Improving Crisis Care and Access for Children Through Integrated Models with Imagine Pediatrics

Summary

Becker’s Healthcare Podcast Summary: "Improving Crisis Care and Access for Children Through Integrated Models with Imagine Pediatrics"

Episode Information:

• Title: Improving Crisis Care and Access for Children Through Integrated Models with Imagine Pediatrics
• Host: Erica Spicer Mason, Becker's Healthcare
• Guest: Dr. Courtney Bolten, Chief Behavioral Health Officer at Imagine Pediatrics
• Release Date: July 9, 2025

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Introduction

In this episode of the Becker’s Healthcare Podcast, host Erica Spicer Mason engages in an insightful conversation with Dr. Courtney Bolten, Chief Behavioral Health Officer at Imagine Pediatrics. The discussion centers on transforming behavioral health access and crisis support for children and families through an integrated, technology-enabled care model.

About Dr. Courtney Bolten and Imagine Pediatrics (00:35 - 01:35)

Dr. Bolten introduces herself and provides an overview of Imagine Pediatrics:

“Imagine Pediatrics is a medical group that delivers both medical and behavioral care for kids with special healthcare needs and complex medical situations. We operate virtually and in-home, utilizing a unique value-based care model akin to a concierge service for our patients.”
(00:48)

She highlights the organization's commitment to integrating behavioral health seamlessly into medical practice, addressing the growing demand and limited availability of behavioral health services.

Integrated Behavioral Health Model (01:35 - 05:09)

Dr. Bolten elaborates on how Imagine Pediatrics differentiates itself through an interdisciplinary care team:

“You’re not a behavioral health patient or a medical model patient. You’re an Imagine Pediatrics patient. You have access to our full suite of services.”
(02:04)

Key Points:

• Interdisciplinary Teams: Behavioral and medical professionals collaborate closely, ensuring comprehensive care.
• Comprehensive Access: Families can utilize various care components as needed without navigating a fragmented system.
• Technological Integration: Use of paramedically trained team members to facilitate virtual consultations, reducing unnecessary emergency department visits.

Crisis Support Systems (05:09 - 13:01)

The discussion shifts to crisis intervention and support mechanisms:

“Our crisis team is trained in de-escalation and stabilization, helping families manage emergent situations without defaulting to the emergency department.”
(08:45)

Key Points:

• Preventative Care: Longitudinal care teams understand patients’ histories, avoiding repetitive care plans.
• Crisis Team Functionality: Focus on immediate stabilization using evidence-based protocols to prevent trauma.
• School-Based Support: Providing resources to school personnel, such as nurses and counselors, to manage crises effectively.
• Post-Crisis Follow-Up: Ensuring patients receive appropriate short-term care and a seamless transition to ongoing support within six weeks to reduce suicidal ideation.

Clinical and Economic Outcomes (14:06 - 20:12)

Dr. Bolten discusses the impact of their model on clinical outcomes and economic structures:

“We’ve seen double-digit decreases in inpatient stays and an 80% reduction in emergency department returns within 60 days after crisis intervention.”
(19:30)

Key Points:

• Data-Driven Approach: Utilization of evidence-based tools and a sophisticated data team to track symptom reduction and well-being.
• Economic Impact: Preventative, low-cost interventions significantly reduce long-term healthcare costs by minimizing emergency and inpatient care.
• Value-Based Care Integration: Demonstrating the economic benefits of early behavioral health interventions to support value-based care models.

Access to Care (21:04 - 25:23)

Access remains a critical focus, especially for Medicaid populations:

“Our social services team ensures recommendations are not only clinically appropriate but also accessible based on family’s insurance and local resources.”
(24:10)

Key Points:

• Patient Engagement Team: Building strong relationships with primary care providers and community networks to identify and support at-risk families proactively.
• Social Work Integration: Navigating transportation, medication access, and other social determinants of health to remove barriers to care.
• Personalized Approach: Tailoring care plans to fit the specific needs and circumstances of each family, enhancing adherence and trust.
• Technology and Human Touch: Combining advanced technology to identify needs with compassionate, personalized support from dedicated teams.

