P2.Q328: Increasing Engagement in Pediatric Behavioral Health Care During Primary Care Well Child Visits

Background: Integrated behavioral health (BH) staff can aid pediatricians in improving the parent-child relationship, enhancing both child health and psychological development. HealthySteps (HS) is an evidence-based, parent-child interaction program in New York City that employs child psychologists to help foster healthy child development. Despite the efficacy of HS, families continue to experience challenges accessing and engaging in this program, especially since the COVID-19 pandemic.

Methods: Currently, all families belonging to the New York-Presbyterian Ambulatory Care Network (NYP-ACN) who present with any behavioral health concern during routine pediatric care are electronically referred to HS. We recently piloted an enhanced method of referring families to HS at two ACN clinic sites, in which pediatricians integrate HS behavioral health psychologists into visits in real time via an iPad-on-wheels to discuss identified parent-child behavioral challenges and whether to formally enroll into the program. Pediatricians at these clinic sites were formally instructed on how to utilize an iPad-on-wheels to introduce HS during well-child visits.

We performed a retrospective chart review of families who were linked to HS via an iPad-on-wheels and compared demographic and visit data with a random sample of families linked to HS via the traditional referral method between August-December 2023. Our primary aims were (1) establishing program feasibility in clinics and (2) whether this referral method improved initial and follow-up HS appointments. Descriptive statistics summarized demographic and visit data.

Results: 30 families were traditionally referred to HS whereas 26 families were referred to HS after engaging with an iPad-on-wheels during well visits (“enhanced referral”). Demographics are reported in Table 1. Most families identified as Hispanic, and most spoke primarily English or Spanish. HS iPad-on-wheel visits averaged about 11 minutes, often discussing nutrition or other routine toddler topics (Table 1). Nearly all families who were introduced to HS with an iPad-on-wheels attended their initial (83%) and follow-up appointments (if applicable, 78%) (Table 2). Families who were introduced to HS via the IPAD on wheels were more likely to keep their intake appointment compared to those traditionally referred to the program (83% vs. 77%, p< 0.001).

Conclusion: Leveraging an integrated tele-BH care approach may be a feasible way to increase family engagement in BH services. Recognizing the shortage of pediatric mental healthcare, integrated tele-BH may streamline care, avoid unnecessary referrals, and minimize over-utilization of limited BH services.