Ensuring All Children Have Access to Behavioral Health Care

New study reports the results of integrating psychologists into primary care clinics.

Cody A. Hostutler, PhD, a psychologist in the Department of Pediatric Psychology and Neuropsychology at Nationwide Children’s, is concerned about the mental health of the children and adolescents visiting primary care centers.

“There is a mental health crisis for kids happening right now. The CDC recently reported that more than 50% of adolescent females say they feel hopeless and sad. Many parents take their kids to a primary care pediatrician instead of a therapist or psychologist. Yet, most pediatricians don’t have the training or time to treat mental health issues,” Dr. Hostutler says.

Very few primary care centers have psychologists or other behavioral health professionals on staff. Pediatricians refer patients to a mental health agency where there could be a long waiting list and other barriers to timely care. As a result, many children do not receive treatment, and will likely experience even more significant mental health issues down the road.

“Aside from the delay in getting an appointment, there are documented inequities in the accessibility of mental health care due to language, race and ethnicity. Also, many families are reluctant to visit a mental health facility due to stigma. But visiting their doctor is completely acceptable,” Dr. Hostutler says.

Dr. Hostutler and colleagues launched a study, recently published in Pediatrics, to answer three questions.

• Would integrating psychologists into primary care centers increase the number and timeliness of patients receiving treatment to care compared to clinics without integrated clinicians?
• Would this integration also increase equity of care?
• Would integration reduce the number of patients receiving behavioral health treatment outside of their primary care office?

For the study, four of 12 primary care clinics within the Nationwide Children’s Hospital health system integrated psychologists into their services. The study compared changes in access and utilization from the year before integration with the two years after integration. Dr. Hostutler measured access as the median wait time for behavioral health services. He measured utilization as the percentage of primary care visits that resulted in a behavioral health contact within 6 months.

Before integration, access and utilization were similar across all locations. After integration, behavioral health utilization increased by 143% in integrated clinics compared to 12% in nonintegrated clinics. The utilization of behavioral health services outside the primary care clinic decreased for integrated clinics only. In clinics with integrated psychologists, 93% of initial behavioral health visits happened on the same day. The median wait time for patients not seen on the same day was 11.4 days compared with 48.3 days for nonintegrated clinics.

As a whole, the integration of psychologists resulted in more patients getting the care they needed with less stress on the overburdened behavioral health system. The control clinics did not see any increase in utilization even when the hospital hired more than 60 clinicians to work in their behavioral health facilities.

“Integrating four psychologists in primary care clinics had a more significant impact on access and utilization than those 60 new behavioral health providers,” Dr. Hostutler concludes.

The results were so conclusive that Nationwide Children’s expanded the program before the study concluded. Psychologists are now integrated into 10 primary care clinics. Mental health therapists were also added to clinic staff.

Dr. Hostutler’s team uses the learnings from the study to assist primary care clinics outside the Nationwide Children’s health system in integrating behavioral health providers within their practice.

Reference:

Hostutler C, Wolf N, Snider T, Butz C, Kemper AR, Butter E. Increasing Access to and Utilization of Behavioral Health Care Through Integrated Primary Care. Pediatrics. 2023;152(6):e2023062514.

Image credit: Nationwide Children’s