Conclusion (25:23 - End)

Erica Mason wraps up the conversation by acknowledging Dr. Bolten’s passion and the innovative approach of Imagine Pediatrics:

“Your holistic approach ensures that pediatric patients have timely and high-quality access to behavioral health services. It’s truly inspiring.”
(25:23)

Dr. Bolten expresses appreciation for the opportunity to discuss their work and emphasizes the importance of collaborative efforts in advancing pediatric behavioral health care.

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Key Takeaways:

• Integrated Care Models: Combining medical and behavioral health services within a unified framework enhances access and quality of care for children with complex needs.
• Preventative and Crisis Intervention: Proactive and evidence-based approaches significantly reduce emergency department visits and inpatient stays, improving both clinical outcomes and cost efficiencies.
• Comprehensive Support Systems: Dedicated teams addressing not just medical and behavioral needs but also social determinants ensure families receive holistic and accessible care.
• Value-Based Care Commitment: Demonstrating the economic and clinical benefits of integrated behavioral health supports broader adoption and investment in such models.

For more insights and updates, listeners are encouraged to visit the Becker's Healthcare Podcast page at beckershospitalreview.com.

Transcript

[A]

Hi, everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series. Today we're going to talk about reshaping behavioral health access and crisis support for children and families with an integrated tech enabled care model. We have a special guest to walk us through this topic today. Joining us is Dr. Courtney Bolten, the Chief Behavioral Health Officer @imagine Pediatrics. Dr. Bolten, welcome to the podcast. Thank you so much for being here.

[B]

Thank you so much for having me. I'm really excited to talk about this topic. It's something near and dear to my heart.

[A]

Yeah. Oh, and I'm so excited to learn more about it from you to get us started. For those who aren't familiar with you or Imagine Pediatrics, can you say just a little bit more about yourself and the organization?

[B]

Absolutely. So I am actually a psychologist by training, and Imagine Pediatrics brought me in before they really launched commercially because they really recognized the need for integrating behavioral health into a medical practice. So Imagine Pediatrics is a medical group that does get delivers care, both medical and behavioral, for kids with special health care needs and complex medical situations. And we do that both virtually in home and through a really unique business model. So we actually are a value based care company, meaning we take on the total cost of care for these patients so that we can deliver care in what's akin to a concierge model for them. Fantastic.

[A]

And you're really hitting on a key need here. I know behavioral health demand is only growing and service and providers are so limited. So great to hear how Imagine Pediatrics is kind of innovating in this space. And I know, Dr. Bolton, you mentioned this idea of integrated behavioral health care. Can you share a little bit more about how Imagine Pediatrics delivers integrated behavioral health differently than perhaps other providers? And what kind of impact does that have for children and families?

[B]

So our model really is an interdisciplinary care team. So we developed our behavioral health model right along with our medical model. And the reason that that's so important is because even though we have people who are deeply entrenched in both behavioral health and physical health, we're able to really rely on one another when we have a patient. And one of the things that we say a lot at Imagine Pediatrics is you're not a behavioral health pat or a medical model patient. You're really an imagined pediatrics patient. And what that means is you've got access to our full suite of services. And it is a broad and comprehensive model which may seem really complex but what we've really done is try to think about all of the barriers that our parents and patients face in accessing care. And we've started with a group of kids that we believe are going to utilize and be high utilizers and have very engaged and active parents. Parents. But navigating a really fragmented system between hospitals, PCPs, specialists, social work, even though those services are out there, and there's not necessarily what I would consider to be a lack of care available, sometimes getting to that care at the right time can really be a challenge. So what Imagine Pediatrics has done is we have created a model where you don't have to have all of our different care delivery components that you're utilizing at the same time, but you have access to all of them when you need them, and you have one dedicated empaneled care team. And I think about my own situation. So I'm a mom of four. And even just navigating our PCP is incredible. She's wonderful. But the after hours experience isn't great. And so a lot of times we end up having to go to urgent care or having to go to the emergency department for something that maybe could have been handled either virtually or, or with a quick virtual check in. That's facilitated by, in our case with Imagine Pediatrics, we use paramedically trained team members to go into the home to get the physician on camera while they're helping facilitate care. So those little elements and those little touches help us keep our kids who don't need to be going to the ED or inpatient out of the ed and really allow for those who do need it to have that access to care when they need it.

