P2.051: A Novel Hybrid Model to Provide Equitable Developmental and Behavioral Health Care to Children Living in Rural Areas

Background: In 2021, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association co-declared a national emergency in child and adolescent mental health. The AAP highlighted the necessity of improving access to evidence-based behavioral health services.
One in 6 children in the United States between the ages of 3 and 17 have a developmental or behavioral health disorder. Over half of these children encounter difficulties accessing healthcare services. Rural children have the highest prevalence of developmental and behavioral problems and suffer worse outcomes, largely due to poverty and limited healthcare resources. The current model of healthcare delivery is failing to meet the needs of rural children with developmental and behavioral health conditions. We answered the AAP’s call to action by creating a novel outreach program to address this unmet need.

Project Description: We created a novel hybrid model to provide equitable care for rural children with developmental and behavioral needs. Our developmental and behavioral multidisciplinary team provides longitudinal care for patients from infancy through young adulthood. Our primary office is located at an academic, tertiary health center in an urban setting. The first facet of this rural outreach program was to establish two rural satellite offices, closer to where our patients reside. They are staffed in-person by a physician and case manager twice a month. The second facet of this program focuses on utilizing telehealth to allow patients to access multidisciplinary group services housed on our urban campus.

Discussion: 156 children were seen in our satellite offices from March to December 2024, with a no-show rate of 13%. 100% of satisfaction survey (n=26) respondents agreed that the program/services met their needs/goals, with 92% rating the quality of the program/services as “Excellent” or “Very Good”. Satellite offices improved access to care for patients in 10 counties and decreased travel times by an average of 1 hour per visit. From 2023-2025, 67 rural patients and parents utilized virtual services, including parent support and social groups. Our parent management and new diagnosis support groups were most utilized.1 This program is fiscally viable, as only select members of the clinical team travel to the remote sites. Travel time is recouped by an improved no-show rate and the linking of all families back to the previously established salaried and grant-funded larger clinical support team.

Conclusion: This hybrid program has contributed to the AAP’s vision of ensuring all patients receive necessary behavioral healthcare. Satellite locations allow patients to receive in-person care while reducing the caregivers’ burden of travel time. Combined with telehealth services, this model of healthcare delivery improves efficiency and cost, while enhancing health equity and access for rural children.