SBHI San Diego Recommendations

Framework and Recommendations

Over the past year, 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.  The completion of this phase of the project led to the development of a systems-change framework and a series of recommendations to improve the available continuum of services in San Diego County.  The SBHI Steering Committee reviewed these recommendations and initiated the process of prioritizing based on Need and Opportunity for implementation given current County and State Initiatives and available resources.  

Framework and Recommendations

Facilitate Access to Care

  • Expand behavioral health integrated care in pediatric offices; introduce CETA global methodology and leverage opportunities for reimbursement from Managed Care Medi-Cal and Commercial Insurance to ensure sustainability into the future.
  • Develop a more coordinated referral, eligibility and access to care system by facilitating the integration and coordination of services provided by Mental Health Access Program (MHAP) (San Diego Center for Children), SmartCare (Vista Hill), Call for Connection Warmline (YMCA), Access and Crisis Line, and Community Information Exchange. 
  • Enhance equity in the system of care by promoting culturally responsive access to care resources and ensure clinical recommendations match language and culture of youth and families.
  • Engage 211 San Diego to update their database and participate in Access to Care integration and coordination effort
  • Lead effort to help connect community-based organizations (CBOs) with Care Solace to facilitate school referrals to providers; and effort to promote and connect CBOs with BrightLife Kids and Soluna.
  • Expand after-hours appointment accessibility for parents and children, outside of school and work hours to accommodate family need. 

Commercial Insurance

  • Develop an education campaign in pediatric practices to understand how SB 855 new guidelines can improve access to care for families covered by Commercial Insurance. Develop materials and guidance for patients to access in-network or out-of-network care given new guidelines.
  • Advocate with commercial insurance plans to cover in-home and wrap-around services.
  • Advocate for plans to cover Integrated Care Services in pediatric practices (similar to Dyadic Care) by implementing in 2026 the new guidelines set forth by the passage of SB 1320.
  • Improve Commercial insurance rates of reimbursement.

Managed Care Medi-Cal

  • Advocate and implement process for Enhanced Care Management (ECM) to serve as a bridge between outpatient Managed Care Medi-Cal and Specialty Mental Health. 
  • Provide technical assistance (TA) to help CBOs contract with Managed Care Medi-Cal to provide outpatient services (delivered by Associates) – address concerns about network adequacy and poor access to care.
  • Provide technical assistance (TA) to help establish sustainable integrated care in pediatric practices for Medi-Cal patients using Dyadic Care. 
  • Evaluate the possibility of having CBOs join an Integrated Practice Association (e.g. Full Circle Health Network) to facilitate contracting and access to resources, training and infrastructure.
  • Advocate to remove medical / behavioral same day billing exclusion in FQHC settings.
  • Improve Managed Care Medi-Cal rates of reimbursement.

Specialty Mental Health

School Based Multi-Payer Fee Schedule

  • Partner with San Diego County Office of Education (COE) to provide community support and TA to increase number of school districts participating in the Fee Schedule through partnerships between Local Educational Agency (LEAs) and CBOs.

*Services covered by commercial insurance and managed care Medi-Cal to be provided at schools or at sites designated by the LEAs (third cohort application deadline = January 1, 2025, and LEAs will be able to apply for cohorts every 6 months).

Pediatric Behavioral Health Workforce

  • Engage academic programs and CBOs to develop a behavioral health workforce training hub for the pediatric population to expand community-based training programs for practicum students and associates.
  • Train and expand utilization of Certified Wellness Coaches to provide services to youth and families.
  • Support existing advocacy efforts to allow Associates to bill commercial insurance as per SB 855 language.
  • Support workforce retention efforts, including clinical and reflective supervision.

