Purpose:
Integrating behavioral health into primary care (PC) is known to be an effective approach to caring for children with complex health care needs. The purpose of this study was to describe the impact of embedding predoctoral psychology interns (PSY residents) in a continuity care clinic on behavioral health care utilization with additional attention paid to diverting emergency department (ED) visits.
Method:
Doctoral psychology PSY residents participated as team members in pediatric resident continuity care clinics and also were available to consult with specialty and urgent care clinic providers within the ambulatory center. During a 6-month period, services provided by PSY residents were tracked (numbers of warm-handoffs, behavioral consults [including covisits with pediatric residents], psychotherapy appointments, and crisis evaluations).
Results:
PSY residents completed 184 warm-handoffs, 250 same-day consults, and 223 follow-up appointments. Sixty-five patients attended group therapy sessions offered in the pediatric clinic. Of 23 patients evaluated for suicidal/homicidal ideation (who previously would have been referred immediately to the ED), 21 were stabilized in PC and only 2 required ED services.
Conclusion:
Integration of PSY trainees resulted in more than 700 rapid behavioral health services in 6 months, and diverted 91% of mental health crises from ED and other possible psychiatric hospitalization. Prior to integration, none of these services were provided on site. In addition to providing interprofessional team training, integrated continuity care clinics can improve access to behavioral health services and offer significant cost-saving opportunities to health care systems. Ways to promote interdisciplinary training will be identified.
Implications for Impact Statement
Embedding predoctoral psychology interns in a pediatric continuity care clinic can result in increased access to behavioral health clinicians and division of emergency department visits for high-risk patients. This model also increases opportunities for interdisciplinary training.