[A]

Fascinating. Yeah. I really appreciate how there's really this level of innovation behind getting care at the right time. It sounds like you really Imagine Pediatrics has done something quite a bit different than what we're seeing more generally in the field. And getting care at the right time, I know, is so important, especially when we're thinking about crises and crisis support. Especially to your point about primary care providers, it might be a challenging setting in which to provide CRIs. Hard to get it right. So how does Imagine Pediatrics support families during those moments and walk them through it? I think you were starting to touch on that. But if you could elaborate just a.

[B]

Little bit, we do not see a ton of integrated PCP practices, meaning they are doing what they need to be doing. And one of the things that the American Academy of Pediatrics recommends for all pediatric practices is that they're doing Regular screenings for developmental delays, for mental and social emotional health. But what happens when they get a survey back or a patient walks in and they have endorsed suicidal ideation, or a parent has come and said, you know, we're seeing a lot of homicidal ideation in our child, where do we go and who can support us with that? And it can be, as, you know, common as a diagnosis of ADHD that's having really significant impact to a child's daily living and a family's functioning. And our physician partners are fantastic, fantastic in supporting from medical and even sometimes behavioral recommendations. But there really needs to be an extra level of care. And one of the things we talked a lot to our partners about early on was how ADHD is really can be one of the most common things that brings a parent to the emergency department from a behavioral health standpoint. And there's a really clean patient journey that shows that they're more likely to experience bully and bully victimization. And that can lead to pretty severe depression, like when you start to think about being out of school more often or being isolated from your peers, and then you get to a point where you're dealing with a more complex behavioral, social situation. And really there are two things that we look at. We look at that long term preventative care. We have longitudinal, as I mentioned, our patients all get empaneled to a care team. So they really know the backstory and what has worked in the past and what hasn't worked in the past. So we're really trying to avoid recreating the wheel in terms of delivering a care plan. And then we also have a crisis team that works for any of our acute needs that come through. And I think there are two things that are important about the crisis team. One is the understanding of what happens when a patient with a behavioral health need actually goes to the emergency department and what type of care they're going to be receiving. So very infrequently, is there a pediatric psychology team that is there to catch and handle and support those families in a way that will help them de escalate. So our crisis team is really there and trained in de escalation and stabilization. So when our patients call in, our first blush is to get the temperature of what is happening in the emergent situation and to see if the caregiver or the team that is there supporting that child feels comfortable in trying to de escalate while we sort of learn more about how the situation is unfolding and what has happened. But really we're focused on following a really evidence based protocol for just making sure that we can de escalate and stabilize that patient. And if we can do that, then we can really avoid a waterfall of different things that can be kind of traumatic for that family. And what we do is we work with everybody on the child's care team. So I think one of the things that makes us really innovative is it's not limited to the parent calling in. When we have a patient, we want to make sure, especially because we are working in pediatrics and most often they're spending the majority of their day in a school based setting. And so we really want to make sure that the care team, whether that is a, a private duty nurse, a school counselor or teacher, has access to our suite of services so that if this crisis event or emergent