Behavioral Health Integration and Referral Around Washington

Tatiana Sarkhosh, MPH
Program Manager, WCAAP, Pediatric Transforming Clinical Practice Initiative

*Editor’s note: See P-TCPi behavioral health resources, including this integration toolkit for primary care providers and this guide to integration on

As pediatric practices around the state strive to improve timely access to behavioral health care and/or integrate behavioral health in their clinics Pediatric Transforming Clinical Practice Initiative (P-TCPi) physician champions have found ways to partner to improve care. Here are the experiences and lessons learned from three clinics:

South Sound Pediatrics | Olympia, WA

Beth Harvey, MD, FAAP, from South Sound Pediatrics in Olympia shared how important behavioral health integration is at her practice and how a partnership with a community agency has made this possible. South Sound Pediatrics is integrated with Catholic Community Services (CCS) Crisis and an intensive home-based team. At a provider’s request, CCS can meet a suicidal patient in the office, conduct a safety sweep of the home, support an immediate connection to care, and visit the home to educate parents on mood and behavior changes. South Sound Pediatrics now has two therapists, including a bilingual Spanish speaker, in the South Sound Pediatrics clinic building available to connect families to care.

Dr. Harvey recalls, “one family in particular had an 8-year-old ask to talk to me privately and he told me his mom was an alcoholic and she hit him, and he didn’t feel safe.  I was able to work with the therapists to get him therapy right away as we got him in a safe living situation and CPS got involved to support the dad.  The other four siblings were also supported at various stages and they are now moving back to their home state and starting fresh with their trauma being addressed rapidly.”

The behavioral health integration program has allowed the practice to support kids ages 4 to 5 with behavioral challenges stemming from trauma, anxious and depressed teenagers needing a 2-month intensive therapy program and patients who need to be connected to long-term care. Dr. Harvey also credits the program with an improved ability to connect with schools and community resources, and to support families at risk of homelessness.

Eastgate Public Health | Bellevue, WA

Crystal Shen, MD, FAAP from Eastgate Public Health in Bellevue shared a powerful example of how her clinic’s partnership with Youth Eastside Services (YES) has improved the health of pediatric patients. Eastgate and YES formed a partnership while engaged in P-TCPi. Dr. Shen recalls a specific example of engaging YES in the care plan for one of her patients. She said she had an adolescent patient with a new psychiatric diagnosis admitted to inpatient psychiatry three times over the course of a few months. This patient would be discharged from care without any outpatient psychiatry care plans in place. This, along with the family’s language barriers, made coordinating care and managing medications difficult.

Dr. Shen says, “Through the connections with YES that we made through P-TCPi work, I was able to get the patient connected with intake, counseling, and medication management much quicker than otherwise possible.”

Dr. Shen was able to provide YES staff valuable collateral information from his inpatient psychiatry stays. By directly communicating with staff and sharing discharge information such as medications, lab results, and discharging psychiatrist notes, care coordination for the patient has improved.

Dr. Shen shares, “since this patient got linked in with outpatient psychiatry care, there have been no repeat inpatient psychiatry admissions, and last I heard, this patient was working and going to school.”


Skagit Pediatrics, LLP | Mount Vernon, WA

Sarah Trajano is a recently hired clinical social worker responsible for starting the integrated behavioral health program in Skagit Pediatrics. She explains that the practice has a number of patients with mood disorders but are having difficulty connecting to outside behavioral health providers. Families are encountering barriers to engaging in care, particularly due to the recurring appointment times occurring during work hours for parents. Sarah notes that kids who go to school across the street or within walking distance of Skagit Pediatrics can now schedule and travel to their own appointments without parental involvement. Parents feel comfortable with this option thanks to the familiarity of the practice and providers and the location of the practice.

Sarah recalls that some “parents have mentioned that for some kids they have been talking about getting them into counseling for a while but have been too anxious to go to a new place and meet a new provider.”

Thanks to the integrated behavioral health services, parents have said that coming to the clinic, where they already feel comfortable, has made it easier to initiate counseling.