Bringing Behavioral Health Into the Medical Home

Scaling integrated care across community pediatrics increases access to and utilization of mental health care.

When a teenage patient shared feelings of anxiety and depression during a routine wellness visit, the pediatrician immediately called in the behavioral health clinician down the hall. Within minutes, both providers met with the patient and family. They left with a treatment plan, a follow-up appointment and a care team they already knew and trusted.

“That is the promise of integration,” says Cody A. Hostutler, PhD, primary care psychologist and clinical director of Behavioral Health Integration (BHI) at Nationwide Children’s. “Behavioral health care is immediate, coordinated and grounded in relationships the family already has within their medical home.”

Integration Changes Access and Outcomes

A study published in Pediatrics found that embedding psychologists in four primary care clinics increased behavioral health utilization by 143%, compared to a 12% increase in non-integrated clinics. 93% of initial visits occurred the same day and median wait times fell from 48 days to 11.

“Integrating just four psychologists in primary care made a greater difference in patient access and service use than hiring 60 new behavioral health providers for specialty clinics,” Dr. Hostutler explains.

A 2025 meta-analysis in Pediatrics reinforced those findings: youth in integrated primary care were 12 times more likely to receive any treatment and 19 times more likely to complete a full course of care. Integration helps reduce inequities by connecting with families at their points of need, boosting follow-through and continuity.

Nationwide Children’s now has behavioral health clinicians stationed at most of their primary care clinics.

As the clinical director for the BHI Program, Dr. Hostutler is utilizing these results to help community primary practices embed behavioral health clinicians into everyday pediatrics. This program is a joint venture between Nationwide Children’s and Partners For Kids®, the nation’s largest pediatric accountable care organization serving more than 470,000 children.

The program prioritizes practices in Ohio but can provide training to organizations across the country through consultations and site visits. In fact, multiple hospital systems and state initiatives have already used the program to learn about and receive consultation on integrated primary care practices.

Scaling Integration Across the Region

Caroline C. Weingart, MD, pediatrician at Nationwide Children’s and associate administrative medical director at Partners For Kids, oversees behavioral health integration in 14 hospital-owned and 23 community primary care practices.

The BHI support framework includes four components:

• Practical curriculum
• Individualized consultation
• Collaborative Learning for Integrated Care (CLIC), a monthly learning collaborative
• Resource library of clinical, operational and financial tools

“To get started, we meet practices where they are,” Dr. Weingart says. “We help them explore whether integration makes sense for their patients and their teams.”

She continues, “If it is, we help them find the right behavioral health partner. Then, we collaborate with both entities to create team-based care. This includes shared treatment plans, clear communication in electronic medical records (EMR), same-day pathways and billing that fits the model.”

Once embedded, behavioral health clinicians function like any other team member. They see scheduled patients, accept same-day warm handoffs, take part in family consults and co-create care plans with pediatricians.

“With a short conversation, we can create a plan and help a family leave with clear next steps,” Dr. Weingart explains. “That efficiency matters when clinicians are booked every 15 minutes.”

Partnering With Community Providers

To extend reach, Nationwide Children’s collaborates with Mid-Ohio Psychological Services (MOPS), one of the Partners For Kids community behavioral health organizations. For several years, three pediatric practices in central Ohio have hosted MOPS clinicians, who typically spend two to three days per week there.

“We aim for about 15 patient or provider contacts per day,” says Kimberly Blair, MA, LPCC-S, MOPS executive director. “Some days it’s less because hallway consults and crisis support take time, but the value in those touchpoints is enormous.”

Last year, MOPS served 466 families within these practices, up from 340 the prior year.

“Families engage faster in a trusted setting,” says Samantha Black, PsyD, MOPS clinical supervisor. “The pediatrician’s introduction reduces stigma and accelerates results by addressing the child’s behavioral and physical health together.”

A recent case illustrates this collaboration.

“A preteen came in for anxiety,” says Elaine Parsons, MA, a clinician with MOPS. “During our sessions, ADHD symptoms emerged that we had never evaluated. Because we were in the clinic, I quickly coordinated with the pediatrician, completed the necessary assessments and started appropriate treatment. The child’s functioning improved almost immediately.”

Impact on Primary Care Clinicians

Integration benefits not only families but also providers. In a Partners For Kids survey of 51 primary care clinicians:

• 94% reported better patient access to behavioral health care
• 86% noted easier coordination
• 73% of respondents felt that their jobs are easier

Research has shown that visits are about 12 minutes shorter on average when an integrated clinician is available.[3] “That time adds up,” Dr. Hostutler notes. “It allows pediatricians to focus on medically complex patients.”

Behavioral health providers also support the well-being of clinic staff.

“We’re often asked to help teams process difficult cases or losses,” says Dr. Black. “We’re supporting the caregivers as well as their patients.”

Blair adds, “We see it as a shared brain; medical providers and mental health providers working together to help people, teams and communities become healthier.”

Barriers Worth Solving

Policy and reimbursement issues remain among the most significant hurdles for BHI. Commercial insurers often deny coverage for medical and behavioral visits on the same day. Prevention visits without a diagnosis are frequently nonreimbursable.

“These are fixable issues,” Dr. Hostutler says. “If we value mental health prevention the same way we value well-child care, coverage should reflect that.”

The BHI team helps practices navigate current billing structures while advocating for legislative and payer reforms to make integrated models financially sustainable

A New Clinical Standard

BHI improves access, efficiency, equity and outcomes within the medical home, where families are already comfortable.

“We’re building a system where pediatricians are never alone in treating behavioral health issues,” Dr. Weingart says. “Even better, families don’t have to choose between a long wait or no mental health care.”

Dr. Hostutler frames the opportunity plainly: “If we want different health outcomes, we need different systems. Integrated primary care is that system; practical, scalable and grounded in the relationships that already keep kids healthy.”

References:

1. 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.
2. Hostutler CA, Shahidullah JD, Rybak TM, Stephenson KG, Freeman KA, LaLonde L, Danzo S, Koval ET, Hughes H, Riley AR. Integrated Primary Care and Mental Health Service Utilization: A Meta-Analysis. Pediatrics. 2025;156(2):e2025071275
3. Riley AR, Paternostro JK, Walker BL, Wagner DV. The impact of behavioral health consultations on medical encounter duration in pediatric primary care: A retrospective match-controlled study. Families, Systems, & Health. 2019;37(2):162.

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