Integrating behavioral and physical health care for Children: Evaluating progress

Integrating behavioral and physical care for children is one of the foundations of the medical home model. This comprehensive patient centered approach is challenging to implement but has great promise to enhance health care. In 2001, The Institute for Community Health, along with the Cambridge Health Alliance (CHA) department of pediatrics and division of child/adolescent psychiatry embarked on a project to integrate behavioral and physical health for children (IC3).

The IC3 project used a multi-faceted approach to integration that included screening, training, co-location, and consultation. First, behavioral health screening at preventive visits was implemented in primary care along with training to improve provider skills. Simultaneously, social workers were co-located in several primary care sites. Finally, child/adolescent psychiatry developed a phone consultation service for primary care providers and attended consultative meetings at multiple sites. Project evaluation utilized quantitative and qualitative methods to ascertain outcomes. Measures included Pre/post provider surveys, parent interviews, monitoring of screening, referrals and referral completion rates. More than 10,000 children (4 to 18 yrs) were screened for behavioral health at preventive visits (approximately 70% of eligible) and over 800 children were referred from screening to mental health services. Moreover, providers report improvements in how they manage psychosocial problems and screen for mental health. They are significantly more likely to utilize mental health diagnostic codes and their behavioral health screening rates have risen. This presentation will discuss the results of the IC3 project and lessons learned pertinent to others wishing to integrate behavioral and physical health for children.