State Program Puts Social Workers in Doctors Offices to Get Kids Mental Health Treatment


COLLEGE PARK, Md.—A new state program is working to help doctors in Maryland connect children with mental health services.

Nationally, an estimated one in five children have a mental disorder severe enough to disrupt their daily lives, yet only a third of children with mental disorders receive treatment, according to the National Institute of Mental Health.

The Maryland Behavioral Health Integration Program in Primary Care (B-HIPP) is placing social worker interns in pediatric primary care offices to help promote children’s mental health.

“The primary care office is kind of the gatekeeper and the starting spot for referrals to different kinds of specialists,” program coordinator Amy Habeger said. “So, it makes sense that that would also be the gate point for mental health related services as well.”

Many pediatricians do not receive thorough training in mental health. But with a national shortage of pediatric psychiatrists, experts said it is becoming more important to emphasize children’s mental health in a primary care setting.

B-HIPP aims to give pediatricians the resources they need to manage mild cases in the primary care office and refer more severe cases to mental health specialists.

Marissa Cooke, a second-year graduate student in the social work program at Salisbury University, is one of four interns from the school working in primary care offices on the Eastern Shore as part of B-HIPP.

Cooke, who has been working as an intern at Chesapeake Pediatrics in Salisbury since August, said she can take the time to speak with patients at length when doctors often cannot.

When patients come in with a long list of issues, Cooke said, “I can step in and talk with them and spend that time they need really getting to the heart of what's going on and then provide them with the resources or the referrals that they need.”

Cooke helped one patient who was constantly running away from home and missing school, putting his mother “at her wits end.” Cooke worked to help the family find an appropriate therapist and the two have kept in constant contact about the boy’s progress. She said that he is now doing much better in school and behaving at home.

“That’s kind of rewarding for me to see, when we have patients like that who just have an all around turnaround because of things that I’ve been doing and the way that we worked together,” Cooke said. “I think that without me here, without a social worker in this setting, it would have been a lot more difficult to do that or it wouldn’t have happened at all.”

Many of the children Cooke sees show signs of anxiety disorders, depression, hyperactivity or problems with bullying. If the case is mild, interns can work with the primary care doctor to recommend behavioral change techniques. Interns like Cooke cannot diagnose patients. But for more severe cases, she helps them find a licensed therapist.

Intern Jennifer King, a Salisbury University graduate student, said that one of the most important aspects is helping families understand their options. “The biggest thing is getting the resources out there,” she said. “Not many people know about what resources they have available to them.”

The availability of children’s mental health services is a problem nationwide. Maryland’s B-HIPP is one of over two dozen programs across the United States seeking to address the issue at a state level. In 2011, the National Network of Child Psychiatry Access Programs was formed to guide and support these programs. While the details vary from state to state, program leaders often turn to one another for advice.

“We network with each other, we learn from each other,” NNCPAP program administrator Irene Tanzman said. This collaboration with efforts in other states was a boon in the development of Maryland B-HIPP, according to co-director Dr. Larry Wissow.

Maryland B-HIPP also offers primary care doctors support via a phone consultation service where physicians can speak with child psychiatrists, psychologists, clinical social workers and licensed professional counselors about mental health issues.

Dr. Susan Nuber of the Children’s Medical Group in Cumberland said she has found the phone consult service very helpful.

While she estimates that about 20 percent of the patients she sees in a day have mental health problems, she said that there are few pediatric psychiatrists in her area.

Like many pediatricians, Dr. Nuber’s training did not include much mental health. Instead, she has relied on reading and talking with other physicians to learn how she can help her patients. B-HIPP’s phone consultation service not only helps her manage her patients mental health needs, but also helps her continue expanding her own knowledge.

“It’s not just a straightforward ‘oh, use this medication, prescribe this,’” she said. “It’s definitely more of a dialogue about what would best serve that particular child, so that in itself provides me with some education.”

Since opening the call lines on Jan. 2, B-HIPP's team of seven child mental health specialists have fielded about 20 phone calls from pediatric primary care physicians with both general and case-specific questions about children's mental health, according to directors.

All B-HIPP services are free and the program is supported by funds from the state Department of Health and Mental Hygiene and the state Department of Education. The program is a partnership between the University of Maryland School of Medicine, the Johns Hopkins University School of Public Health, and the Salisbury University Social Work Department.

Nearly 50 pediatric primary care providers in rural counties have already enrolled. Although the program's current focus is in specific regions like the Lower Eastern Shore and Western Maryland, directors said that the phone consultation service should go statewide in June and up to nine new interns will be placed in primary care offices this fall.

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