Emily Duffy, a licensed social worker, was walking down the hall of her North Philadelphia clinic last month when she heard crying in Exam Room 3. She opened the door and met Patricia Stone, 26, and her children ages 5, 3, and 2.

What happened next illustrates a paradigm shift in mental health care - seamlessly integrating what is known as behavioral health into a primary practice - that is gaining traction nationwide.

While the children underwent routine physicals, Duffy learned that the 3-year-old's father had died violently three weeks earlier.

"She may have a delayed reaction," she explained to Stone, after drawing one of the children onto her lap while blood was drawn.

Duffy, a behavioral health consultant at 11th Street Family Health Services of Drexel University, described how toddlers grieve. It was important, she said, that Stone provide consistency and keep the father's memory alive. She gave the young mother a three-page handout.

The effort is part of a national movement to embed a form of mental health in primary care. The idea is to give simple interventions in 15- to 30-minute visits that will address behavioral issues ranging from stress to traumatic reactions that often go untreated.

Insurers, however, have been slow to pay even for brief visits, so the model is catching on mostly in settings where the same entity provides insurance and medical care: Kaiser Permanente in Northern California, federally funded health centers such as 11th Street, and Veterans Affairs medical centers.

"Over the last decade," said Lt. Col. Les' Melnyk, a spokesman for the Department of Defense, offering behavioral health alongside primary care has been a "growing movement across the country and in a variety of health delivery services." The Pentagon has adopted varying approaches in the Army, Navy, and Air Force. Private foundations have launched projects in several states.

Mental health traditionally has been considered a specialist level of care, and often requires a referral. Yet huge numbers of people go to their doctor for problems that have a behavioral component: headache, fatigue, even diabetes that is out of control because stress has gotten in the way of refilling a script.

Some have a serious problem but don't want to see a specialist; more antidepressants are prescribed by primary doctors than by psychiatrists. Others have less significant behavioral issues, such as difficulty getting to sleep, that may not warrant referral to a specialist.

In most places, overtaxed primary-care providers deal with it all as best as they can.

Not at 11th Street. While Duffy, the pediatric behavioral health consultant, was talking with the young family, Rebecca Vlam, her counterpart for adults, was seeing diabetics who had come in for eye exams.

One patient was having trouble controlling her blood pressure because she wasn't taking her meds; the side effects scared her. They talked about her fears, and what kind of support she needed to set them aside.

"I ask different questions," Vlam said.

As an integral member of the team, Vlam immediately consults with Gail Partridge, the nurse practitioner in charge of the diabetes program. Two years into the partnership, Partridge loves it.

The people served by the clinic, largely on Medicaid or uninsured, are living on the edge, facing traumas almost daily. Their stories tumble out on the exam table.

"In the past, we didn't want to go there because it could open up a can of worms," Partridge said. She didn't have the necessary expertise, referrals for therapy could take months, and most patients wouldn't go anyway.

Now Vlam comes over for a brief conversation, trying to catch a potentially serious problem before it develops.

People with serious mental health issues are still referred for traditional therapy. But most are handled in a few follow-up visits, never with an appointment; patients often call in from their cell phones to talk.

That is also part of the reason the new model has been slow to grow. Many of the interventions, for example, do not involve the traditional psychiatric diagnoses that are used to bill insurance companies for reimbursement. The clinic absorbs the cost for those sessions.

Research shows that integrated care saves society money in the long run by, among other things, reducing emergency room visits.

"The whole question is who is saving the money," said Neftali Serrano, a primary-care psychologist in Madison, Wis., who trained behavioral health consultants at several local clinics as part of a Health Federation of Philadelphia initiative.

Research on effectiveness has been limited, partly because definitions vary: "Integration" can range from simply offering behavioral services at the same primary-care location to the team approach practiced at 11th Street, where Duffy and Vlam may see patients alone or alongside the nurse practitioner, or at a serendipitous meeting in the corridor.

The impact on depression, which has been studied the most, appears to be similar to traditional therapy - but integrated care reaches far more people.

That has ripple effects for the growing population with chronic illnesses, especially in low-income communities.

"If you are depressed, you are not as able to do the things that manage these illnesses: good diet, exercise, taking medication to manage the illness," said Hyong Un, the Blue Bell-based national medical director for behavioral health at Aetna, whose foundation is aiding the integration at six health centers in Philadelphia.

Entwining services can have a large impact. "If I can do something that's timely or focused that helps you quit smoking, then I've done something more for your health than anybody else can do for you," said Alexander Blount, director of behavioral science in the family medicine department at the University of Massachusetts Medical School.

Suzanne Daub first tried to introduce mental health services in Delaware Valley Community Health's two primary-care centers in North Philadelphia by making appointments for in-house psychotherapy. Half were no-shows.

Many people "can't tolerate the emotions that come up," Daub said. "There are cultural or language barriers and economic barriers."

Over the last four years, she has integrated behavioral health. The same staff, retrained, sees three times as many patients.

"It's been really quite extraordinary," said Daub, the clinics' director of behavioral health, who still does psychotherapy in private practice. "All of a sudden you are working in a way that people are responding to."

A few days ago, Patricia Stone took her traumatized 3-year-old back to the 11th Street clinic. The reason was a cold, but when the mother saw Duffy, she told her that Aaliyah had been asking "to see her daddy."

Although the response is normal, Duffy was concerned about the child's future. She suggested that they come in for a series of short meetings.

"When you are looking at grief, you want to maintain their developmental progress," she said, "and make sure they are not regressing."

Contact staff writer Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.