A Los Angeles children's hospital is meeting demand for pediatric mental health care with a workforce most families do not think of first: more than 100 medical and psychiatric social workers providing coverage around the clock.
Sandy Himmelrich, a licensed clinical social worker who serves as executive director of clinical support and care coordination and co-director of the Behavioral Health Institute at Children's Hospital Los Angeles, oversees a team spanning virtually all inpatient and outpatient settings. She points to rising demand driven by cost-of-living pressure, caregiver burnout, health care insecurity and communication challenges between families and providers, and argues that medical social workers have long been doing behavioral health work without being counted as behavioral health practitioners.
This is an institutional account rather than a peer-reviewed outcomes study, and that framing should stay attached to it. The hospital has described its staffing model and its rationale. It has not published data demonstrating that the model produces better patient outcomes than alternatives.
The Shortage the Model Is Built Around
The staffing choice is not primarily a philosophical preference. It is arithmetic.
Child and adolescent psychiatry is among the most persistently understaffed specialties in American medicine. Training requires medical school, a general psychiatry residency and an additional subspecialty fellowship, which means the pipeline responds to shortages over roughly a decade rather than a year. Large portions of the country have no practicing child and adolescent psychiatrist at all, and waits measured in months are common even in major metropolitan areas. Demand has moved in the opposite direction, with pediatric anxiety, depression and suicidal ideation presenting to emergency departments at rates that have not returned to earlier baselines.
No individual hospital can recruit its way out of that. What a hospital can do is redesign who performs which tasks, reserving psychiatrist time for medication management and diagnostic complexity while licensed clinical social workers, psychologists and psychiatric nurse practitioners carry assessment, therapy, crisis response, safety planning and care coordination.
The institute describes psychiatrists, psychologists and social workers working with medically ill hospitalized patients, alongside developmental-behavioral pediatrics and newborn follow-up programs that embed the same disciplines in other departments.
Integrated Behavioral Health Means Care Comes to the Patient
The term appears constantly in health system communications and is rarely explained.
In a traditional model, a pediatrician who identifies a mental health concern refers the family elsewhere. The family then finds a provider, checks insurance, joins a waitlist, and starts over with a new clinician. Attrition at each step is substantial, and many referrals never result in a first appointment.
Integrated behavioral health places behavioral health clinicians inside the medical setting where the child is already being seen. A warm handoff during an existing visit replaces a referral slip. At CHLA, clinical social workers are embedded in the psychiatry consultation-liaison service and many other medical teams, which means a child admitted for a chronic illness or a surgical recovery is seen without leaving the unit.
Around-the-clock coverage matters specifically for emergency departments and inpatient units, where crises do not respect clinic hours. Children presenting in psychiatric crisis frequently board in emergency departments awaiting placement, and staffing that can assess and stabilize on site is one lever institutions have.
Social workers in this role also handle the practical layer that determines whether a treatment plan survives discharge: insurance authorization, school coordination, housing and food resources, transportation and connection to community services.
What This Model Does and Does Not Substitute For
Precision here protects families from a misunderstanding that could matter.
The hospital's clinical social work team is not uniform. It includes master's-level and licensed providers as well as bachelor-level caseworkers, and CHLA notes that some, not all, are trained to provide psychotherapy. Licensed clinical social workers are trained and licensed to conduct diagnostic assessment, perform risk assessment and deliver evidence-based treatments including cognitive behavioral therapy, and in most states they practice independently within their scope. A caseworker coordinating resources is doing different and also necessary work.
None of them prescribe medication. A child who needs a psychiatric medication started, adjusted or monitored requires a psychiatrist, a psychiatric nurse practitioner, or in some cases a pediatrician working within their training. A model built on social workers extends access to assessment, therapy and coordination; it does not eliminate the need for prescriber capacity.
Families should understand which clinician is responsible for which part of a plan, and should ask directly who will manage medication and how often that person will reassess. Continuity matters too, since a plan that depends on a rotating roster of clinicians is harder for a child to engage with.
Steps for Families Facing a Wait
Practical options exist between doing nothing and securing a specialist appointment.
Start with the pediatrician. Many pediatric practices now screen for depression and anxiety and can begin treatment or refer within an integrated system, which is faster than an independent search. Ask specifically whether the practice has embedded behavioral health.
School-based services are frequently underused. School counselors, psychologists and social workers can provide support and initiate evaluations, and a child with a mental health condition affecting learning may qualify for accommodations under a 504 plan or an individualized education program.
For insurance barriers, federal parity law generally requires comparable coverage for mental health and medical care, and denials can be appealed. Community mental health centers, federally qualified health centers and university training clinics often offer sliding-scale care with shorter waits than private practices.
In a crisis, the 988 Suicide and Crisis Lifeline provides call, text, and chat support around the clock. A child expressing thoughts of suicide, or showing a sudden severe change in behavior, needs urgent evaluation rather than a waitlist. This is a difficult topic, and families do not have to navigate it alone.
MedicalDaily will continue reporting on pediatric behavioral health capacity and access.
Frequently Asked Questions
What is the staffing model? More than 100 medical and psychiatric social workers providing 24-hour coverage across virtually all inpatient and outpatient settings at Children's Hospital Los Angeles.
Is this backed by outcomes research? Not as presented. This is an institutional account of a care model, not a peer-reviewed study of results.
Why rely on social workers? Child and adolescent psychiatry has a long-standing national shortage, and the training pipeline takes about a decade to respond.
Are all of them licensed therapists? No. The team includes master's-level and licensed providers alongside bachelor-level caseworkers, and only some are trained to provide psychotherapy.
Can social workers prescribe medication? No. Medication requires a psychiatrist, psychiatric nurse practitioner or a pediatrician working within their training.
What is integrated behavioral health? Placing behavioral health clinicians inside the medical setting so care happens during an existing visit rather than through an outside referral.
Where do I turn in a crisis? The 988 Suicide and Crisis Lifeline offers call, text and chat support at any hour.