event that they don't feel equipped for is occurring, they can call our care team and really get immediate support in how to de escalate and sort of contain that situation and help the child sort of re regulate. Right. So we're really thinking about maybe even reinforcing skills that the child has already learned, but that just needs like a little bit of in person support. And that caregiver or may not be familiar, or may be very familiar and in that moment may not know how to apply the skills and the training that they've had. And so we're really just sort of that extra layer to reinforce and to support and build confidence for whether again the school nurse, the school counselor or a parent caregiver in that moment. And then once we've stabilized and we are certain that the caregiver and the team feel comfortable that they can keep stabilized and we don't pull back, that's really where we start to lean in more because we want to make sure that they've got all of the resources that they need not only to feel safe for, let's call it that 24 hour period after, but that they immediately have a more appropriate level of care. So again, I go back to the emergency department situation where we saw this emerging from the pandemic, that we were flooding our emergency departments with behavioral health needs. And the emergency departments really aren't equipped to handle that in a way that isn't a medical intervention. And so what we're doing now is really trying again to get them into the right supports where they're going to have a less traumatic experience. One of the terms that I think became pretty commonplace and I think was no surprise to a lot of the behavioral health professionals who've Been in the space for a long time watching what was happening. Even prior to the pandemic was the term boarding where kids were really checked into the ED but didn't have another step down care or appropriate level of care to go to. And so the hospitals operating in the best interest of the hospital system were trying to figure out what they could do, but also couldn't because of liability issues, discharge those patients. And so we ended up in a really tough position where it wasn't necessarily the right place to get therapeutic care, but they didn't feel like they had another option given how overwhelmed the system was. And what that does is it puts a strain on everybody because it prevents those kids who have needs that are well suited for the emergency department from going there. So when we think about crisis, there are really two points. There's that emergent event and then making sure that they're really well cared for through what we look at the next 45 days, especially because we see a lot of suicidal ideation. And research shows that about six weeks is what it takes to really reduce and see a clinically significant reduction in that ideation. So we know if we can get them in short term care for about six weeks, that we can get them very stably over to our longitudinal care teams. And so we just, we follow really intensely and we make sure that they are in, whether it's intensive outpatient or partial hospitalization, or even if they need a residential treatment center placement, but not that they're not having to go from the emergency department to a less optimal setting of care and that we're not missing time or creating more trauma in their experience. And then the other component is when they're coming out of a hospital stay because they have been in the emergency department or they have been an inpatient. We really want to make sure that they have been able to access the next level of care. And the hospital and the ED social workers are incredible. But sometimes they lose track of those patients just because there's so many calls that happen and so many meetings with parents are flooded. And so it's a really hard time to navigate what was an emergency situation. And then the instructions following and there may be a discharge because they've been stable, but they still need care and they're on a wait list for 30 days for a facility. So in those events we can really bridge that care with our therapists. So we do direct service in those moments to ensure that those patients are able to stay stable and safe in their communities or in their homes.

