A Need for Increased Pediatric Integrated Behavioral Health Care: A Nationally Representative Study

Background and Purpose:

The emerging health systems approach of integrated behavioral health care considers patient health as an inextricable and complex combination of mental and physical health. Strategies to coordinate and co-locate healthcare professionals in primary care and behavioral health settings are being developed to provide comprehensive and holistic health care. Social workers are a natural partner in these interdisciplinary teams as they provide expertise regarding psychosocial barriers, community resources, and behavioral health treatment. One target demographic of integrated care is pediatric patients, particularly those with developmental, emotional, and behavioral health diagnoses. These children often receive care from multiple services to address their complex needs. Further, caregivers often require additional supports due to high rates of caregiver burden and parenting stress. However, despite a national push for integrated care promoted through the Patient Protection and Affordable Care Act, there is little evidence regarding access to integrated services for pediatric populations. The purpose of this study was to describe the receipt of integrated and coordinated physical and mental health services among children with developmental, emotional, and behavioral health needs.

Methods:

The 2011/2012 National Survey of Children’s Health (n=95,677), a nationally representative survey, was used to estimate the caregiver-reported receipt of pediatric mental health services and care coordination in the United States among children with developmental, emotional, and behavioral health problems. Selected variables aimed to identify service gaps and disparities regarding integrated care services. Bivariate tests of association were used incorporating complex survey weights.

Results:

Over 44% of caregivers of children in the United States with a developmental, emotional, or behavioral problem reported that mental health services were delayed or not received. This unmet need is despite the finding that 90% of caregivers reported their child was engaged in a primary medical home. Additionally, 9% of caregivers of these children reported experiencing a “big problem” in getting needed referrals compared to 4% of caregivers of children without behavioral health needs (p<.001). Though care coordination is received at a higher rate by children experiencing developmental, emotional, or behavioral health problems (28% compared to 18%, p<.001), that rate is still low considering their high level of need. Indeed, over 27% of these caregivers reported needing more help than received to coordinate their child’s care as compared to 7% (p<.001) of all other caregivers.

Conclusions and Implications:

Children who experience developmental, emotional, and behavioral problems are not receiving mental health service integration and care coordination at the expected level. Caregivers of these children report that they need more help and are having difficulties in getting referrals and receiving care. Fortunately, it seems there is little disparity in this population in terms of access and engagement in primary care, indicating that these mental health and care coordination services could be delivered as part of their medical care treatment and negating an idea that this unmet need is due to lack of primary care engagement. This research supports the need for social workers in primary care settings as part of an integrated behavioral health model.