Pediatric IBH Learning Collaborative Qualitative Evaluation

  • 17 Oct 2022

CTC-RI’s 3-year pediatric integrated behavioral health (IBH) learning collaborative ended in April. Funded by the RI Foundation, Tufts Health Plan, and UnitedHealthcare, its goal was to help 8 practices establish an IBH program to better identify, assess, and treat behavioral health (BH) concerns in their pediatric population. Practices hired IBH clinicians, implemented BH screeners, and developed workflows so patients could have immediate access to the clinician when BH concerns arose. Practices improved and increased early detection of BH concerns, and helped families recognize that mental and physical health are both part of a child’s overall health and wellness.

At the conclusion of the learning collaborative, CTC-RI contracted with outside consultants to conduct a qualitative evaluation to gain a deeper understanding of the participants’ experiences of the project, and to gather information that would inform CTC-RI in planning for future learning collaboratives. In addition to the preliminary evaluation highlights described in the May Newsletter, here are some key findings and recommendations from the final report (see link to Executive Summary for more.)

Key Findings:

  • The learning collaborative structure and practice facilitation were both key ingredients for implementation success.
  • Across practices, BH screening identified concerns that might not have become evident otherwise.
  • Practices reported that discussing mental health concerns became more normalized and less stigmatized for patients and parents; and, warm handoffs to the IBH clinician led to an overall increase in acceptance of BH treatment.
  • Providers reported that implementing pediatric IBH often added time to the medical visit, but it was time well spent.
  • The COVID pandemic created barriers for implementing IBH workflows on site, especially warm handoffs; however, practices continued to provide IBH services to their patients via telehealth, and all practices completed the learning collaborative despite the challenges of the pandemic.
  • Overall, practices reported an interest in more IBH training, and some would have appreciated more training at the outset of the project.
  • All practices are committed to continuing their pediatric IBH services at their sites.

Key Recommendations:

  • Consider additional training for practice staff at the beginning of a learning collaborative.
  • Consider additional training and “booster sessions” for a period of time after a learning collaborative has ended.
  • Practices should plan to continue to provide internal trainings on IBH to keep existing staff engaged and provide new staff with the skills they need to implement the program.
  • Continue to work with state policy makers to develop a funding system that fully supports pediatric IBH.

Overall, this evaluation found that pediatric IBH is a critical primary care service that can prevent more serious BH problems in children and adolescents, and help patients and families better cope with BH symptoms and concerns as they emerge. There is ongoing concern about financial sustainability given the care management needs in pediatrics, as well as the amount of unreimburseable time clinicians must spend (e.g., consulting with medical providers, training staff) in order to ensure that the program runs optimally. Nonetheless, all practice sites are committed to continuing to screen for BH concerns and provide pediatric IBH services because of its clinical value to the practice and to the patients.