Behavioral Health Integration Program

The most prevalent model for addressing behavioral health concerns in pediatric primary care is failing to meet the needs of children and families.  In 2013, the PPOC, in partnership with the Department of Psychiatry at Boston Children’s Hospital, launched the Behavioral Health Integration Program (BHIP) to create sustainable capacity to deliver integrated, evidence-based, behavioral health services in 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:

  • Delivering education and skills training to improve the medical home team’s comfort and skill, managing behavioral health concerns
  • Integrating behavioral health providers in the medical home
  • Providing rapid response, case-focused, consultative support from child psychiatrists and substance use specialists

Clinical psychologists, clinical social workers, and mental health counselors, integrated in the pediatric medical home, provide diagnostic evaluation, evidence-based treatment, consultation to PCPs, and support behavioral health care coordination.

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

  1. Increase rates of screening for mental health and substance use issues
  2. Increase rates of appropriate evaluation for children with identified needs
  3. Increase rates of referral to behavioral health services for children with identified needs
  4. Increase coordination of care, and bi-directional communication with community providers, for children referred outside the practice
  5. Decrease emergency room utilization for behavioral health conditions
  6. 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.

To address this, the PPOC has joined forces with the Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s Hospital, to create a new model of primary care substance use intervention, called the Adolescent Substance Use and Addiction Program in Primary Care, or ASAP-PC.  Through this approach,  specially trained clinical social workers are integrated with 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.  ASAP-PC 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 initative to an additional 20-25 practices. This award will dramatically bolster our network’s capacity to address substance use and addiction in primary care. 

The ASAP-PC program includes the following components:

  • Comprehensive Substance Abuse Evaluation 
  • Provider Education
  • Substance Use Intervention
  • Parent/Caregiver Guidance
  • Medication-Assisted Treatment (MAT)
  • Referral Support 

To learn more about BHIP and ASAP-PC, 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, and 75 integrated behavioral health clinicians, 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