Rady Children’s Embeds Mental Health Into Pediatric Primary Care

Rady Children’s Hospital-San Diego has released promising results from a pilot program that integrates mental health clinicians into pediatric primary care practices.

Preliminary results of the program, published in the November 2023 issue of Frontiers in psychiatry, indicate that the patient’s response to therapy has resulted in a 62 percent decrease in depression symptoms and a 44 percent reduction in anxiety symptoms.

The pediatric mental health crisis continues to grow at an exponential rate. Rady Children’s noted that the American Academy of Pediatrics has declared the mental health crisis among children and adolescents a national emergency. A recent study of Journal of the American Medical Association found that emergency department visits among children, adolescents and young adults for mental health reasons approximately doubled, from 4.8 million to 7.5 million between 2011 and 2020. The emergency has been further exacerbated by the pandemic of COVID-19.

“The difficult truth is that children and adolescents often do not receive mental health care when they need it,” Domonique Hensler, MHA, senior director of systemwide care at Rady Children’s, said in a statement. Hensler, co-author of the study, added that “the need for effective and accessible treatment is more pressing than ever. “Our interdisciplinary, team-based approach to pediatric mental health care has proven to be effective, accessible and cost-effective.”

Under Rady Children’s Transforming Mental Health model, established in 2020, primary care providers screen children and adolescents for potential mental health problems during regular visits, such as annual wellness checks. Children and teens identified as struggling with depression or anxiety or in the early stages of a mental health problem can speak with a mental health professional in the same office, often on the same day. A more typical healthcare experience leaves it up to families to navigate through a list of unfamiliar mental health resources to arrange care on their own, often with wait times exceeding several months.

“With the integrated care model, the pediatrician can literally walk down the hall and introduce the family to the therapist right there in the office,” said Benjamin Maxwell, MD, division chief of Child and Adolescent Psychiatry and Family Chair of A Davis in Conduct. Health at Rady Children’s and associate clinical professor of psychiatry at UC San Diego School of Medicine, in a statement. “Families are already coming to a place they trust, which improves continuity of care and, ultimately, better outcomes.”

Eleven primary care sites and four regional support centers in the San Diego and Riverside regions participate in the program, which emphasizes early detection, early intervention and early recovery for mild to moderate cases using a family-centered approach and based on population health. Routine depression screening begins at age 12, while other individualized screening methods are used for younger ages.

Primary care providers are trained on the integrated care model and offered a three-day in-depth training on the assessment and treatment of common mental health conditions with six-month follow-ups. So far, more than 200 providers have completed a fellowship in the program, and an estimated 100 referrals are made each week.

“Starting at the top, before mental health problems in children and adolescents worsen, is crucial to solving the mental health crisis,” said Adam Breslow, MD, MBA, president and CEO of Children’s Primary Care Medical Group ( CPCMG), in a statement. CPCMG is San Diego’s largest medical group specializing in health care for children from birth to age 19. “In our collaborative model, families meet a mental health professional through someone they know and trust. The process is well accepted by patients and their families. Because we are your medical home, the ease of access is unmatched,” Breslow added.

The Primary Care Mental Health Integration program is part of a broader Mental Health Transformation Initiative at Rady Children’s that encompasses all of the health system’s behavioral health services, including behavioral health urgent care and the Department Copley Psychiatric Emergency Services, both serving the unique needs of patients. requiring immediate and long-term care for mental and behavioral health issues.

“By integrating mental and behavioral health services into pediatric primary care settings, we are helping to overcome the biggest barrier to treatment: access to care,” said Patrick Frias, MD, president and CEO of Rady Children’s, in a release. “We are incredibly encouraged by the results of the program and believe this model has the potential to become the standard of care across the country.”

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