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One-of-a-Kind Neurobehavioral Continuum of Care Meets Growing Needs
Key Takeaways
The Neurobehavioral Continuum of Care at Cincinnati Children’s offers the entire spectrum of treatment for children with neurodevelopmental disorders, who often can’t find the specialized care they need.
An integrated treatment team, over 10 neurodevelopmental psychiatrists on staff and a dedicated space make the Neurobehavioral Continuum of Care one-of-a-kind, serving as an example for other health systems.
Cincinnati Children’s continues to expand its neurobehavioral continuum of care offerings. Two new programs began in 2024—the Neurobehavioral Partial Hospitalization Program (NB PHP) and Severe Behavior Intensive Treatment (SBIT).
The Neurobehavioral Continuum of Care within the Division of Child and Adolescent Psychiatry at Cincinnati Children’s is truly a one-of-a-kind treatment approach in the U.S. In fact, health systems from around the world regularly consult the program’s medical director, Martine Lamy, MD, PhD, to see how they can create programs to support youth with the full spectrum of neurodevelopmental disorders.
“What makes us unique is we have every level of care available to families affected by neurodevelopmental disorders,” says Lamy. “We also serve the full continuum of kids with neurodevelopmental disorders. We design multidisciplinary treatment programs that are specific for these children and work to improve access, so they can get this evidence-based care when they need it.”
One Dedicated Initiative, Many Specialized Care Options
In many health systems, behavioral and mental health care for patients with neurodevelopmental disorders—including autism spectrum disorders, intellectual disability, and genetic disorders, such as Fragile X Syndrome or Angelman Syndrome—is either fragmented or doesn’t exist. When a child has multiple medical and psychiatric needs, and a different provider and location for each one, families often struggle to navigate care. Additionally, children with the highest levels of need often get turned away from therapy services—either because their disability is too severe, or their behaviors are too challenging for them to receive care safely.
“A program may say, for example, ‘Your teenage child is still in diapers and uses a communication device, so we can’t have them in this treatment program if they aren’t toilet trained or don’t talk,’” says Lamy. “But we say, ‘Don’t worry. We actually have a program designed just for them, and we don’t expect our patients to be independently toilet trained or to communicate verbally to access therapy.’”
The neurobehavioral continuum of care has six levels, including specialized care management for families with significant psychosocial barriers to accessing healthcare across the entire continuum (Figure 1). Each level of care focuses on:
A dynamic, individualized positive behavior support plan with embedded emotion regulation, behavior, communication and occupational therapy supports
Targeted psychopharmacology
Integration of pediatric medical and mental health care
Transfer of management skills to caregivers, school teams, outpatient therapists and in-home staff for long-term stabilization
Figure 1: All six levels in the neurobehavioral continuum of care offer specialized treatment for a child—no matter where they are on the care continuum.
Staff and Space to Serve Those with Neurodevelopmental Disorders
Very few health systems in the U.S. offer the entire psychiatric continuum of care for youth with neurodevelopmental disorders, let alone one with an integrated treatment team that stays involved in a patient’s care no matter where they are along the continuum. At Cincinnati Children’s College Hill Campus, the newly constructed William Schubert, MD, Mental Health Center has helped with the continuum’s development and expansion.
A dedicated outpatient clinic for children and young adults with neurodevelopmental disorders includes spaces designed for psychiatric treatment, medical subspecialties and different kinds of therapy. And although the continuum lives within the Child and Adolescent Psychiatry division at Cincinnati Children’s, it’s heavily integrated with the divisions of Developmental and Behavioral Pediatrics and Behavioral Medicine and Clinical Psychology. When a family comes for care, they have every specialist they need in one place—psychiatrists, psychologists, neurologists, geneticists, speech therapists, occupational therapists and others.
Cincinnati Children’s neurobehavioral continuum of care benefits from having 11 neurodevelopmental psychiatrists and six specialized psychiatric nurse practitioners who support the full care continuum. These providers focus on neurodevelopmental psychiatry all day every day. They’re training others to work with this patient population, too. For example, triple board residents, child psychiatry fellows and neurology fellows see patients in specialized training clinics and have clinical experiences across the care continuum embedded into their training.
“We try to be a training site for all types of medical and mental health professionals who might work with this patient population to provide clinical experience with patients who might display more challenging behaviors,” says Lamy. “This can include nursing students, allied health students, counseling students and more. We provide opportunities to work with these patients and families that will improve care wherever these providers go in the future.”
Cincinnati Children’s, the largest inpatient pediatric mental health provider in the country, opened a new 160,000 sq. ft. William K. Schubert, M.D. Mental Health Center at its College Hill Campus in 2023.
Photography by Ryan Kurtz.
Continued Expansion and Improved Outcomes
In January 2024, the Neurobehavioral Continuum of Care added two new programs that have been in the works since 2018:
Neurobehavioral Partial Hospitalization Program (NB PHP): A day program that’s structured like school. It focuses on helping kids who have mild intellectual disability and emotion dysregulation. By working on academic and social skills, and teaching parents and caregivers how to support their child’s needs, NB PHP helps many kids return to the school setting.
Severe Behavior Intensive Treatment (SBIT): A program focused on kids with more significant intellectual disabilities and severe progression or self-injury. Participants receive very intensive, one-on-one applied behavioral treatment every day, three hours a day, for about 6 weeks, plus less frequent follow-up appointments. The goal is to stabilize severe and challenging behaviors and teach parents and caregivers how to do the same.
We have a responsibility to make sure all children with neurodevelopmental disorders get the best possible evidence-based, multidisciplinary care throughout their childhood. It’s not just supporting their mental and behavioral health needs but addressing all other aspects related to their health, so they can have the most successful childhood experience.
Martine Lamy, MD, PhD
“What we’ve seen from both programs is that not only do we have improved outcomes, but kids are going back to school, which is huge,” says Lamy. “They’re also not coming back to the emergency department in crisis as frequently. These two new programs have been treating patients for only about 10 months, but the outcomes we’ve seen so far are really incredible.”
As the continuum keeps growing, the team is happy to share its success with others looking to do something similar.
“We have a responsibility to make sure all children with neurodevelopmental disorders get the best possible evidence-based, multidisciplinary care throughout their childhood,” says Lamy. “It’s not just supporting their mental and behavioral health needs but addressing all other aspects related to their health, so they can have the most successful childhood experience.”
