HAGERSTOWN, Md. — Going into her toddler’s annual check-up at Opal Court Pediatrics, Mallory Churchey worried about his behavior.
Her youngest child, 3-year-old son Bronnsen, was having unusual tantrums and outbursts.
“I just knew it was not normal,” said the mother of four from Williamsport, in Western Maryland’s Washington County.
Churchey expected to navigate referrals and waitlists before finding a professional who could help her son. She didn’t expect to schedule an appointment to return to Opal Court the next week.
For the next six weeks, her son Bronnsen met with Miguel DeCastro, a master’s level social work student, free of charge.
DeCastro is an intern for the Co-Location Internship Program sponsored by Salisbury University and Maryland’s child psychiatry access program, which has placed social work graduate students in pediatric offices in rural areas of Maryland since 2012.
“He was very active in playing with our son and engaging with him but also kind of giving him boundaries,” Churchey said. “Our son never listened to any of us with boundaries. It’s just shocking to watch, to be able to see him be so well-behaved.”
Many other parents are just as content, according to the Maryland Behavioral Health Integration in Pediatric Primary Care program’s last quarterly report. Of 231 families who completed a satisfaction survey, 98.3% reported they would be likely or very likely to recommend the social work intern to a friend or family member.
Along with its internship, the program — known by the acronym BHIPP — offers statewide, over-the-phone behavioral health consultation services in collaboration with the University of Maryland and Johns Hopkins School of Medicine.
The program that brings fledgling social workers into pediatric offices is part of the National Network of Child Psychiatry Access Programs. Yet despite positive reviews from pediatricians and parents, of the 54 programs in the network, the Maryland program stands out as an exception. Those other programs often offer hotlines to mental health services, but not access to a mental health professional embedded in a pediatrician’s office.
“I don’t know anyone else that’s partnering with a social work school,” said Dr. John Straus, the founder of the network.
Partnering with universities could be a viable option for other access programs in states that struggle to maintain the workforce needed to address the demand for youth mental health services, Straus said.
“I’ve always known what Maryland was doing, but I hadn’t really thought about it nationally, and I think we need to promote it a bit more,” he said.
‘First line of defense’
This school year, eight pediatric and family medicine practices in Wicomico, Somerset, Frederick and Washington counties have social work interns through the program.
The social work interns do behavioral health screenings, brief six-week interventions and coordination of resources and referrals, said program director Meghan Crosby Budinger. Interventions primarily consist of cognitive behavioral therapy and parent management training
Since the program began in 2012, its interns had conducted 12,160 visits with families as of mid-February, Crosby Budinger said.
DeCastro said providing behavioral health services in a primary care setting serves as “the first line of defense” for youngsters who need that help.
In fact, about half of all pediatric check-ups consist of conversations about psychosocial, emotional, behavioral or educational concerns, according to a 2024 academic paper published in ScienceDirect.
“All pediatric practices and family medicine practices that see kids need to be comfortable taking care of behavioral health issues,” Straus said.
Despite this, the Accreditation Council for Graduate Medical Education has not required pediatricians to train in this field, Straus said.
While its guidelines will change at the beginning of July to require a month of mental health training for new pediatricians, most current practitioners aren’t equipped to deal with these issues and have sent families to look for help elsewhere.
The social work internship program offers a better, quicker alternative, DeCastro said.
“Because I’m here three days out of the week, sometimes from those regular checkups, the providers are able to just walk into the office and be like, ‘Hey, there’s someone I’d like you to meet,’ and I’ll meet them in the exam room,” he said.
The program is both convenient and free, said Gabriel Simpson, a social work intern at Gateway Pediatrics in Salisbury, Maryland.
The program runs on funds from the state’s Behavioral Health Administration, the Health Resources and Services Administration as well as grants from the federal government. That allows the program to offer its services with no charge to its patients or their insurance, thereby steering clear of problems that may otherwise arise regarding insurance coverage.
“The accessibility feature that comes along with the … program is, I think, invaluable,” Simpson said.
A stepping stone
DeCastro said most of the issues he sees in young children are beginning stages of ADHD.
For hyperactive children, strategies as simple as changing how they play can have a significant impact on shaping behavior — and that’s what DeCastro recommended to Churchey.
“He gave homework for us parents to work on with our child after each appointment,” Churchey said. “Mr. Miguel wanted us to get down on the ground with [our son] and have special play time set aside every day to where our son could choose the direction as far as where the play is going to kind of give him a sense of control in that moment, because he wants to control everything.”
Physically putting parents at the same level as their children and role playing situations as simple as meeting a new friend on the playground are common homework assignments for parents, DeCastro said.
