Pediatric BHCs provide a wide range of services to pediatric populations in the context of integrated behavioral health programs. Implications for workforce capacity development, evaluation of outcomes and impact, and sustainability are discussed.

The practice of early childhood behavioral health (ECBH) integration in primary care settings promotes optimal care for families with young children while simultaneously improving health care utilization and averting unnecessary health care expenditures. Implementing ECBH integration activities across four domainsscreening processes, prevention and health promotion, case-based consultation and intervention, and care coordination-has the potential to enhance the lifelong health and well-being of children and families. Unfortunately, billing and reimbursement for activities focused on prevention, early identification, and early childhood intervention in primary care settings presents challenges. The current article describes a financial analysis of a grant-funded project focused on ECBH activities delivered by pediatric psychologists and psychology fellows. A business case for HealthySteps (HS), an evidence-based intervention to enhance primary care in early childhood, was applied in a site serving a high risk pediatric population. Delivering HS in this pediatric primary care setting yielded significant cost aversion across both maternal and child level interventions. Estimated costs averted exceeded the program operating costs of HS implementation in this setting. In a changing health care landscape that is shifting away from volume-based, fee-for-service models to value-based, cost-control models, optimizing the potential of primary care for early childhood populations is necessary to improve health outcomes and reduce the total cost of care across the life span.

Objective: Children are accompanied to primary care settings by caregivers who present with their own mental health and psychosocial distress. Primary care is an optimal place to identify negative impacts on child health. Clinics with integrated behavioral health (IBH) clinicians are well-positioned to implement and respond to caregiver screenings. Methods: Universal screening to address perinatal mood and anxiety disorders (PMADs) and psychosocial distress was implemented in 3 primary care clinics within 1 hospital system. Pediatric psychologists supported implementation across all clinics. Screening frequencies, average scores of elevated screeners, and most common treatment recommendations made by IBH clinicians were extracted from medical records. Results: Universal caregiver screening effectively identified mental health and psychosocial concerns and was a driver of increased behavioral health access in pediatric primary care. A total of 6,080 caregivers were screened over 3 years. Results showed 10% and 16.4% of caregivers had elevated PMADs screening results, 33% to 46% identified social determinants of health needs, and 6.6% to 11.5% identified mental health concerns. Responses to screeners including follow up with the IBH team, brief interventions, and caregiver referral to mental health services. Conclusions: Caregiver screening is an essential component of comprehensive well-child care. Without universal screening processes, caregiver mental health and psychosocial concerns may go undetected and unaddressed.

Pediatric primary care (PPC) settings provide optimal contexts for pediatric psychologists to deliver behavioral health services, including health promotion, prevention, early identification, and intervention. Policy statements and recommendations detail mental health competencies for PPC and delineate competencies for primary care psychology, providing a roadmap for training and preparing pediatric psychologists to work in primary care settings. This article focuses on the developmental progression of professionalism in postdoctoral fellowship training in PPC psychology. Using the Professionalism Cluster of the training competencies in pediatric psychology (Palermo et al., 2014), we apply the competencies to fellowship activities and provide examples of behavioral anchors that demonstrate readiness for independent practice. Project CLIMB (Consultation Liaison In Mental Health and Behavior) is an integrated behavioral health services program embedded in an urban, pediatric residency teaching clinic located at a regional children's hospital within a large university system. Postdoctoral fellows train in 1 of 2 tracks, general PPC or early childhood mental health in PPC. Fellows engage in clinical care, scholarly activities, training and education, and professional development efforts under the supervision of pediatric psychologists. Goal setting, continuous evaluation, and reflection facilitate fellows' preparation for independent practice. The Project CLIMB fellowship model illustrates the potential of training within PPC settings to cultivate competent and skilled pediatric psychologists.