Opportunities to Strengthen Implementation of the Medicaid Behavioral Health Home Model for Children with Serious Emotional Disturbance: A Systematic Review.

BACKGROUND: Children and adolescents with Serious Emotional Disturbance (SED) comprise 7-12% of the total U.S. youth population. Untreated, they risk negative outcomes such as school dropout, juvenile justice involvement, frequent hospitalization, and long-term residential placement. Integrated care approaches, like Medicaid's Behavioral Health Home (BHH), are considered effective for coordinating care and improving outcomes among adults, but less evidence is available for youth. OBJECTIVES: Using the Consolidated Framework for Implementation Research (CFIR), identify and synthesize literature on barriers and facilitators influencing implementation of Medicaid BHHs for children with SED. METHODS: Following PRISMA guidelines, three electronic databases and relevant reference lists were searched for U.S. primary research articles published from 2010 to 2026. Inclusion criteria included documented barriers and facilitators to BHH implementation for children with SED. States with Medicaid BHHs serving youth were identified, and relevant grey literature was included if it met the inclusion criteria. RESULTS: Of the 4,700 references that were imported into Ryyan software for screening, 1,529 were duplicates. Following review of the remaining 3,171 titles and abstracts, 3144 were excluded for being unrelated to the Medicaid BHH intervention, focusing on adult care, or having non-empirical designs. The remaining twenty-seven full-text studies were assessed by two independent reviewers. All 27 articles were excluded because they did not meet the inclusion criteria, including ineligible intervention (not a Medicaid BHH intervention), ineligible population, ineligible publication type, or ineligible outcome. Consequently, no studies were included in the review. Data extraction and deductive coding according to the CFIR were not possible. CONCLUSION: Despite the widespread use of BHHs, no studies were found describing the unique factors affecting implementation for children with SED. Insights may be drawn from related models, adult BHHs and evidence based parenting programs. Future research should explore specific barriers and facilitators for children's BHH implementation. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42025645796.