support – If a patient is in need of a higher level of care than can be managed in the medical home, the practice helps families identify and access services in the community to meet the patient’s needs.

To learn more about this important project, or to participate, contact the Behavioral Health Integration Program.

The PPOC is one of the largest pediatric primary care physician organizations in the country, with more than 360 pediatric primary care physicians, 130 nurse practitioners and physician assistants working in community-based practices in 105 locations throughout Massachusetts.

The PPOC has enabled us to offer multiple new services (counseling, care coordination, telepsychiatry, etc.) to our patients while also improving our business and clinical QI performance in a much more rigorous way than ever before.

Peter Kenny
Northampton Area Pediatrics