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BHIPP Bulletin
Volume 9, Issue 8
February 2024
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Youth Mental Health System of Care
in Maryland
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This month's BHIPP Bulletin is a contribution from
Rheanna Platt, MD, Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine and BHIPP Consultant.
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In this newsletter, we will provide an overview of the youth mental health system of care in Maryland. The array of services is often challenging to understand and navigate for patients and families, primary care providers, and even mental health providers themselves.
The National Technical Assistance Center on Children’s Mental Health defines a system of care as “a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs in order to help them to function better at home, in school, in the community, and throughout life." However, the reality of the current/existing system of care is that the array of services can feel uncoordinated and difficult to access, especially over the past several years, during which mental health needs and crises have increased substantially among youth.
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What are the different levels of mental health care for youth?
One overarching principle of care is that it should be provided in the “least restrictive environment,” with the aim of maintaining children in their homes and communities if possible. This means that there are a variety of supports and services that range in intensity, with the most restrictive setting being inpatient hospitalization. The table below describes the range of youth mental health care levels. It is important to note that some programming may be available based on insurance (e.g., offered for patients with Medicaid).
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Youth Mental Health Levels of Care | |
| Office Practice/Community Clinic | “Standard” outpatient care; may include psychotherapy (often weekly) and medication management (often monthly). Variability in type/background of provider. | | School-Based Mental Health | Clinicians who are frequently social workers or licensed clinical professional counselors provide direct care in the school setting; some include a psychiatrist or nurse practitioner (NP); clinicians often employed by external behavioral health provider; organized by county/school district. Services can also include primary (e.g., psychoeducation, youth groups or clubs) and secondary (e.g., screening for mental health disorders) prevention. | | Mobile Treatment | Community-based, intensive, outpatient mental health services designed for individuals who have exhausted traditional forms of outpatient treatment interventions or who have had repeated psychiatric hospitalizations and are at risk of out of home placement. Can meet patients at home or in the community. | | Intensive Outpatient Program | Typically, after-school or starting towards end of school day; ~3 hours per day, 2-5 days per week; includes variable therapeutic activities such as groups, individual psychotherapy, usually seen by psychiatrist/NP weekly. Length of stay variable, usually between 2-12 weeks; can be used as a “step-up” service meaning an increase in intensity of services to children for whom standard outpatient care is insufficient or “step down” service with a decrease in intensity of services from inpatient hospitalization or partial hospital program. | | Partial Hospital (“Day Hospital”) | Programming during school hours (typically ~8am-3pm); 5 days per week; includes some school activities/coordination with school, multidisciplinary treatment team (may include psychology, social work, occupational therapy, psychiatry/NP). Seen by MD/NP daily; typically 1-3 week(s) length of stay. Can be used as a step-up or step-down. | | Inpatient Hospital | “ICU” of mental health treatment; 24/7 care for those who cannot be maintained safely at lower levels of care; length of stay typically is 5-10 days. Some units offer specialty programs (e.g., eating disorders, neurobehavioral units). | | Residential Treatment Center (RTC) | Typically reserved for youth who have repeatedly/chronically (vs acutely) demonstrated behaviors that have been difficult to manage in the community setting or unable to be maintained in the home setting. Typically, several month length of stay. May require an agency (e.g., DSS, DHMH) to sponsor. | | |
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Additionally, in some cases, adjunctive services are delivered by a different agency than formal mental health services, introducing some complexity in the coordination of services. The table below describes adjunctive or supplemental mental health services.
Supplemental/"Wrap-Around" Services
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| Psychiatric Rehabilitation Program (PRP) | Adjunctive, focused on optimizing functioning (promote positive peer interaction, communication, self-help skills, completion of activities of daily living) and recovery. Variable intensity and location (can be “on-site” at program/clinic or “off-site” with PRP worker meeting patient in community). | | Therapeutic Behavioral Services (TBS) | More intensive in-home services designed to support children who are at risk for a higher level of care without said intervention. Includes assessment, development of behavioral plan, and use of a therapeutic behavioral aid to help family implement behavior plan. | | Targeted Case Management | Case managers assist families in coordinating referrals and authorizations and identifying resources for families in their communities including providers, transportation, and even non-medical services. | | |
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What types of services are on the horizon?