[A]

Yeah, Dr. Bolton, thank you so much for the info. It's fascinating to hear how pediatric behavioral health issues are really intersecting with some of the larger issues that we're seeing throughout healthcare. You know, ed boarding is something that Becker's reported on so much last year when the ed boarding levels were really at crisis level across the country. So really interesting to hear about how this intersects with, with many of these major issues and then to also hear about this highly preventative approach and holistic approach your organization is taking on. You know, when you were saying some of the, how some of these services can help ensure that patients are getting the appropriate level of care if they can avoid an ED admission, you know, that's, that's certainly part of the goal. And I know that in that of course a lot of cost conversations are happening. You know, ED visits and admissions are expensive. And so I know healthcare organizations are looking at this from a financial lens. But beyond reducing cost of care, you know, what are, how else are you thinking about behavioral health outcomes with your approach?

[B]

So first and foremost for us is clinical outcomes. We absolutely are based on clinical measurement and we have a very sophisticated platform for measuring using evidence based tools across the spectrum. And not just we love the Gad 7 and PhQ 9, but we are really focused on what the unique needs are of our patients. And so we look at a number of different things and we have an incredible data team. And I think one of the really amazing things about Imagine Pediatrics is our intersection of human touch and technology and our data team is a really big part of that. So with that we really are focused on not just qualitative improvement, but quantitatively are we seeing symptom reduction? Are we seeing an increase in well being? Are we seeing an increased safe days at home and time in community? And so those are all metrics that we track and we look at on a patient to patient and then also on a population level. In addition to I have had the ability to stand up our quality programming around behavioral health and really looking at some of the quality measures around our Fuh 7 program and our Fuh 30 programming. And we really believe in follow up care post hospitalization and the customization of that process. And so it's also something that we have really supported our partners in closing their care gaps and we've seen tremendous clinical outcomes from that. And so it's something that we're really doubling down on, building and building out more robustly so that we can meet our patients needs, not just virtually as they're coming out of a hospital. Stay. But also we've got a fantastic team of community health navigators that are there helping support and like I mentioned in the very beginning, really ensuring that it's not just, you know, their presentation of symptoms. It's a lot of times it's things like transportation or utilities or access to meds. And so they're able to ensure, if there is a shortage of ADHD medication in their area, that we're able to get it from someplace else. One of the other things that we see often is a patient might be discharged from an ED or setting, but the closest inpatient stay or the closest facility that can take them is several hours away. And the parent doesn't want to lose the opportunity to have their child in the care that they need. But the idea that they get medical transport and then the family has to figure out how to get there to find them or to pick them up is really challenging. And we've seen even in the states that we serve, of patients sent as far as six hours away from their families, which for a lot of our families who are working full time jobs is really cumbersome for them to figure out just even how to get to their child and get them back home. And so those are things that our team spends a lot of time leaning with the families so that they just, we can release the mental load of that for them. But I do want to go back to something that you mentioned in your question, which was around the economic structures. And I think one of the things that's fascinating about behavioral health, and I think one of the reasons that it's a little bit late to the value based care game is that there's been a notion that to reduce the emergency department spend, which for behavioral health, because there really aren't that many interventions or time is less expensive than a lot of the medical cost. But what it does is it creates a burden on the system. Then for inpatient stays, they are incredibly costly, especially for certain diagnostic groups. But with those groups, I think because we started with an adult framework, we forget the fact that it's very, very small amount of cost to deliver preventative care that actually has a really large economic impact on the trajectory and the future of these kids and families. And so I think that there's now emerging support for value based care models in behavioral. But I think that it has taken a long time to prove that really small intervention and lower cost interventions delivered preventatively or just the social support and behavioral support at the right time can really have a massive economic impact for these families. And so I will say I think that it's part of the reason we haven't seen a lot of investment in the pediatric space, but specifically in the behavioral health space. I'm excited to see as these new models are emerging, a lot of great outcomes. They're starting to get published. We've seen really double digit decreases in inpatient stays that we're very excited about and then marrying that with the clinical outcomes. What we're seeing previously all of the research was around ED diversion programming. So if we put a psychologist at the emergency department and they are there to triage, what do we see? And we saw about a 90 diversion rate in some of the research. And so what we really wanted to know was within a 30 day period after that, how many people come back into the emergency department or into some other emergent form of care, urgent care. And what we found was that when Imagine Pediatrics is able to get them through our crisis programming and crisis line, or they're able to call their Imagine Pediatrics care team first, we don't see any presentation for the next 60 days for about 80% of those families, which makes us feel very confident that we are actually able to stabilize them in the community. And so that's one of the things that we look at. It's not just did we divert them, did we believe that we stabilize them, but did they actually go back to the emergency department within that 30, 45, 60 day period and did we miss something and there could be a new emergent issue, but that's we're tracking at the highest level to just ensure that we're not, you know, diverting somebody who really needs that care.

[A]

Absolutely. Such important considerations. And Dr. Bolton, it's really reassuring to hear some of those measures that you shared. I think the 91% diversion rate after the triaging intervention, it sounds like behavioral health is starting to get more of the time and interest and attention that it needs. And it's great to hear about some of these early programs showing some signs of. Showing some promising signs.

