Integrating mental health services into your practice: the "how and why"

In his session on integrating mental health services into the pediatrician’s practice at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition,Jay Rabinowitz, MD, FAAP, MPH, founding pediatrician of Parker Pediatrics and Adolescents in Aurora, Colorado, began by noting, “As the need for mental health services increases beyond a pediatrician’s ability to provide these services, integrating behavioral/mental health services in one’s office and expanding through ‘colocation’ with other professional health care providers becomes necessary.”

Rabinowitz stressed how integrating mental health service in a practice can be good for the practice itself, patients, and provider. “There are more behavorial and mental health issues these days,” Rabinowitz emphasized. “One out of 5 children have a mental health diagnosis and there are not enough psychiatrists to see all these children. When seeing these patients in your office, it reduces stigma, offers a familiar setting with a family provider. Nationally, 50% of families do not make an appointment with an outside mental health provider if they are referred by their pediatrician. Additionally, while 50% of those children who do see a psychiatrist do not go back for a second visit, 96% of patients do come back to their pediatrician for a second mental health visit. Furthermore, it is usually more convenient to go to a pediatrician for these services: you get quicker appointments, can get a comorbid diagnoses (such as abdominal pain), better follow-up and better outcomes, Rabinowitz noted.

Rabinowitz shared the results of a patient satisfaction survey conducted in his own office recently. He pointed out that 89% of parents said it was important that their children receive mental health services in the same location as their medical care; 95% were satisfied with the mental health services provided at the office (which were with a psychologist); and 93% said the services were beneficial to their child. Additionally, of those who had not seen psychologists in Rabinowitz’ office, 91% said that if the need arose, they would prefer accessing the service at his office.

For the mental health providers in the office, Rabinowitz notes that there is more convenience, improved satisfaction, better communication (since the electronic health records (EHR) are shared onsite), and better follow up when a mental health care provider is working alongside a pediatrician at his or her office. Having mental health services integrated into a pediatric practice offers increased efficiency, can attract new patients, and meets the needs of the families involved.

Rabinowitz pointed to the dramatic downturn in visits to his office during the first month of lockdown (50%), and yet the mental health visits remained at 100%. “Since then," says Rabinowitz, “mental health visits continued at or above these rates.”

In terms of making this happen (the “how”), Rabinowitz listed 9 steps, which included commitment (have a partner meeting to assign responsibilities/develop timeline); choosing your provider type (psychologists, social workers, psychiatric nurses, etc.); physical space (putting aside an area for consultation rooms); develop office protocols (who will be the schedulers, what will length of appointment be, who makes the phone calls to the patients, who does the billing, etc.), and others.

Finally ,Rabinowitz offered some key tips to keep everything going smoothly. “Have a key scheduler,” he suggested. “Keep your progress notes brief, and consider scanning your paper notes to your EHRs, then create templates. Keep 90% full on schedules, and no-show fees need to be charged. Finally, keep in mind seasonality: spring is the busiest season for mental health appointments.”

Reference

Rabinowitz J. Integrating mental health services into your practice: “the how and why.” American Academy of Pediatrics 2021 National Conference & Exhibition; virtual. Accessed October 8, 2021.