Behavioral Health - Key Activity 16C


Manage Treatment of Adolescents’ Behavioral Health Needs in Integrated Person-Centered Ways


This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; behavioral health integration.


This activity provides general recommendations on the treatment of adolescents’ behavioral health needs in integrated and person-centered ways. As with adults, evidence-based care practices include the following (singularly or in combination):

  • Psychopharmacology, including referring out or leveraging same-day consults with child psychiatrists (described below), when needed.
  • Behavioral health interventions, such as motivational interviewing, acceptance and commitment therapy, problem-solving therapy for primary care (PST-PC), cognitive behavioral therapy (CBT), interpersonal counseling, behavioral activation, dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT).
  • Peer support.

For additional information regarding behavioral treatment in general, refer to Key Activity 12B: Embed Evidence-Based Care Practices. The provision of these services differs for adolescents, as it is ideally provided by clinicians who have training, experience and comfort in responding to the behavioral health needs of adolescents.

Model recommendations for treatment that resonate with youth include:

  • Involving youth as partners in project design.
  • Implementing and monitoring recommendations made by youth.
  • Considering the ways that a fundamental understanding and respect for youth can be incorporated into ongoing inreach and outreach efforts.

Confidentiality and adolescent care

Youth list concerns about confidentiality as the number one reason they might forgo medical care. For this reason, youth need assurances of privacy and confidentiality from their healthcare providers. However, many providers feel overwhelmed or in the dark about the myriad of laws governing confidentiality and their responsibilities in minor consent laws and reporting child abuse. It is beyond the scope of this activity to include all relevant details, but it is encouraged that teams take advantage of such resources as Understanding Confidentiality and Minor Consent in California: An Adolescent Provider Toolkit and Teen Health Law’s charts on California Minor Consent and Confidentiality Laws to familiarize themselves with when minors may consent and when parents may – or must – be informed. Given that parents’ rights to access adolescent medical records depend upon the health service provided, who consented or could have consented for the service, and the service provision site, in most cases, parents will have a right to access their child’s records. However, in some cases, parents cannot access records until their teen provides them with written authorization.

Teams need to consider what processes and workflows are necessary to maintain confidential records in the EHR setting. This includes training staff to know how to document in a manner that maintains adolescent confidentiality. In addition, they should provide education about parental access to medical record information to adolescents and their families. As communication, such as texting and portal communication (e.g., emailing) become more ubiquitous, teams must consider alternative mechanisms by which to communicate with adolescents about the elements of their medical record that they want to be kept confidential.

Implementation tips

As patients need a greater level of psychiatric care than can be provided in the health center setting, practices should refer and connect them with county-level services. The mental health plan (MHP) in each county is responsible for providing or arranging for the provision of specialty mental health services (SMHS) to Medi-Cal beneficiaries in their county. SMHS are meant to support a beneficiary when the impact of their condition is severe enough for them to require the services of a specialist, as opposed to a generalist, in the field of mental health. The health center team continues to provide integrated care with an emphasis on care coordination rather than treatment provision. As an individual’s severity of mental health needs wax and wane, the health center could again be the provider of behavioral health treatment and support. behavioral health treatment and support.

Many practices are not able to employ staff who have training and experience in working with adolescents. To address the dual pressures of the behavioral health workforce shortage and increasing rates of childhood mental health conditions, 37 states and the District of Columbia staff psychiatric consultation lines that offer free same-day telephone consultation with child psychiatrists.[1] In California, this resource has been offered since 2019 by the UCSF Benoit Children’s Hospital through the UCSF Child & Adolescent Psychiatry Portal (CAPP). CAPP provides telephone consultation for pediatric primary care providers (PCPs) to help them manage common mental health conditions in their patients.

In addition, CAPP offers continuing medical education (CME) for PCPs, website resources for PCPs and patients and families, and direct virtual psychological consultation for families, and it aids with care coordination for families having difficulty accessing needed mental health resources.

DHCS’s new behavioral health virtual services platform launched for public consumption in January 2024 and offers technology-enabled behavioral health tools and services focused on adolescents and young adults: BrightLife Kids for parents and caregivers, young children, and adolescents and Soluna for teens and young adults.

In addition to knowing that such a service is available, integrated teams should consider familiarizing themselves with how to access such resources (e.g., typical wait times for connecting, conditions best suited for referral, etc.). In addition, teams can consider how to incorporate consultancy notes from the psychiatric consultation lines into the clinic records, including who has visibility.

Evidence base for this activity

Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. practice preparation, identification, assessment, and initial management. Pediatrics [Internet]. 2018 Feb 26;141(3):1–21. Available from:


  1. Sullivan, K, George, S. & Horowitz, K. (2021) Addressing National Workforce Shortages by Funding Child Psychiatry Access Programs. Pediatrics January 2021; 147 (1). https://e20194012. 10.1542/peds.2019-4012