Substance Use Disorders

  • Need for more intensive clinical services for youth with Substance Use Disorders (SUD) or Dual Diagnosis
  • Advocate for higher Medi-Cal reimbursement rates and expanded coverage under commercial insurance to promote parity with Medi-Cal services
  • Advocate for reduced administrative burdens for Drug Medi-Cal contracts
  • Expand and improve screening for substance use to support utilization of existing services

Special Populations

  • Advocate to address the need for more intensive clinical services and residential programs for youth with Substance Use Disorders (SUD) or Dual Diagnosis.
  • Advocate for a single point of entry and the ability for kids with substance use to receive services along the continuum regardless of payer.
  • Advocate for higher Drug Medi-Cal reimbursement rates and expanded coverage, including early intervention services.
  • Advocate for reduced administrative burdens for Drug Medi-Cal contracts.
  • Expand and improve universal screening for substance use in all settings and improve screening in schools by focusing on secondary risk populations. Improve communication and referral process to (underutilized) service options.
  • Promote integration and coordination of substance use and mental health programs to improve screening and assessment, and impact capacity.
  • Address stigma related to youth substance use, including education for the medical community, mental health providers, schools and parents / caregivers. Promote implementation of AB 2711 that prevents students seeking help for substance abuse to be suspended from school.
  • Engage Regional Center to identify how to best coordinate care for youth with developmental disabilities.
  • Improve access to intensive clinical services for youth with eating disorders.
  • Coordinate with Child and Family Well-Being Department to facilitate access to foster youth to intensive clinical services (IOP, PHP, PRTF in the future).
  • Support efforts to facilitate access to services to youth exiting foster care.

Care Coordination & Interoperability

  • Leverage understanding and utilization of Community Information Exchange (CIE) to enhance communication and coordination between early childhood and youth providers.
  • Implement process to facilitate exchange of information between provider Electronic Health Records (EHR) systems ( (primary care and behavioral health EHRs).
  • Establish communication pathway between medical (crisis) providers and schools regarding student reentry after a mental health crisis.

Prevention, Early Identification & Intervention

  • Sustain and expand Healthy Developmental Services (HDS) system to ensure continued coordinated screening, assessment and treatment of behavioral health concerns for young children and their families.
  • Develop and implement comprehensive, coordinated, consistent strategy to address the negative impact of social media and smart phones on youth mental health.
  • Analyze the impact of Proposition 1 (funding reallocation from MHSA to BHSA) on County Children, Youth and Families Behavioral Health spending. Assess how Full Service Partnership (FSP) funding reallocation may affect existing School Link programs.
  • Support the County of San Diego with State advocacy to establish an interim claiming system for FFPSA dollars to ensure timely roll out and expansion of the Family Connection Hub operations and EBPs.
  • Promote universal behavioral health (mental health, substance use, developmental and trauma) screening – from birth, infant, toddler, youth and their caregivers
    • Support San Diego County Office of Education’s mental health universal screening grant to inform development of a local and statewide roadmap
    • Expand and coordinate behavioral health screenings in schools without limitations to payer source, including ensuring universal assessment in kinder (regardless of pre-school, TK participation) 
    • Continue and expand developmental and behavioral screening for kids 0-5 
    • Improve caregiver mental health screening in OB and Pediatric offices and linkages to appropriate care 
  • Sustain and expand home visiting programs to ensure a trauma-informed approach to support the well-being and education of caregivers and provide access to appropriate supportive services.
  • Advocate for increased funding to expand Infant and Early Childhood Mental Health (IECMH) Consultation Services (to support children 0-8,) including consultations in maternity and TK programs.
  • Standardize increased early identification and intervention of student behavioral health issues and family functioning, for example, regular review of absenteeism in schools.

Ongoing Coordination and Advocacy

  • Transition SBHI Steering Committee to a permanent Pediatric Behavioral Health Regional Council to coordinate advocacy and implementation efforts at the local and State level

 Recommendations address early childhood developmental and behavioral health.

Recommendations bolded in blue: Top priorities based on need and opportunity.

Our Work

Connecting children and their families to the appropriate level of care is paramount to the ideal system.   Learn more about moving into the clinical system of care. 

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Advocacy

Comprehensive behavioral health system and equitable resources to meet the unique social, developmental, and clinical needs of children and youth with timely access to services.

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