202 - A Qualitative Analysis of Providers’ Experiences with a Multi-component Behavioral Health Integration Program: Considerations for Scale-up

Poster Number: 202
Publication Number: 202.320

Sarah L. Goff, University of Massachusetts, Amherst, AMHERST, MA, United States; Betsy A. Brooks, Boston Children's Hospital, Amherst, MA, United States; Marisa DaCosta, University of Massachusetts Amherst, Dartmouth, MA, United States; Erin DeCou, University of Massachusetts - Amherst, Amherst, MA, United States; Jonas Bromberg, Harvard Medical School, Wellesley, MA, United States; Louis Vernacchio, Pediatric Physician's Organization at Children's, Wellesley, MA, United States; Heather J. Walter, Harvard Medical School, Boston, MA, United States

Background: The multicomponent Behavioral Health Integration Program (BHIP) implemented since 2013 in a large community pediatric practice network in Massachusetts provides education, clinical consultation, and support for BH integration in pediatric medical homes. BHIP has increased practice BH integration, provider BH self-efficacy, and patient BH access while containing ambulatory costs. Rapid scale-up of programs such as BHIP may help address the ongoing serious challenges of meeting children’s BH needs.

Objective: To understand pediatric providers’ perspectives on BH integration and experiences with BHIP, including potential contextual and structural barriers and facilitators to BH integration.

Design/Methods: Semi-structured interviews were conducted with providers (medical directors, managing partners, and BH champions) in purposively sampled pediatric practices (SSRI prescribing rates, size, Medicaid percentage and geographic location). Applying directed qualitative content analysis methods, an a priori code book was developed using interview guide domains. Each team member read and coded the first two transcripts deductively using Dedoose qualitative software. The full team resolved coding differences through consensus and amended the code book. Subsequent transcripts will be coded in pairs and iteratively reviewed by the full team. Emerging major themes are being identified both deductively and inductively. Interviews will be conducted until data saturation is achieved, an estimated 30 interviews.

Results: 13 provider interviews have been conducted across 8 practices to date. Examples of preliminary emerging themes include: 1) Endorsement of improved self-efficacy for BH diagnosis and treatment through BHIP; 2) Provider variation in screening, treatment, and referral within practice; 3) Impact of personal relationship between medical and external psychiatric consultants on care delivery; 4) Structural barriers to BH care (e.g., insurance/reimbursement). Although providers felt their ability to provide BH care improved, limited quality assurance processes, changes in the psychiatric consultation structure, and variation in insurance coverage for BH/poor reimbursement rates limited BH capacity.Conclusion(s): Preliminary results suggest that programs such as BHIP may provide critical support for integrating BH in pediatric medical homes but addressing contextual factors such as intra-practice variation in screening, treatment, and referral and policy-level barriers such as quality assurance, consultation stability, and insurance coverage variation may further improve BH care for children.