Behavioral Health Clinicians Help Patients in Arkansas Children’s Primary Care

To provide a more holistic approach to child health, Arkansas Children’s is part of a national trend to include behavioral health experts in primary care, following a unique approach to meeting the mental health needs of children before a crisis.  

“We want to do our part as a health system to alleviate some of the crises children are going through. We have a crisis-oriented mental health system in our country to give children care when they get to a point where they’re already in crisis. It’s not designed and supported in a preventive way,” said Jason Williams, Psy.D., M.S. Ed., senior vice president, chief and mental and behavioral health officer at Arkansas Children's Hospital (ACH) in Little Rock and professor of psychiatry at the University of Arkansas for Medical Sciences. “Our Arkansas Children’s Health System is committed to this unique model to help children before they reach crisis level in their communities, to help our community partners manage the care of kids more effectively, and when they’re here, we make it as easy as possible for families to be able to access behavioral health services at the same time that they’re getting their medical services. We’re able to do both of those things simultaneously.”   
 

How it works 

In January 2024, Arkansas Children's Health System rolled out a behavioral health primary care integration model. The model includes universal depression screenings, known as patient health questionnaires, for all children 12 and up.  There is a different screening for younger patients.   

Pediatricians are trained to spot mental health concerns. If a need is identified or a patient screens at high-risk, a medical social worker or behavioral health clinician (BHC) will come in during that patient's appointment and evaluate them. If a patient requires more short-term therapeutic intervention, a BHC - a licensed social worker (LCSW/LMSW) or a licensed professional (LPC/LAC) - typically schedules six therapy sessions within primary care to help stabilize the child. Some require fewer or more sessions. BHCs can see patients as young as 5 years old. Younger patients are referred to more specialized therapy.    

"We're not doing long-term psychotherapy, but therapy to help stabilize a child's situation and make sure that child and their family have the resources they need going forward. That's a little different than some other collaborative models, where it's more navigation to the community instead," Williams said. "We believe that having the provider in the clinic so a patient can come back to the same place for therapy makes it easier on the family."   

If a patient needs more therapy, a physician can make a referral.   

Beyond BHCs, the model also includes:   

• Medical social workers, who have long been part of Arkansas Children’s Primary Care, help families navigate social determinants of health or community-based needs.   
• Community health workers help connect families back to resources in the community in a more in-depth way.   

There are currently two BHC's working in Arkansas Children's Primary Care, with plans to hire more. 

 

BHC perspective 

BHC Dominque Norman, DSW, LCSW, has worked for a year at the Arkansas Children’s General Pediatric Clinic and sees patients with a variety of symptoms associated with mental and behavioral conditions, including:   

• Anxiety
• Depression   
• Psychosis   
• Aggression   
• Struggles with impulsive behaviors

BHCs do not diagnose these conditions, but they do help children and parents navigate the symptoms.   

Within three months, from October through December 2024, Norman completed 111 consults, including mental health assessments, discussion regarding therapy sessions and crisis response. She completed a total of 55 therapy sessions.   

Norman said wait times at an outpatient therapy clinic can typically run about four to six weeks, and early intervention in primary care is beneficial.  

"When you come to the clinic, typically, I'll have appointments in the same week, sometimes the next day. We have a little bit more flexibility," Norman said. "In many clinics, there are several steps a family has to take - you have to verify your insurance and sometimes set up an intake appointment before an appointment with a therapist. Our process is more streamlined."   

She also pointed out that the cost of outpatient therapy can be a burden for parents.   

"Sometimes you have to choose between buying groceries for the week or bringing your child to therapy. And if you're in survival mode, therapy isn't number one," she said. "We don't want you to choose between groceries and therapy. We want you to be able to have both."   

Norman said she's seen this care model's impact on several patients. She shared about an older patient who had several therapy sessions after a physical assault. If the child's anxiety symptoms had been left untreated, it could have led to post-traumatic stress disorder. After therapy, their patient health questionnaire scores improved dramatically.   

"The patient was scared to go out, even to come to the clinic initially. They were scared to go anywhere. Since meeting and talking through these events, they have made such profound improvements in their ability to go places without fear and even work on their responses to things," Norman said. "They expressed a lot of anger, and now, they've said, 'This is the new me.'"   

 

Working together for patients 

Since the behavioral health primary care integration model began, the program shared that social workers, BHCs and community health workers have had over 8,500 encounters with 2,988 individual patients.  

"They're really good kids. I think parents sometimes lose sight of that with some behavioral issues," Norman said of her patients. "But when you have a medical team behind you explaining how they can cope with these behaviors in a healthy way, it does make a difference."   

Norman said collaborating with other specialties and departments at Arkansas Children’s is an important part of the program’s success.  

"If I feel like a child is in danger, I can easily call the emergency department (ED) and say, 'I have some concerns; we're going to go to the ED,'" Norman said. "I think parents are more trusting to agree to an acute care placement because we're at Arkansas Children's."   

While it allows for a quick response in a crisis, it also relies heavily on prevention, allowing a child to get help before things become more serious.   

This mentality goes back to caring for the whole child, Williams said.   

"We know that there's a lot of stress on children today. So, how do we help them successfully and in one setting? My big goal for our health system is to see mental and behavioral health equal to medical levels of care, staying true to our mission of treating the whole child," Williams said. "By providing this care to these children, even if it's not an acute mental illness or mental health concern, it's still thinking about it from a holistic perspective. It changes the culture of the environment in which we're operating so that it's seamless for a family to access all health services in one place."   

    

*This article was written by the Arkansas Children’s content team and medically reviewed by Jason Williams, Psy.D., M.S. Ed., and Dominque Norman, DSW, LCSW