Why wait: Co-locating pediatrics and mental health to facilitate access to resources and care for marginalized youth

Mental health disorders among youth are rising, yet the majority—especially those from historically marginalized backgrounds—remain underserved due to systemic barriers such as high treatment costs, limited access, and long waitlists. Barriers contribute to disengagement, mistrust, and early termination of care. Pediatric primary care settings offer a promising platform for elevating trust and engaging youth in universal, targeted, and intensive mental health care. This paper describes the development, implementation, and early outcomes of the Wellness program, a co-located behavioral health initiative at a large pediatric hospital designed to increase access to mental health services through early education, identification, timely intervention, and coordination to specialty care. At the universal prevention level, 136 primary care physicians were trained to recognize and respond to youth mental health needs, resulting in a high volume of referrals (∼600) and timely consultations—70% of which were scheduled within seven business days. At the targeted level, 826 follow-up sessions of brief intervention were provided to youth for a range of social, emotional, and behavioral needs. Despite high attrition rates commonly reported among underserved populations, the program maintained a relatively low no-show rate of 19%. At the intensive tier, a personalized approach facilitated rapid referrals and provided interim support for families awaiting long-term services—addressing the critical “in-between” period that often undermines sustained engagement. Preliminary findings suggest that developing a prevention-oriented, equity-driven, rapidly accessible mental health program in primary care can strengthen early intervention and foster engagement among underserved youth. Lessons learned highlight the importance of flexible delivery models, interdisciplinary collaboration, and robust evaluation infrastructures to ensure sustainability and impact.