Hub-Extension Model and Access to Pediatric Behavioral Integrated Primary Care

Objective: Investigation into models of integrated behavioral health primary care and innovative adaptations of these models can help address challenges associated with behavioral health service delivery. To date, few studies have examined access to pediatric behavioral health treatment in primary care, and no known studies have investigated access for pediatric patients in a hub-extension model. In this model, behavioral health providers receive referrals from both hub clinics (integrated sites in which behavioral health providers treat patients) and extension clinics (coordinated off-sites without behavioral health providers). Method: This study investigated differences in latency between referrals and intakes, scheduling rates, and intake show rates between patients from extension versus hub clinics using retrospective electronic medical record data from pediatric patients referred for behavioral health in primary care over an 8-month period. Results: During the time frame, 766 patient referrals were placed from 3 hub clinics and 6 extension clinics (483 hub; 283 extension). Of those referred, 98 patients never scheduled (36 hub; 62 extension). Patients were more likely to schedule intakes following referrals from hub clinics (92.3%) than extension clinics (78.1%). In addition, hub patients (M = 14.2, SD = 12.4) scheduled for sooner initial appointments than extension patients (M = 25.0, SD = 19.8). Hub clinic patients were 2.4 times more likely to cancel and 2.2 times more likely to not show than extension clinic patients. Conclusions: Although additional research on the hub-extension model of behavioral health implementation is needed, this study provides a preliminary examination into the innovative alteration of integrated care models.