Optimizing Mental Health Integration for Adolescents in Primary Care

From the 2023 HVPA National Conference

Diane Liu MD, MBA, FAAP (University of Utah)

A clinically integrated network (CIN) is a formal partnership between healthcare providers who voluntarily collaborate to reduce cost and improve health outcomes for patients. The participating providers vary depending on the type of CIN.

The purpose of The Children’s Behavioral Health Learning Network is to provide an introductory CIN data-sharing experience for independent private and group practices in Utah while simultaneously harnessing collaborative learning through quality improvement methodology. The focus on adolescent well-care and mental health provided patient-centered objectives such as improved assessments for common behavioral health conditions, population health management, coordination of care across systems, and reducing ED visits for mental health crises.

Led by the Utah Pediatric Partnership to Improve Healthcare Quality, 13 large pediatric and multidisciplinary community health systems (a.k.a. CHAC) across the state of Utah formed a behavioral health learning network starting in 2020 aimed to address mental health integration for adolescents in primary care.

Pediatric practice teams (comprised of physician champions, nursing, administrative staff) joined monthly meetings to learn QI principles based on the “Model for Improvement.” With external facilitation from a QI specialist, teams designed and implemented process changes to improve behavioral health assessment (BHA) in adolescent well-child visits for depression, anxiety, and/or childhood trauma, and reducing ED visits for mental health-related crises. At monthly team meetings, practice-specific and aggregate data reporting provided opportunities for shared learning and discussions including barriers and solutions for progress through cycles of change.

Teams also collaborated with behavioral/mental health therapy organizations state-wide to adopt communication strategies aimed at coordinating care between levels of treatment. Primary care clinicians received access to webinars from psychiatrists to support diagnosis & management of common mental health conditions including Traumatic Stress, Depression, Anxiety, Suicide, and Substance Use.

Graph 1. Completed Adolescent Well-Child Visit with Behavioral Health Assessment. For baseline measurements in 2019, CHAC aggregate demonstrated 10% completion of BHA with Adolescent WCC. Over the next 3 years, this improved to 30%.

Graph 2. Mental Health-Related Emergency Department Visit Rate per 1000 attributed members. CHAC aggregate reduction in ED visits per 1000 members reflect a baseline of 0.8 to under 0.5 over three years. Non-CHAC aggregate reduction in ED visits reflect a baseline of over 0.85 to over 0.55 in the same time frame.

Through The Children’s Behavioral Health Learning Network, primary care practices optimized mental health integration resulting in reduced ED visits for mental health related diagnoses.

Clinical Implication:
Before forming or joining a CIN, private group practices may benefit from testing elements of a CIN together such as data-sharing and quality improvement collaboration to demonstrate proof of concept before committing to such a financial endeavor long-term.

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