Expanding access to mental health care for kids starts with training their pediatricians

Over spring break, Izaac Barrera road-tripped to Branson, Mo., where he stayed in a houseboat and road go-karts. He’s a natural pickleball player, and the kind of guy who as a kid used his birthday money to help a friend during a hard time.

He’s quick with observational humor and has a long-term girlfriend who his parents adore. In the fall, he started college with the goal of becoming a mental health counselor.

He’s 20 years old and has a lot of hopes and dreams.

He also has a different perspective on life than he did five years ago, when he made a suicide attempt at his high school.

“The experience opened my eyes to how many people are struggling with mental health. People are hiding their issues and not really talking about it,” said Izaac, who was rushed to the Emergency Department at Children’s Medical Center Dallas after the incident. “I want to de-stigmatize mental health and help others who have gone through situations similar to mine.”

The mental health care needs of children are vast and significant, and they are growing as the pediatric population in North Texas increases, too.

Children’s Health is at the forefront of expanding access to comprehensive mental health care, starting with the first person most parents and guardians call when there’s a problem: their child’s pediatrician.

Several years ago, the hospital system launched the Behavioral Health Integration and Guidance (BHIG) initiative, which focuses on training, equipping and supporting community pediatricians to identify and address most mental and behavioral health concerns among their patients before they reach a crisis point.

This collaborative effort with the Meadows Mental Health Policy Institute was born out of a shared commitment to significantly improve the mental health well-being of children in North Texas and beyond. That commitment transformed into a vision and, with investments from the community, has become a reality.

Adolfo Flores, M.D., a pediatrician in Children’s Health primary care, began the provider training last year. Previously, he worked as a medical director at a large pediatric urgent care, where he noticed an influx of kids and teenagers walking in with a range of mental health issues – depression, panic attacks and anxiety. And in that fast-paced care setting, he wasn’t able to provide the long-term treatment they needed.

“A lot of the issues when it comes to mental health is access and barriers to care. We may know what the diagnosis is, but we lack training in understanding how to manage conditions. There’s also a shortage of mental health providers and the wait time to be seen can be very long,” Dr. Flores said.

When he shifted to primary care at Children’s Health, a colleague introduced him to the BHIG initiative after understanding his desire to better support mental health issues for his patients.

Now, Dr. Flores is working to open a second BHIG hub at his clinic in Plano to expand training opportunities to community providers north of Dallas. This presence will complement and extend the work of BHIG anchored south of Dallas, led by Vijeta Salunkhe, M.D., a Children’s Health pediatrician in DeSoto.

“The ability to step up and help has been remarkable. The whole point is to try to identify the problem before it becomes a bigger problem, and as the primary care pediatrician, we are the ones best suited to help,” said Dr. Flores, who now feels more comfortable screening patients and prescribing medications when needed.

“We are the most in-tune with our patients’ social history because we’ve known them for years. Kids will not talk to you if they don’t trust you, and that trust takes time to build.”

The BIG wins of BHIG:  

• Since its launch, more than 150 providers across the North Texas region and beyond have been trained through BHIG, expanding the potential for approximately 300,000 families to now benefit from mental health services in a pediatrician’s office.  
• These pediatricians will be able to carry these techniques and approaches in the future as their patients age and as more children enter their practice, extending the impact of this initiative beyond those served today.
• Participating providers represent 50 cities and nearly 40 counties across Texas, and there are plans to embed more training opportunities and facilitate more resources in communities to the south and north of Dallas.
• When surveyed, providers said they were more likely to believe that mild-to-moderate behavioral health disorders may be safely and effectively co-managed in primary care. They also remained eager to improve their clinical skills to serve this population at the program’s conclusion.
• More providers reported treating depression, anxiety, substance use disorders and trauma/post-traumatic stress disorder than had prior to the program.
• The percentage of providers prescribing medications for behavioral health diagnoses increased for depression and anxiety.
• The program has received national attention among peer pediatric hospitals seeking to learn from the successes of BHIG. Children’s Health was awarded the Texas Hospital Association Excellence in Community Service Award and included in Fast Company’s Most Innovative list for our BHIG initiative.
• Sabrina Browne, M.D., Pediatric Psychiatrist at Children’s Health and Assistant Professor at UT Southwestern Medical Center, received a 2024 North Texas Hospital Employee of the Year award from the Dallas-Fort Worth Hospital Council for her work on BHIG.

Philanthropic investments of all sizes have been instrumental in collectively bringing the BHIG initiative to fruition. This remarkable feat speaks to the trust the community has placed in this initiative to shift the landscape of how pediatric mental health is addressed.

“The BHIG initiative was created because of incredible support and confidence from the community who believed in what we set out to do. And, now, we are already giving back to our community by addressing an issue that has long been too complicated to tackle,” said Dr. Browne, who is the Child and Adolescent Psychiatrist for BHIG.    

Izaac and his family, who annually donate to Children’s Health through fundraising campaigns, are grateful for the expanded support to address mental health needs in kids before they escalate to a life-threatening situation.

“For me, it was a slow build until I reached my limit. I thought I could get through it on my own, and so I never talked about it,” said Izaac, who went through counseling after he was discharged from Children’s Health.

“Now, I understand that it’s OK to express my feelings, and I can talk about them with people, especially my family since they are all so supportive. I hope others know that there is a light beyond their lowest point. You can keep going up and make it out of that valley.”   

BHIG in the News

Children's Health is one of the most innovative healthcare companies | Fast Company

Excellence In Community Service Award 2023 Award Winner | Texas Hospital Association

North Texas kids need mental health support. A new initiative is closing the gaps | KERA News

Children's Health and Meadows Mental Health Policy Institute Expand Pediatric Mental Health Initiative to 150,000 Families | D Magazine

Training Pediatricians in Behavioral Health | ChildrensHospitals.org

BHIG Donors (as of 7/31/24)