Over the past year (2023-2024), the Strategic Behavioral Health Initiative (SBHI) completed and Environmental Scan and Mapping of the Behavioral Health Services for children and youth in San Diego County. As we expected, the children’s behavioral health system of care is extremely complex. The SBHI Steering Committee started by defining an ideal continuum of pediatric behavioral health services (below.) Each area of the continuum was carefully considered, including examining the strengths, challenges, gaps and opportunities that currently exist. We translated our findings into a comprehensive framework and set of initial recommendations focused on leveraging existing resources and system change to establish an ideal continuum of care for pediatric behavioral health services in San Diego County.
Ideal Continuum of Pediatric Behavioral Health Services:
It is widely agreed that prevention and early identification, or tier one, is a priority for universal focus in order to prevent kids from entering the higher-level tiers. Additionally, connecting children and their families to the appropriate level of care is paramount to the ideal system. As we move into the clinical system of care, there is outpatient, intensive clinical services, acute crisis response and inpatient.
The following outlines Tiers 1-5:
Tier 1:
Prevention, early intervention, screening and assessment. Tier 1 also includes facilitating access to the appropriate level(s) of care.
Tier 2:
Outpatient programs and services, including pediatric integrated care models, school-based programs and outpatient mental health services.
Tier 3:
Intensive clinical services, including in-home therapy, wrap around, intensive outpatient, partial hospitalization and residential.
Tier 4:
Acute crisis response, includes mobile crisis, crisis stabilization and emergency services.
Tier 5:
Inpatient includes all inpatient programs and services.
In 2024, the SBHI conducted a survey to determine how many pediatric offices in San Diego are utilizing behavioral health “integration” practices and to establish a baseline for pediatric behavioral health “integration” in San Diego.
Integrated Care
School Based
Outpatient Mental Health
In-home Therapy
Wrap-around
Intensive Out-patient (IOP
Partial Hospitalization (PHP)
Residential
Mobile Crisis
Crisis Stabilization / Emergency Department
Hospitalization
The following is a mapping analysis of the children’s behavioral health system of care :
There are currently three primary payers for children’s behavioral health (schools will be added as a payer in late 2024.) The following chart shows Commercial, Medi-Cal Managed Care and the County Specialty Health Plan coverage for tiers two through five. It is important to understand that Medi-Cal Managed Care covers mild to moderate conditions and the County Specialty Mental Health Plan covers serious conditions. Services in tiers three, four and five are considered serious conditions and therefore, they are covered by the County Specialty Health Plan. Ideally, a community should have all these levels and services available and covered.
In an ideal system:
It is important to provide access to youth and their families regardless of insurance coverage. In addition to getting access to a service, we need additional focus on ensuring the youth are receiving referrals to the appropriate level of care based on their needs and level of severity. The following chart includes examples of resources facilitating access to behavioral health services and programs in San Diego.