Strategies for integrating behavioral health into pediatric primary care

Supporting greater integration of behavioral care for pediatric physicians could offer benefits despite a scarcity of specialists.

States have options for supporting primary care physicians as they confront the behavioral disorders that plague nearly 1 in 7 children in the U.S.

A recent report sponsored by Milbank Memorial Fund surveyed the current state of behavioral health integration in pediatric primary care to produce a short list of policy guidelines for state governments seeking a better handle on the issue. The report cites significant barriers to access that leave the vast majority of children with psychiatric disorders without specialty care. That puts more of the burden for treatment and diagnosis on primary care physicians, which the report sees as an opportunity.

“Policymakers, planners, and providers can work together to use data and evidence-informed strategies that create sustainable programs that address the mental health needs of children and families,” the authors say. In support of that goal, they suggest several steps states can take:

  • Since pediatric behavioral health resources are scarce, leverage and efficiency are key components of any plan. States need to identify which conditions can be treated effectively by primary care pediatricians and which require specialty care. The lower the level of intervention, the better-equipped a primary care physician will be to deal with an issue, according to the report, allowing for more efficient use of the relatively few specialists on patients with greater need.
  • Clarifying Medicaid’s early and periodic screening, diagnostic and treatment (EPSDT) program and developing quality metrics for pediatric primary care can guide physicians toward proper reimbursement procedures for effective treatments. The report also notes the importance of tracking outcomes to build evidence for the effectiveness of integrated behavioral health programs to spur best practices both within a given state and across multiple states’ programs.
  • Likewise, the report notes that states can design integrated behavioral health initiatives into Medicaid managed care contracts or accountable care organizations. The report suggests states develop billing codes for behavioral health services, allow payments for telehealth consultations with specialists, and allowing same-day billing for both medical and behavioral health visits, among other ideas.