Innovative Funding and Regional Partnerships Critical to Advancing Integrated Behavioral Health in Maryland - State of Reform

Innovative Funding and Regional Partnerships Critical to Advancing Integrated Behavioral Health in Maryland – State of Reform

Maryland is taking steps to improve the integration of behavioral health services into the primary care space, especially for children and adolescents. With initiatives such as educating providers, strengthening regional partnerships and promoting more coherent funding, experts are working to address what they identify as a “rising crisis around the mental health of children and adolescents”.

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Growing demand for behavioral health services and ongoing follow-up labor shortage has been a major concern in Maryland, especially after the Covid pandemic. Kelly Coble, LCSW-C, Executive Program Director for the Integrating Maryland Behavioral Health into Pediatric Primary Care (BHIPP), detailed the impact of these factors on children’s access to care.

“There just aren’t enough specialty vendors out there,” Coble said. “When we talk about children and adolescents, we think of child psychiatrists, specialist providers like psychologists, clinical social workers or other people trained to treat children and adolescents and meet their specific needs.”

Programs like BHIPP use a multi-pronged approach to educate primary care providers – and more recently emergency physicians and mobile crisis teams – to meet the behavioral health needs of patients, with the goal of reducing referrals to high acuity care.

Due to the regularity of healthy child visits, vaccinations and working with schools and camps, pediatric health care providers have the most contact with children, adolescents and their families and are more likely to ‘identify and address their behavioral health needs early,’ Coble said.

BHIPP’s approach to integrating behavioral health care includes several services:

  • Care providers can call the Help line for consultations, who is available Monday through Friday, to speak with licensed social workers, a psychiatrist or other child mental health experts for consultation on medication management, diagnoses or referrals. The University of Maryland School of Medicine, which administers the BHIPP program, as well as partnerships with Johns Hopkins School of Medicine, ensure providers receive expert consultation, Coble said.
  • BHIPP also works with the Maryland Department of Health and the Behavioral Health Administration to maintain a database of behavioral health services. When a provider requests services for a particular patient, BHIPP verifies which services are covered by their insurance and provides the list to the provider within 24 hours.
  • BHIPP also works to strengthen the behavioral health workforce, including working with master’s-level social work students. These students assist with case management, counseling calls, and intervention services under the supervision of the social work faculty. BHIPP initially started with intern positions from Salisbury University and Morgan State University, and plans to expand to additional positions (for a total of 24) in the West and South of Maryland in August.

“The reason we’re focusing on these areas is that we really think about and work collaboratively with the state to target areas that are typically underserved and don’t have as much access to behavioral health services,” Coble said. .

Covid has also led BHIPP to focus on reducing gaps in care, particularly when children need to move from high-acute care in a hospital or long-term care facility to less-acute care, at home or community. Coble emphasized that working with local and community organizations would lead to more individualized and effective results.

“We know what’s going to work in Garrett County won’t be the same thing that’s going to work in Somerset or Wicomico,” Coble said. “We try to have active relationships with our partners, such as the Mental Health Association of Maryland and others who have been very active in helping to shape and design some of our initiatives, whether training or fact sheets on telemental health.”

Innovative financing models could also be key to closing gaps in care. Strong partnership and funding from the Behavioral Health Administration and additional federal funds have sustained BHIPP through its decade of operation, but Coble said the state needs to focus on improving behavioral health funding for the provider. .

Currently, primary care physicians do not bill for behavioral health services, or vice versa. Coble says collaborative care billing codes or additional grant-writing services can be especially helpful for smaller primary care providers who have been consistently overwhelmed during the pandemic.

Looking toward longer-term goals, Coble noted the expansion of BHIPP’s model to other areas of care. For example, BHIPP’s companion program, Maryland Addiction Counseling Service (MACS) is focused on creating a network of similar resources to respond to the state’s opioid epidemic. In 2021, this program was extended to MACS for momswhich specifically supports perinatal patients with substance use disorders.

Coble said the end goal would be for family physicians and other primary care providers to use all of these resources simultaneously, to meet the behavioral health needs of an entire family.

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