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Abstract

Behavioral health integration in primary care is identified as an important strategy to achieve early identification and treatment of behavioral health disorders. This paper describes a pilot project designed to test the feasibility and sustainability of integrating behavioral health into pediatric primary care clinics. Five private, fee for service pediatric primary care practices were identified in the greater Houston area to establish behavioral health integration. The practices were supported with establishment of behavioral health integration, specifically with recruitment of the behavioral health provider, training of the clinical and administrative teams, and development of interdisciplinary clinical protocols. Difficulties in implementation included differences between medical and psychological provider’s work cultures, credentialing delays, reimbursement barriers, and behavioral health provider difficulties in meeting productivity targets. Strategies for addressing these issues are discussed.

Key Take Away Points

  • This article summarizes the establishment of behavioral health integration in five primary care pediatric sites in the Greater Houston Area
  • Difficulties in implementation included differences between medical and psychological provider’s work cultures, credentialing delays, reimbursement barriers, and behavioral health provider difficulties in meeting productivity targets.
  • Strategies for improving behavioral health integration in the pilot sites include additional training for clinical and administrative teams, additional support for credentialing and billing, increased lag time for behavioral health providers to reach billing productivity targets.

Author Biography

Stephanie Chapman, PhD Stephanie Chapman is a psychologist, Assistant Professor at Baylor College of Medicine and Associate Medical Director of Behavioral Health at the Centers for Children and Women. In her work Dr. Chapman provides bilingual (English/Spanish) consultation, diagnostic and therapy services within an integrated interdisciplinary team. Her research interests are in primary care behavioral health integration, treatment of disruptive behaviors, reproductive psychology, and in improving health care service for low-income and minority status communities. Nancy Correa, MPH Nancy Correa is the Senior Community Initiatives Coordinator for the Section of Public Health and Child Abuse Pediatrics at Texas Children’s Hospital. In this role, she leads community collaboratives to strategically address gaps in practice and knowledge to mitigate childhood adversities and foster resilience in individuals, families, and communities. Nancy has a bachelors degree from Rice University in Chemistry and Policy Studies, a masters degree from Boston University School of Public Health, and a certificate in nonprofit management from Northeastern University. Angela Cummings, DrPH Angie Cummings received her DrPH in Community Health Practice from The University of Texas School of Public Health. Currently, she is an assistant professor at Baylor College of Medicine in the Section of Public Health Pediatrics. Her current work includes evaluation of integrated behavioral health in primary care and research related to health care utilization for behavioral health issues. Bethanie Van Horne, DrPH Beth Van Horne is an Assistant Professor at Baylor College of Medicine and Director of Research, Section of Public Health & Child Abuse Pediatrics. Her research interests include postpartum depression, perinatal substance use, maternal mortality, caregiver support programs, mental/behavioral health, child maltreatment, and services and programs for foster and at-risk families. Heidi Schwarzwald, MD, MPH Heidi Schwarzwald is currently the Chief Medical Officer of Aetna Better Health of Texas. With over 20 years of experience in the health care system and 7 years in managed care, Dr. Schwarzwald has a strong background in integrated health systems both in the United State and around the world. A pediatrician by training, Dr. Schwarzwald has always worked with medically underserved populations.

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