BHIP is a collaboration between the Department of Psychiatry and Behavioral Sciences at Boston Children’s Hospital and the Pediatric Physicians’ Organization at Children’s (PPOC) to provide behavioral health education and consultation, operational support for behavioral health integration, and on-site clinical behavioral health services in the PPOC practice network. The PPOC network includes more than 80 practices across Massachusetts with more than 400 primary care practitioners caring for more than 350,000 infants, children, adolescents, and young adults.
The goal of BHIP is to enhance the capacity of PPOC practitioners to safely and effectively assess and treat mild to moderate presentations of common child and adolescent psychiatric disorders, with an emphasis on anxiety, depression, ADHD, behavior problems, stress- and physical illness-related adjustment difficulties, autism, and substance use.
The educational component of BHIP, known as the Behavioral Health Learning Community (BHLC), is a 29-hour interactive curriculum delivered in-person and via televideo over a two-year period to PPOC primary care practitioners (physicians and nurse practitioners), behavioral health clinicians (psychologists, social workers, and counselors), and care coordinators. Teaching is provided by Boston Children’s child and adolescent psychiatrists, developmental/behavioral pediatricians, adolescent medicine specialists, psychologists/neuropsychologists, and clinical social workers. The formal BHLC is supplemented by ongoing bimonthly televideo case conferences (TEACH Rounds) and, in ensuing years, periodic in-person advanced sessions addressing special interest topics in primary care behavioral health.
The consultation component of BHIP provides real-time, workday, 9am-5pm telephone consultation by child and adolescent psychiatrists to primary care practitioners. Consultation is designed to reinforce and extend the knowledge, skills, and resources acquired in the BHLC to the management of individual patients. Telephone consultations provide initial assessment and treatment suggestions and ongoing medication management support. For severe presentations, the psychiatrist facilitates referral to specialty behavioral health for in-person consultation, interim treatment until stable, or ongoing treatment as indicated. Although initially provided by BHLC faculty, consultation now is provided through a state-wide collaboration with the Massachusetts Child Psychiatry Access Program (MCPAP).
The practice transformation component of BHIP comprises formal in-person and televideo sessions as well as individualized practice-based sessions focusing on the operational aspects of integrated behavioral health care. Clinical support for behavioral health clinicians comprises individual telephonic supervision, televideo case conferences, and in-person trainings.
The on-site clinical service component of BHIP is delivered by primary care practitioners and behavioral health clinicians, and utilizes a stepped-care model in which each step has a clearly defined patient population, goal, and provider and ascends in treatment intensity in accordance with the severity of the clinical presentation. In this model, the clinical roles of primary care practitioners are behavioral health screening, guided self-management, and psychopharmacology; the primary roles of behavioral health clinicians are focused assessment and brief psychotherapy, and informal consultation/liaison with primary care practitioners. Practice-based care coordinators assist practitioners with referrals to specialty care as indicated.
Through this initiative, BHIP aims to expand the behavioral health workforce in pediatric primary care in and so doing, help alleviate the substantial gap between the millions of youth needing quality behavioral health services and those receiving them.
