Seeing Behavioral Health Through a Primary Care Lens

Our pediatric primary care behavioral health program is in its twelfth year and continues to evolve. Part of that evolution is further integration of our behavioral health providers into the routine medical care that our practice provides. More recently, and as new medical providers have joined the practice, we have reexamined how we communicate reminders to the medical providers to include a first contact behavioral health encounter in the patient’s care. 

With twelve primary care physicians (PCPs) and five nurse practitioners, we work in many ways to help the medical providers remember to consider when a behavioral health visit can help a patient. At a recent behavioral health team meeting (the team includes two MDs, one psychologist, and three LICSWs), we talked about conceptualizing a behavioral health provider as a primary care provider to educate the rest of our team about when to refer a patient to behavioral health. 

What We Are Trained To Do

A pediatric primary care provider is a generalist. For a well visit, the provider structures the visit appropriately for that appointment but also may spend more time on a concern or need that comes up. For other visits, such as sick or follow-ups, the doctor helps the patient for the reason expressed by the patient. The orientation is to help. The provider starts with the concern, problem, or need, then gathers the information needed to treat the patient. Referral or follow-up is part of the treatment plan. The medical provider reviews the patient’s history in the shared medical record; if the patient is part of that doctor’s panel, the patient and family are already known. This allows for better, more informed treatment. The physician treats the patient or, at least, begins treatment for the presenting complaint. 

A behavioral health provider in primary care can be seen in the same way: to help the patient for the reason they’ve come in, to treat the patient or begin treatment, and to lead the patient to further resources if needed. The behavioral health provider starts with the concern and gathers context and more information. As with the medical provider, the orientation is to help solve the patient’s presenting problem. 

What We Bring to the Team

However, the skill set is different. We let PCPs know what we do, what we’re good at, and how our education, training, and experience have prepared us. We are excellent at building relationships and listening. We know about feelings and management of feelings. We know how to ask about behavior, and how behavior relates to feelings. We know a lot about thoughts and beliefs. We review systems and explore context in a deeper way.

Behavioral health providers may have more time to focus on the emotional and behavioral contributors to health and how they affect adherence to treatment and the implementation of health-promoting behaviors. We understand families, caregiver responses to behavior, and how the experiences of caregivers affect their parenting.

Why This Distinction Matters

Behavioral health work is complementary to that of the medical provider. The PCP oversees physical and overall health. The behavioral provider is an expert on mental and social emotional health. Both are generalists, provide preventive and routine care, know the family and context, are the first point of contact for health and development, and make an initial assessment and diagnosis to begin treatment and, as appropriate, determine if additional specialty care or resources are also needed. 

Using this framework of behavioral health clinicians as primary care for mental and emotional health can be a powerful model for communicating our role to busy primary care medical providers. 

Photo by Vardan Papikyan on Unsplash