Many families referred by pediatricians for mental health care never make it to the first appointment, particularly in underserved communities. This project evaluates the B-HIP program, an integrated behavioral health model embedded in a family medicine clinic, which provided universal mental health screening and same-day services using a tiered care approach. Results showed symptom improvements and strong engagement with in-clinic services. The findings support redesigning care systems, not blaming families, to address pediatric referral dropout and improve access for all.

Abstract

Background: Referral dropout is a critical barrier to pediatric mental health care, with up to 50% of families failing to follow through after referral from primary care. This disproportionately affects underserved families and is often misattributed to parental noncompliance rather than systemic challenges. Population: This program evaluation draws from retrospective data on the B-HIP initiative, an embedded, tiered behavioral health model in an academic family medicine clinic serving predominantly Medicaid-insured and racially diverse children (N = 493 PSC; N = 235 Y-PSC at baseline). Design & Methods: A descriptive evaluation tracked referral engagement patterns, pediatric symptom screening using the Pediatric Symptom Checklist (PSC, Y-PSC), and access to integrated behavioral health services. A tiered care protocol guided treatment assignment based on severity. Analytic Approach: Descriptive statistics summarized symptom severity and service utilization patterns across two time points. Results: Screening data indicated symptom improvement from intake to follow-up, with PSC mean scores decreasing from 10.48 to 9.86 and Y-PSC scores from 13.23 to 9.94. Conclusions: These findings suggest that embedding behavioral health into the pediatric medical home can reduce early dropout and promote engagement. Rather than viewing non-follow-through as a family-level issue, integrated care reframes it as a solvable systems design problem. Recommendations include expanding tiered IBH models in safety-net clinics and funding infrastructure to support ongoing integration.