Today's devastating school shooting at Annunciation Catholic School in Minneapolis has deeply shaken communities and hearts nationwide. We at Blackbird Health want to acknowledge how this tragic event may be impacting all of us—both professionally and...
Managing and Referring Pediatric Mental Health
Read time: 3 minutes
As pediatricians, you are uniquely positioned to support children’s mental and behavioral health needs. By establishing clear treatment protocols and building strong referral partnerships with mental health specialists, like Blackbird Health, you can provide comprehensive care while maintaining your central role with families—with access to same-week scheduling, direct provider communication, and ongoing consultation support.
In this article, you will learn:
- How to define your mental health treatment scope based on training and comfort level
- How to build strategic partnerships with mental health providers
- Communication strategies for explaining treatment boundaries to families
“Pediatricians are now managing conditions that extend beyond traditional pediatric training while striving to maintain the highest standards of care.”
This guide provides a framework for managing pediatric mental health concerns in partnership with specialists, focusing on sustainable and strategic approaches to care.
How pediatric mental health presentations have changed
Recent epidemiological data indicate that approximately 1 in 5 children aged 3-17 experience a diagnosable mental, emotional, or behavioral disorder, yet fewer than 20% access specialized care. Pediatric mental health presentations of anxiety, depression, and ADHD have become top concerns for pediatricians and families. These cases often involve comorbidities, greater severity, and earlier onset than in previous years. There has also been an increase in acute crises such as suicidal thoughts and self-harm, as well as more frequent repeat visits for mental health emergencies.
As pediatricians, you are now regularly managing:
- Increase in ADHD and anxiety/mood disorders
- More severe presentations (school refusal, agoraphobia)
- Complex medication management needs
- Suicidal ideation in younger children
- Cannabis-related psychotic episodes
- Self-harm behaviors
- Eating disorders
Since ADHD and anxiety/mood disorders represent the majority of pediatric mental health cases, these conditions warrant your primary focus for:
- Building your expertise: Develop diagnostic and treatment skills for ADHD and anxiety/mood disorders, including understanding gender-specific presentations
- Creating protocols: Establish evidence-based procedures for screening, assessment, initial management, and referral criteria
- Fostering collaboration: Create referral networks with specialists and maintain clear communication pathways for continuity of care
How pediatricians may define their treatment scope
Defining a clear treatment scope is essential to provide safe, effective, and patient-centered care, especially when addressing mental health concerns. Here’s how you may approach this:
1. Assess training and comfort level
Start by honestly evaluating your own training, experience, and comfort in diagnosing and managing specific mental health conditions. For example, you may feel confident managing mild to moderate ADHD or anxiety but less so with complex mood disorders or cases involving suicidality.
2. Define clear boundaries
Set boundaries based on your expertise and available resources. This means defining which conditions and levels of severity you will manage within your practice and which situations will prompt a referral to a mental health specialist. For instance, you might decide to manage straightforward ADHD cases but refer out for complex cases, treatment resistance, or diagnostic uncertainty.
3. Develop protocols and decision trees
Having protocols or decision trees in place helps to quickly determine when a mental or behavioral health case is within your scope and when it exceeds your boundaries. Download "Recommended Protocols: Pediatric Mental Health Treatment Boundaries" and keep it handy in your office for easy reference for your team. 
-
Identify common scenarios: Start by listing frequent clinical situations or presenting complaints in your practice (e.g., screening and early detection, anxiety/depression, ADHD, behavioral and developmental issues).
-
Define red flags and boundaries: Clearly outline symptoms or findings that require immediate referral or specialist input (e.g., suicidal ideation, psychosis, severe functional impairment, advanced pharmacological management).
-
Map out inflection points: Create a flowchart or tree diagram that guides you through a series of yes/no or if/then questions, leading to appropriate actions (e.g., treat, observe, refer).
-
Set timeframes for reassessment: Include guidance on when to reassess your patient if symptoms persist or worsen.
- Differentiate routine vs. urgent referrals: Specify criteria for when a referral should be made urgently (and followed up on) versus when it can be routine, based on the severity and risk factors present.
4. Build integrated care partnerships
Establish referral partnerships with mental health specialists like Blackbird Health to ensure integrated care for patients who need more specialized care. These relationships also allow for shared care and consultation, which can expand your effective scope over time.
When building these partnerships, identify specialists who:
- Share your treatment philosophy
- Cover a broad range of expertise (psychiatry, psychology, OT, ASD, ADHD, SLT, etc.)
- Communicate effectively with families
- Provide timely access to care
- Support co-management rather than complete handoffs
- Offer consultation on cases you continue to manage
5. Communicate scope to patients and families
Being transparent with families about what you can manage and when a referral is needed helps set expectations and builds trust. This also reassures families that their child will receive the most appropriate care, whether within the pediatric practice or through a specialist.
Create a collection of helpful materials to share with families who may be on the fence about seeking additional professional help, such as this blog post “When and how to seek mental health for my child" or this downloadable printout.
By defining your scope based on training, resources, and clear protocols (and by building strong referral networks) you can confidently provide comprehensive care while ensuring that complex or severe mental health cases receive the specialized attention they require. This approach supports both patient safety and high-quality, integrated care. Establishing clear protocols and strong referral partnerships allows you to provide comprehensive care without burnout.
Building mental health partnerships that support your quality of care
By partnering with a specialist who can examine all factors that contribute to each child’s neurodiversity, you can be a part of a care team treating the whole child. While pediatricians are becoming increasingly comfortable diagnosing and distributing medication for ADHD, the patient most likely has additional mental, behavioral, and developmental concerns to address—this is where a specialist comes in.
"60% of children with ADHD have co-occurring mental, behavioral, and developmental disorders that impact the course of treatment."
Providing timely access to mental health care
It’s crucial to find referral partners that commit to timely access for patient treatment. As we know, the wait times for families to be seen by pediatric mental health specialists can be devastating to a child’s development.
The impact on the child: Waiting periods of 12 to 36 months for autism evaluations and 3-6 months for general therapy prevent children from receiving critical early interventions during a crucial period of brain plasticity.
The impact on your practice: While families wait, you become the primary support system, often seeing patients more frequently than planned and managing conditions beyond your intended scope.
"The urgency of early intervention is underscored by suicide now ranking as the second leading cause of death in youth aged 10-14, highlighting the critical role pediatricians play in early identification and intervention."
How Blackbird Health participates in care
What I love about our model at Blackbird Health is that if I have a patient I see in a session today and they are struggling, I have the ability to go to that therapist's schedule, see where they're empty, and say, "I really need you to see this patient tomorrow." This integrated care approach ensures continuity while providing specialized expertise when you need it most.
At Blackbird Health, strong collaborative care means:
- Scheduling patients within 7 days of contact
- Same-week autism evaluations when needed
- Direct provider-to-provider communication
- Shared scheduling systems for urgent cases
- Consultation support for cases you continue to manage
- Clinical progress updates and discharge summaries sent directly to your chart
- Monthly summaries showing treatment status and progress
Pediatricians remain the cornerstone of care
Will partnerships replace your role with patients? Absolutely not. The research confirms that primary-care physicians provide a good home for children's mental health conditions. Strategic partnerships enhance your ability to provide excellent care, they don't replace your central relationship with families.
Pediatricians remain the cornerstone of the family's care. Any issues that arise, families are going to go back to the pediatrician who knows them so well. The relationship you maintain with families positions you perfectly to coordinate care, monitor progress, and ensure continuity across all aspects of a child's health, including mental health.
