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Integration of Behavioral Health Into Primary Care Settings

Key Features

  1. Cross-sector training on topics such as behavioral health, social and emotional development, and trauma
  2. Use of developmental and social–emotional screenings in primary care settings
  3. Use of an infant/early childhood mental health specialist in primary care settings at various levels (e.g., co-location, collaboration, integration)
  4. Referrals, follow-up, and care coordination with community-based services
  5. Parenting support and health promotion activities

Pediatric primary care providers (PCPs) play a critical role in supporting wellness in young children. A pediatrician or family physician is often the first person with whom a parent shares concerns or asks questions related to mental health. Early detection of developmental, social–emotional, and behavioral issues, as well as the provision of appropriate supports, is critical to children’s success in school and life. Integration of behavioral health into primary care settings is one of Project LAUNCH’s five core prevention and promotion strategies.

The infusion of mental health supports into primary care can be implemented at various levels of intensity. This continuum ranges from coordination of care for children and families, to co-location of mental health with primary care services, to an integrated approach that involves strategies such as embedding a mental health consultant into pediatric practices, developing shared treatment plans across physicians and mental health consultants, and implementing shared data systems that integrate behavioral and medical electronic health records.

Project LAUNCH grantees have embedded early childhood mental health clinicians into pediatric medical settings to promote family-centered, relationship-based services.

Cross-disciplinary teams work together to assess, support, and follow families with infants and children who are identified by providers as showing early signs of social and emotional difficulties or are experiencing risk factors known to lead to poor social and emotional development outcomes. Other efforts include providing parenting support and family strengthening services within the primary care setting (e.g., the use of Triple P [Positive Parenting Program] or Incredible Years).

Screening children for developmental and social–emotional issues using standardized tools is a core aspect of integration. Project LAUNCH grantees ensure that PCPs use social–emotional screening tools to identify children or families with elevated risk so that further assessment can be conducted by on-site mental health clinicians. If needed, a PCP can provide a “warm handoff” to a mental health clinician or family partner to ensure the family accesses appropriate services. In addition, primary care providers can screen and support the family as a whole on a range of mental health issues, such as parental depression, substance abuse, domestic violence, and other areas that can have a negative effect on a child’s optimal growth and development.

Project LAUNCH supports workforce development activities to build the capacities of PCPs in social–emotional development, behavioral health, and trauma-informed care. Cross-sector professional development (e.g., training mental health consultants and PCPs together) helps build partnerships across systems as well as a common core of knowledge among providers who work with young children and their families. Other workforce development approaches include embedding infant and early childhood mental health training into continuing education requirements for pediatric PCPs.

Grantee Highlights

  • Numerous Project LAUNCH grantee sites use “family navigators” or “health navigators” embedded within pediatric primary care practices. In Weld County, Colorado, Project LAUNCH has funded navigators to help families access services across several systems including: housing; economics; family support needs; family service needs; parenting skills; and children’s developmental, social–emotional, educational, and other needs.
  • Project LAUNCH New Hampshire has funded the Manchester Community Health Center to employ bilingual health workers as community liaisons to support care coordination, referrals, and community linkages.
  • North Carolina Project LAUNCH has integrated an early childhood mental health team, comprising a mental health professional and a family-centered health navigator, into two private pediatric primary care practices. Members of the early childhood mental health team, along with other community-based providers (i.e., the Family Resource Center, the local health department, and the local school district), have been trained in Triple P. Families can receive Triple P assistance in many places they regularly visit, thus creating environments that foster children’s ability to reach their full potential.
  • Massachusetts Project LAUNCH was successful in integrating early childhood mental health services in pediatric primary care by creating a unique partnership within the pediatric medical home. The partnership consists of a “family colleague” (a trained parent who works directly with families to navigate health care systems) and an early childhood mental health clinician. Massachusetts Project LAUNCH also created a resource-rich guide called the Early Childhood Mental Health Toolkit: Integrating Mental Health Services Into the Pediatric Medical Home. The toolkit is intended for use by primary care practices with or without mental health staff.
  • Project LAUNCH in Wisconsin has helped raise awareness about the importance of children’s social–emotional development as part of their overall wellness. Recognizing the shortage of child psychiatrists, the Wisconsin legislature has allocated funding to develop a Child Psychiatric Consultation Line for pediatric and primary care physicians, which offers support to pediatric and primary care physicians for providing mental health care to patients.
  • Pokegon, a tribe from the Project LAUNCH Bodewadmi Consortium, has co-located mental health and primary care services. Providers are working to make sure referrals are completed with “warm” handoffs, ensuring that families successfully access resources and services.

Beyond the Grant: LAUNCH Grantees’ Successes in Expanding and Sustaining Services to Children and Families

This brief highlights many notable and emerging successes of grantees in expanding and sustaining services for children and families in the five core Project LAUNCH strategies (screening and assessment; enhanced home visiting through increased focus on social and emotional well-being; mental health consultation in early care and education programs; family strengthening and parent skills training; and integration of behavioral health into primary care settings).

Early Childhood Mental Health Toolkit: Integrating Mental Health Services into the Pediatric Medical Home

Massachusetts Project LAUNCH offers a comprehensive collection of tools and guidance for integrating early childhood mental health staff, including a family partner, into the pediatric primary care setting. The toolkit supports the building of a core team;  promotion, prevention, and intervention focused services; the development of systems across the medical home; and evaluation and sustainability efforts.

Wisconsin LAUNCH Integration of Behavioral Health into Primary Care Settings Summary

Wisconsin Project LAUNCH summarizes their work to promote the integration of behavioral health into primary care focused on five initiatives, including provider training, behavioral health integration pilot project/brief module development, joint release of information form, primary care provider consultation line and governor’s early care and education advisory council.

Launching Forward: The Integration of Behavioral Health In Primary Care as a Key Strategy for Promoting Young Child Wellness

Analyzes the experiences of a sample of Project LAUNCH grantees, describing 10 common elements of integration approaches and exploring some of the challenges of promoting health and preventing social, emotional, and behavioral challenges at a population level.

Suicide Safe: The Suicide Prevention App for Health Care Providers

Shares information about SAMHSA's "Suicide Safe" free app that helps healthcare providers, in particular primary care providers, integrate suicide prevention strategies into their practice and address suicide risk among their patients. Key features include patient and provider educational material, treatment locator, sample cases, and conversation starters.

SAMHSA–Health Resources and Services Administration Center for Integrated Health Solutions: Standard Framework for Levels of Integrated Healthcare

Helps primary and behavioral health care provider organizations improve outcomes by fostering an understanding of where they are on the integration continuum. This six-level framework can be used for planning; creating a common language to discuss integration, progress, and financing; supporting assessment and benchmarking efforts; explaining integration efforts to stakeholders; and clarifying differences in vision between two or more partnering organizations.

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