Integrating Behavioral Health into Pediatric Primary Care: Early Lessons
April 2018

Atyya Chaudhry, MPP
Senior Program Manager, Health Systems Transformation

Joni Hollis RN, MSN, CNL
Director Program Planning & Development Unit, Office of Children’s Medical Services Managed Care Plan
Florida Department of Health

Kelli Stannard, BSN
Director of Children’s Medical Services (CMS) Plan Clinical Operations and Specialty Programs
Florida Department of Health

Faced with a troubling gap between how many people need mental health services and how many receive those services, the Florida Department of Health, Office of the Children’s Medical Services Managed Care Plan and Specialty Programs set the ambitious goal last year of crafting a project to integrate behavioral health into primary care. With the right tools, patience, and support, the team developed a plan to launch a pilot program integrating behavioral health into primary care for pediatric populations. The process offers lessons for other agencies wishing to tackle the same challenge.

The need for this work is demonstrated by the shortage of pediatric mental health providers, which has resulted in untreated mental health disorders. In Florida, 57.7 percent of children that need mental health services receive them, according to the 2011/2012 National Survey of Children’s Health.

To address this shortfall, the Florida Title V program developed a State Performance Measure (SPM): “Improve the percent of children with a behavioral health condition who receive treatment consistent with their diagnosis,” and an accompanying SPM strategy, “Implement integrated primary and behavioral health models of care.”  The effort was coordinated by the Office of the CMS Managed Care Plan and Specialty Programs. The agency put together a diverse team to meet the goal, consisting of leadership from Florida’s Children’s Medical Services(CMS), family specialists from the National Alliance on Mental Illness, representatives of the state Department of Children and Families, representatives from Medicaid, university partners, and pediatricians, aided by coaching from the National Maternal and Child Health Workforce Development Center at the University of North Carolina.

Center consultants worked with the team to lay the foundation for the project using basic planning tools, such as logic models and measurement tables. An early lesson learned was the importance of dividing the project into bite-sized pieces, understanding that change of this magnitude – implementing a behavioral health integration system – cannot happen overnight. It was also in this initial phase when the team was introduced to the systems support mapping exercise, which gave team members a better understanding of each other’s perspectives. The exercise allowed team members to visualize the larger context of the system under study, understand organizational perspectives, and share contributions.

As the team moved from planning and exploration to implementation, it hosted a Pediatric Primary Care and Behavioral Health Integration Summit in September 2017 in Orlando, Fla. Attendees included primary care providers, psychiatrists, social workers, nurses, and health care administrators. The summit provided education and training to providers and staff using national guidelines on evidence-based integration practices.

Some key takeaways from Florida’s project include the importance of:

  • bringing together a diverse team, whereby stakeholders have different touchpoints with the population and system that is being addressed;
  • building a strong foundation for a new project of this scope;
  • finding the right tools and resources to help the project move forward with proper planning and exploration; and
  • setting manageable goals.

With these principles in mind, it is possible to realize the vision of meeting the behavioral health needs of the maternal and child health population.