“As silly as some of the things were that he gave for homework, it helped,” Churchey said.
Little changes like that are an easy way for kids to develop better behavior, DeCastro said.
“All we’re doing is playing, yes, but we’re also changing the behaviors,” he said. “We’re just meeting kids where they’re at.”
Sometimes, though, children need more help after their six weeks with a social worker.
“We’re a stepping stone to hopefully get them comfortable for a long-term referral later on,” Simpson said.
In other cases, though, no referral is needed.
“Some of the things are acute mental health and may only need a few sessions just to try to help patients get in the right direction,” said Dr. Jennifer Wehberg, the founder of Gateway Pediatrics, which has partnered with the internship program since its start.
‘A huge burden lifted’
The program’s benefits also extend to pediatricians, who can struggle to keep up with youth behavioral health needs.
“We are not mental health providers. I’m not a therapist,” said Dr. Anne Rao at Opal Court Pediatrics.
In addition to lacking the training to fully treat mental health issues, some physicians just don’t have the time.
“Depending on what setting you’re in, doctors can sometimes be under immense pressure to see a certain number of patients per day, and that model of care doesn’t always align with the unique and complex behavioral health needs that children come in with,” Crosby Budinger said.
Lacking time to handle one-on-one sessions with patients and families who have concerns, pediatricians have to give referrals to behavioral health professionals.
“That’s a challenge because everywhere you go now there’s a waiting list,” Rao said. “You can’t get them into therapy as soon as you prescribe it, so then, there is a time gap and the treatment is delayed for those kids.”
Even if the patient makes it through a waitlist, there are other challenges to face with starting treatment somewhere else.
“The parents have to take the kid to some other place, and the kid has to get acclimatized with the new environment,” Rao said.
With a social work intern in house, these issues “were all taken out of the picture,” which isn’t only beneficial to parents, she said.
“It’s like a huge burden lifted off of me, too,” Rao said. “I’m in this business because I care about kids. I want them to thrive, and I want them to get to their best potential.”
A year-round problem
Bronnsen’s annual check-up happened to be in January, but had the appointment been scheduled during the summer, the process would have looked different for the Churchey family.
Because the interns are students, the program only runs from August to May, leaving providers on their own for at least two months during summer break.
“We wish it was year-round,” Rao said. “It is only during the school year, but mental health disorders are there all year-round.”
Wehberg tried filling the missing months by partnering with a local counseling service, but it just wasn’t the same, she said. Now, during the summer, Gateway goes back to its old referral process.
Furthermore, because the interns juggle attending class and working in the office, interns are not available all days of the week, which can cause scheduling issues for busy working families.
“They have him (DeCastro) on a kind of odd schedule compared to the doctors and nurses, so that was a little difficult with scheduling,” Churchey said. “It was very hard for me to be able to be at every appointment.”
The six-session cap can also cause parents to worry about having to go through the referral process they thought they had avoided.
“I would have no idea where to start or what to do,” Churchey said.
It can also be daunting for a child to switch from one counselor to another.
“I was concerned about it before the switch, just because our son liked him (DeCastro) so much,” Churchey said.
But even after the sessions were over, DeCastro helped to coordinate Bronnson’s move to Pediatric Movement Center, the pediatric therapy clinic and sensory gym he thought would be the best fit for the boy moving forward.
Hoping to expand
The leaders of the internship program would like to expand it, Crosby Budinger said.
She’d like to offer positions to students at University of Maryland Eastern Shore and open the program to students pursuing careers as licensed clinical professional counselors, but the program’s funding is limited.
“Unfortunately, the folks who have the power to make decisions about how funding is used don’t always see the value in programs like this,” Crosby Budinger said. “But in the long term, it will really benefit individuals, and it will benefit our community and society as a whole if we’re addressing the needs of the whole person.”
The program not only provides needed services, but it also contributes to developing the social worker workforce.
Since its inception, 114 BHIPP interns have graduated from the program, Crosby Budinger said. Simpson said the program provides great on-the-job training.
“Being able to figure out how to work interdisciplinary before you’re actually entering your professional world, your professional life, is something that a lot of other MSW (master’s of social work) interns aren’t really getting that opportunity to do,” Simpson said.
Social work in a medical setting has become a more viable career path for the interns, Simpson said.
“It’s definitely something that I would like to pursue, something that I wasn’t aware was a thing until my introduction to BHIPP,” Simpson said.
In the meantime, current interns like Simpson and DeCastro are leaving an impact on Maryland youngsters.
“My son really enjoyed Mr. Miguel,” Churchey said in April. “He actually still talks about him, and he’s been released now for probably like a month.”