Re-engineering Behavioral Healthcare at UH Rainbow for Better Outcomes

Innovations in Pediatrics| Winter 2026

Everyone wants better outcomes for children and teens facing behavioral health challenges – enhanced access to care, quicker follow-up appointments, improved quality of life for patients. The question is how best to achieve these goals.

Mary Gabriel, MD

The behavioral health team at UH Rainbow Babies & Children’s is testing a promising new approach to address these concerns, with a focus on innovative thinking. As part of the Ohio Department of Medicaid’s Outcomes Acceleration for Kids (OAK) Learning Network comprising the state’s six children’s hospitals, the UH Rainbow team is focusing on improving follow-up after emergency department visits for mental health or substance use concerns. Other OAK priorities include improving transcranial ultrasound screening for sickle cell disease, boosting use of asthma controller medication and increasing well-child visits and preventive care.

With the behavioral health aspect of the OAK project, the goal is for any child or teen who presents to the ED with a mental health issue – and is discharged from the ED because there is no safety concern – to have a follow-up appointment within seven days of discharge.

That short time window really matters, says UH Rainbow child and adolescent psychiatrist Mary Gabriel, MD, a former pediatrician and Senior Director of Behavioral Health in the UH Primary Care Institute.

“There is strong evidence in the literature that meeting these metrics will help improve outcomes for kids with behavioral health problems,” she says. “Evidence shows that children who are seen within seven days are less likely to return to the ED or be hospitalized within the next five days. They also had higher rates of engaging in subsequent mental health care than those with 30-day follow-up.  We also know that outpatient crisis intervention services within seven days of discharge from the ED are just as good at preventing suicide attempts and repeat ED visits as inpatient hospitalization for adolescents with moderate suicidal thoughts.”

“From an inpatient perspective, first week after a crisis can be unpredictable,” Dr. Gabriel adds.  “Kids leaving psychiatric hospitals have a 56% lower risk of suicide over the next six months if they see a mental health provider within seven days. The situation is similar for seven-day follow-up for kids in the ED who are discharged with substance use diagnoses.”

How is the UH Rainbow team putting this into practice? Dr. Gabriel says they’ve deconstructed and studied each aspect of the ED behavioral health patient journey, looking to shorten follow-up time.

“Using a quality improvement approach, we perform PDSA cycles: Plan, Do, Study, Act,” she says. “We identify one thing we could change, implement that change, study it, take our learnings from that and then iteratively improve. Through these cycles, we get closer to our goal.”

“Here at UH Rainbow, we decided that we really needed an ED-based care coordinator to help patients with navigating the mental health care system.,” Dr. Gabriel adds. “The coordinator engages with patients while they are still in the ED. If they are deemed dischargeable, she will then work with them before they leave to schedule a follow-up appointment, whether that is within our system or with community partners. The goal is to make sure they are followed and seen within that week. We've also helped to train the pediatricians to do some of these follow-up visits.”

Another innovative solution is a Collaborative Care Model between UH behavioral health and primary care, which was first piloted for pediatric patients in 2017. Under this model, behavioral health patients are managed by a primary care practice’s behavioral health coordinator over a relatively short period, typically three to six months. That person is a licensed, clinical mental health provider, whether through a counseling degree or a social work degree with further training in behavioral mental health counseling and therapy.

“They engage in various ways,” Dr. Gabriel says. “They provide direct psychotherapeutic interventions and behavioral health coordination.”

Along the way, the behavioral health coordinator meets weekly with a UH psychiatrist to discuss the patients in the caseload. They also consult with the psychiatrist assigned to see whether the patient could benefit from any sort of psychopharmacology or medication added to their treatment plan, in addition to whatever therapy interventions the behavioral health coordinator is going to perform.

With all these efforts to shorten follow-up time from an ED visit, is it working?

“Early evidence shows that we are improving,” Dr. Gabriel says.  “We are tracking our rates of follow-up scheduling and completed appointments, and yes, we’re making progress.“

It’s a welcome development -- one they’re sharing with their Ohio children’s hospital colleagues.

“For our system, there is very good follow-up, which is so crucial for our patients,” Dr. Gabriel says.

Contributing Expert:
Mary Gabriel, MD
Child Psychiatry
UH Rainbow Babies & Children's Hospital
Senior Director, Behavioral Health
UH Primary Health Institute
Associate Professor of Psychiatry
Case Western Reserve University School of Medicine