To address the fragmentation of available services, there has been a movement towards establishing Certified Community Behavioral Health Clinics (CCBHC). These clinics are required to be accessible regardless of ability to pay, to meet standards for the range of services that they provide (including the availability of crisis services 24 hours per day, 7 days per week), and to get people into care quickly. They are obligated to provide an array of services to decrease the need to have services delivered across a variety of providers and/or agencies. CCBHCs are also required to include care coordination and navigation for patients and families. In 2023, the Maryland state legislature passed a bill requiring the Maryland Department of Health to apply to SAMHSA for implementation funds related to CCBHCs.
What other supports are there for families of youth with mental health care needs?
The Maryland Coalition of Families provides services that connect, support, and empower families of children with mental health needs and help families navigate the often complex mental health service system. Services are confidential and free for families. The Parents Place of Maryland (PPMD) offers a variety of programs and services that support and educate families of children with disabilities or special health care needs. PPMD's information, resources, and trainings are available in other languages than English, including sign language, upon request.
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As always, if you have questions about the behavioral health needs of your patients, we encourage you to call the BHIPP consultation line at
855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for resource/referral networking or consultation support.
We will keep you informed about all our services and training events through our website (www.mdbhipp.org) and monthly e-newsletters. Additionally, BHIPP is on LinkedIn, Twitter, and Facebook. We invite you to follow us there to stay up-to-date on upcoming training events, pediatric mental health research, and resources for providers, families and children.
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Join the BHIPP ECHO Core Foundations Series Learning Collaborative! | |
Register for the BHIPP ECHO Core Foundations series! The third session will be held on March 6th from 8:00-9:00am. Join our multidisciplinary team of child behavioral health experts on the first Wednesday of every month between November 2023 and June 2024 for virtual case-based learning and didactic presentations. This series is great for providers who want to improve their knowledge of child mental health and develop foundational skills. Free CME and CEU credit is available for participation. | |
Sign up for the BHIPP ECHO Beyond the Basics Series! | |
Register for the BHIPP ECHO Beyond the Basics series! The next session will be held on March 14th from 12:00-1:00pm. Join our multidisciplinary team of child behavioral health experts every month for virtual case-based learning and didactic presentations. This series is great for providers who have already participated in BHIPP ECHO, or who feel like they are experienced in treating behavioral health in their practice and are looking to explore advanced topics. This series is held on the second Thursday of the month from 12:00-1:00pm between October 2023 and May 2024. Free CME and CEU credit is available for participation. | |
Register for the upcoming BHIPP & MACS Training! | |
Register for the next BHIPP Mental Health Crisis Training on March 21st at 12:00pm. In response to the increase in mental health crises among children and adolescents, BHIPP has expanded its services and training opportunities. BHIPP Mental Health Crisis Trainings are a series of interactive, virtual learning sessions on practices, strategies, and resources to support emergency medicine and primary care professionals in addressing pediatric mental health crises. Free CME and CEU credit is available for participation. | |
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Register for the upcoming BHIPP & MDAAP
Mental Health Committee Webinar!
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Join BHIPP and the Maryland Chapter, American Academy of Pediatrics (MDAAP) Mental Health Committee on March 28th from 7:00-8:00pm for a webinar focusing on Non-pharmacological Approaches to Managing ADHD. This webinar will be presented by Amie Bettencourt, PhD. Free CME and CEU credit is available for participation. | |
BHIPP is supported by funding from the Maryland Department of Health, Behavioral Health Administration and operates as a collaboration between the University of Maryland School of Medicine, the Johns Hopkins University School of Medicine, Salisbury University and Morgan State University.
BHIPP and this newsletter are also supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $433,296 with approximately 20% financed by non-governmental sources. The contents of this newsletter are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. For more information, visit www.hrsa.gov.
Copyright © 2021 Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP), All rights reserved.
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