P2.087: Increasing Access in a Pediatric Immigrant and Refugee Program through Primary Care Mental Health Integration

Background: Child and adolescent mental health challenges continue to rise. Refugee youth have higher rates of many mental health concerns and face challenges with access to behavioral health care. Models of integrating primary care and mental health services have been shown to increase access and quality of treatment. There is less literature regarding these models in refugee and immigrant populations.

Project Description: A rural academic health network introduced a primary care mental health integration (PCMHI) program based on the AIMS model of patient-centered, population-based collaborative care with a team including a collaborative care mental health clinician (CCMHC), and a psychiatric consultant. In our pediatric immigrant and refugee program, this team collaborates with primary care resources including psychology, social work and nurse care management supporting families with social and medical complexity. The CCMHC provides evidence-based brief behavioral interventions, including cognitive behavioral therapy and behavioral activation. The psychiatric consultant provides diagnostic assessment and treatment recommendations via electronic or in-person consultation. The clinic psychologist provides consultation, psychotherapy, and family therapy for more complex patients with a focus on access and equity. A “warm-welcome” pathway was created to provide for ongoing culturally sensitive psychiatric care through the academic pediatric psychiatry division given known barriers to care for immigrant and refugee families.

We reviewed data over a 1-year period, using language preference as a reliable marker in our program for recent immigration status. Overall, twenty percent of referrals were for patients with a non-English language preference, with Nepali, Somali, Mai Mai, and Swahili the most common, matching clinic demographics. The most common diagnoses were anxiety and depression. Psychology saw a greater diversity of diagnoses. Autism spectrum disorder was the most common diagnosis for psychiatric consultation, specifically around diagnosis and treatment for co-occurring mental health diagnosis. The “warm-welcome” pathway connected 15 patients to specialty psychiatric care with an average wait time of 5 weeks.

Discussion: The PCMHI model improved providers’ ability to get timely support, and patients/families access to mental health services. By integrating multidisciplinary mental health clinicians into the medical home, using shared clinic resources such as exam rooms and video- or in-person interpretation, more families with non-English preference have been connected to comprehensive mental/behavioral care that is accessible, responsive, and culturally informed.

While the AIMS model focuses specifically on measurement-based brief intervention and consultation for depression and anxiety, we loosened referral criteria as the spectrum of emotional/behavioral challenges in pediatrics is broad-based. This has increased access while still maintaining a focus on effective treatment modalities and rapid access to care.

Conclusion: Integrating culturally sensitive, trauma-informed, and comprehensive mental health care into pediatric primary care can be an effective way to increase access to mental health services in an immigrant and refugee population.