Maryland is taking steps to improve the integration of behavioral health services in the primary care space, particularly for children and adolescents. With initiatives such as educating providers, strengthening regional partnerships, and advocating for more cohesive financing, experts are working to address what they identify as a “surge in crisis around kids’ and adolescents’ mental health.”
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Rising demand for behavioral health services and an ongoing workforce shortage has been a top concern in Maryland, particularly following the Covid pandemic. Kelly Coble, LCSW-C, Executive Program Director for the Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP), detailed how these factors are impacting kids’ access to care.
“There just aren’t enough specialty providers,” Coble said. “When we’re talking about kids and adolescents, we’re thinking about child psychiatrists, specialty providers like psychologists, clinical social workers, or other folks who are trained to treat kids and adolescents and attend to their specific needs.”
Programs like BHIPP use a multi-pronged approach to educate primary care providers—and more recently emergency physicians and mobile crisis teams—to address patient behavioral health needs, with the goal of reducing referrals to high-acuity care.
Due to the regularity of well child visits, vaccinations, and working with schools and camps, pediatric providers have the most contact with kids, adolescents and their families and are more likely to identify and address their behavioral health needs early, Coble said.
BHIPP’s approach to behavioral health care integration includes several services:
- Care providers can call the Consultation Warmline, which is available Monday-Friday, to speak with licensed social workers, a psychiatrist, or other child mental health experts for consultation on providing medication management, diagnoses, or referrals. The University of Maryland School of Medicine, which administers the BHIPP program, as well as partnerships with Johns Hopkins School of Medicine, ensure providers are receiving expert consultation, Coble said.
- BHIPP also works with the Maryland Department of Health and the Behavioral Health Administration to maintain a database of behavioral health services. When a provider requests services for a particular patient, BHIPP checks which services are covered by their insurance and supplies the list to the provider within 24 hours.
- BHIPP is also working to strengthen the behavioral health workforce, particularly by working with Master’s level-students in social work services. These students assist with case management, consultation calls, and intervention services under the supervision of social work faculty. BHIPP originally started with intern positions from Salisbury University and Morgan State University, and is planning to expand to additional positions (for a total of 24) in Western and Southern Maryland this August.
“The reason we’re focusing in those regions is that we’re really thinking about and working in collaboration with the state to be targeting areas that are generally underserved and don’t have as much access to behavioral health services,” Coble said.
Covid also led BHIPP to focus on bridging gaps in care, particularly when children need to transition from high-acuity care in a hospital or long-term care facility to lower-acuity, home or community-based care. Coble stressed that working with local, community-based organizations would lead to more individualized, effective results.
“We know that what’s going to work in Garrett County is not going to be the same thing that’s going to work in Somerset or Wicomico,” Coble said. “We do try to have active relationships with our partners, such as the Mental Health Association of Maryland and others that have been really active in helping to shape and design some of our initiatives, whether that be trainings or fact sheets on telemental health.”
Innovating funding models could also be key to bridging gaps in care. A strong partnership and funding from the Behavioral Health Administration and additional federal funds have supported BHIPP for its decade of operation, but Coble said the state needs to focus on improving behavioral health financing for the provider.
Currently, primary care physicians don’t bill for behavioral health services, or vice versa. Coble says collaborative care billing codes or additional grant writing services can be especially useful for small primary care providers who have been consistently overwhelmed during the pandemic.
Looking towards more long-term goals, Coble noted the expansion of BHIPP’s model to other sectors of care. For example, BHIPP’s companion program, Maryland Addiction Consultation Service (MACS) focuses on creating a similar resource network to respond to the state’s opioid epidemic. In 2021, that program expanded to MACS for MOMs, which specifically supports perinatal patients with substance use disorders.
Coble said the end goal would be for family physicians and other primary care providers to use all of these resources simultaneously, to address an entire family’s behavioral health needs.