[B]

I think it's great to see everybody working in collaboration together. It's always exciting to see what else is going on in the field. I mean, a lot of our work is really built on evidence based programming that's happening around the country. And we're uniquely equipped to pull a lot of those threads together just by the number of kids that we're able to serve. But our model and our work is really built on the work of some fantastic clinicians and really wonderful evidence based programming.

[A]

Yeah, Absolutely. And I know we're nearing the end of our time together, but I did want to make sure that to close us out, we addressed one other through line here that has really come through in our conversation today, and that's the concept of access. And so while access to care continues to be a major issue, especially in behavioral health and especially for Medicaid patients, can you just share a little bit more about how imagine Pediatrics is helping families get support when they need and where they need it for this patient population specifically?

[B]

Yeah, absolutely. So I mentioned the fact that we are an interdisciplinary team. And one of the teams that I think is potentially the unsung hero of our team is actually our patient engagement team. We work incredibly closely with our engagement and network team because they're the ones who are really out in the communities and in the field per se, Talking to our PCPs, a lot of the major academic medical centers around the work that we do. And they are responsible for helping us develop those relationships so that we can share these patients clinically and so that we can augment what they're unable to deliver. Like I mentioned, we have incredible practitioners, but their practices aren't equipped necessarily with the same level of resources or the time, or they're very focused on one aspect of care. And so that leads to a really fragmented system with a lot of people who want to do right by their patients and their families. And what we're able to do through those relationships is really ensure that we know when patients are missing their quality gaps or when they might be at risk for an emergent situation. And I mentioned our partnership with our data team. This is another thing that we look at really closely. If we see that one of our families has started to potentially miss a couple of refills on medication, our team's able to reach out and just ensure that they've got everything that they need and that there hasn't been a change in care or any sort of events that we might want to take a look at. We also do this proactively through behavioral health screeners that our families fill out so that if we see something concerning, we can reach out immediately. So a big part of it is again that like, proactive, preventative, I would say population based care, but with a really personalized approach. And then the other component of right access right here is just. Just having people who understand the systems to navigate those systems. And our social work team is really incredible at this. So our social services team is dedicated. They know. And you brought up Medicaid. We serve A predominantly Medicaid population. And one of the things that they have pulled up when they're talking to a patient is all of the access that their health plan might provide. And so they know exactly when they are making a recommendation, that that recommendation is going to be a good recommendation, not only for that use case, but also specifically for that family because their payer covers it, because there's an opening. And again, like I mentioned, just making sure that they're taking the mental load off. So it really is the interaction of having this really great technology to surface all of these insights, like what your benefits are, you know, where you are in your treatment journey, or what has happened recently in the past few months, paired with that team, that human touch that really understands and meets the patients where they are. And we may have a perfect treatment plan lined out for them and a perfectly evidence based treatment plan or care plan, but that might not be the right fit for the family. It may be something that they've tried or it might be too overwhelming for them to implement. And so we're really going to try to get in and meet them where they are at and with what feels right for them so that hopefully our families feel better equipped to be more adherent to their care and to build trust so that they'll reach out to us again. I mean, I think there's nothing more disappointing than really needing help with your children and not having somebody follow through who's promised you something. And so we really just wanna empower our families to be care team partners with us. But we do that through really strong network and really strong family relationships.

[A]

Dr. Bolton, this has been such a fantastic conversation. You know, your passion comes through so strongly for your work. And I can just tell by the way that you describe your teams, the way you work together, the holistic approach your organization is taking to ensure that pediatric patients have timely and high quality access to behavioral health services. It's, it's really inspiring and I just want to thank you for your time and your insights today. Day.

[B]

Yeah, thank you so much, Erica. This has been great and I really appreciate the questions and the time.

[A]

And of course, we'd also like to thank our podcast sponsor, Imagine Pediatrics listeners. Be sure to tune into more podcasts from Becker's Healthcare by visiting our podcast page at beckershospitalreview. Com.