To address the ongoing pediatric behavioral health crisis, Rady Children's Health deployed a multi-faceted set of initiatives. Collectively called the Transforming Mental Health Initiative, their aim is to improve behavioral health outcomes through prevention, early identification, policy advocacy, and research.
Of all the initiatives, an early intervention program called Mental Health Integration (MHI) has had the greatest impact. “I like to think of it as our crown jewel,” said Ben Maxwell, MD, division chief of Child & Adolescent Psychiatry and The Una Davis Family Chair in Behavioral Health at Rady Children's. “Without Mental Health Integration, every other aspect of our continuum of care was working from behind because kids weren't identified quickly enough.”
The MHI program places master’s-level behavioral health providers, called integrated health therapists (IHT), into pediatric primary care clinics across the region. If a patient or family raises a behavioral health concern, or if a child’s well-visit screening reveals a need, pediatricians can refer the patient directly to the on-site IHT.
The therapist can typically begin working with the child immediately in the familiar surroundings of their pediatrician’s office. This arrangement streamlines collaboration between a patient’s therapist and primary care provider.
The program aims to identify mild-to-moderate behavioral health issues early and start treatment without long waits often associated with seeing a behavioral health provider. If the therapist determines more intensive therapy or psychiatric care is needed, they refer the child to one of the hospital’s four free-standing behavioral health clinics. Appointments are typically scheduled within a few days.
“Mental Health Integration has completely transformed the way we’re delivering pediatric mental health care,” Maxwell said. “Without it, a lot of these kids were facing six- to nine-month waitlists to be seen.”
‘Leap of faith’ pays off
Rady Children’s now has integrated health therapists in nine primary care clinics across its health network. Since its launch in 2020, MHI has facilitated behavioral health services for nearly 10,000 children and adolescents. Feedback from patient families and providers has been overwhelmingly positive.
“All the pediatricians who have embedded mental health therapists in their clinics tell me they’ll never go back to doing it the ‘old’ way,” Maxwell said.
That consensus didn’t happen overnight. For almost two years, Maxwell and his team visited area clinics and met with stakeholders to solicit input to ensure the program they were developing reflected the priorities of everyone involved.
Rady Children’s receives philanthropic support to fund the MHI program. Maxwell said it likely wouldn’t be possible without those funds given reimbursement issues that plague behavioral health care. But building a successful program requires more than money. With burnout prevalent among the limited number of behavioral care providers nationwide, job satisfaction is essential.
“We took a leap of faith that if we create a system that works, clinicians will want to work in it,” Maxwell said. “I think that's an underappreciated aspect of recruiting people for job positions. While compensation, workload, and documentation burden are important, it's also important for people to feel like what they're doing is helping kids.”
