Mental health services in primary care
Integrating behavior health services into the primary care setting can be beneficial for the patient as well as profitable for the pediatrician.
Integrating mental health services within the primary care setting would help to provide this continuity of care and benefit a myriad of issues faced by children with mental illness and the pediatricians who care for them (Table 1).
Set up an integrated practice
Although Rabinowitz thinks that many pediatricians recognize the need for and want to integrate mental health services into their practices, he emphasizes that the question that everyone is asking is, “How do you do it?”
In his presentation at the AAP conference, he described several steps that practices can take to set up a successful integrated practice. First and foremost, he says, is a commitment by the practice to integrating mental health services. Such a commitment will include assigning responsibilities to select people to set up the integration and a time line to do so.
Once this commitment is in place, the next steps basically fall into 2 categories: procedural (how to set up the mental health services within the primary care practice) and reimbursement (how to charge for these services).
Fundamentally, the goal of setting up an integrated practice is to provide easy access to and continuity of care. As such, the procedural issues that pediatricians and practices need to think about to achieve these goals include the type of arrangements they want to create, the type of providers to carry out the mental health services, the types of mental health issues addressed (or referred out), and specific protocols to use to carry out these functions (Table 2).
For example, a practice may choose to hire a mental health provider as an employee to work in the practice, or it may choose to partner with a mental health provider who is in the same building, or it may work with a mental health consultant.
Whatever arrangement is made, the practice physicians will need to determine the type of provider they want to work with (eg, psychologist, social worker), the type of mental health issues they will address or refer out, and how to incorporate the provider into their practice (protocols).
Rabinowitz emphasizes the importance of narrowing down the types of mental health issues that a practice is willing to treat. At his clinic, for example, physicians address issues such as attention-deficit/hyperactivity disorder, depression, anxiety, and divorce- and behavior-related problems but refer patients out with more severe illnesses such as bipolar disease.
Taking the preceding steps to set up an integrated practice will help practices put in place the means to provide mental health services, but the biggest challenge remains: how to charge for those services.
“The biggest challenge to integrating mental health services is reimbursement,” says Rabinowitz, who describes a number of barriers that practices can face in gaining adequate compensation for mental health services (Table 3).