I spent fifteen years watching the system fail the same kids. So I built something different.

By Dr. Shar Najafi-Piper, PsyD | CEO & Founder, Roya Health

She was 7 years old and had already seen 4 providers.

Her pediatrician had flagged behavioral concerns at her five-year well visit. A therapist was brought in. Then a developmental specialist. Then, a second pediatrician was consulted for a second opinion on the recurring stomach pain nobody could explain. Four providers across three different practices, none of whom had ever spoken to each other. The mother kept a three-ring binder. She brought it to every appointment and laid it open on the exam table like an offering, here, this is everything, please help us figure out what is happening to my daughter.

Maybe this sounds familiar. Your child has been seen by a pediatrician, a therapist, a specialist, and still nobody seems to have the full picture. You are the one keeping track of everything, carrying notes from one appointment to the next, repeating the same history to every new provider. You are doing everything right, and somehow the pieces still are not connecting.

That is the experience that led me to build Roya Health.

What I was watching was not a failure of individual providers. Every clinician in that child's care was competent and trying. The problem was structural. When a child has anxiety that manifests as stomachaches, the gastroenterologist treats the gut and refers to behavioral health. Behavioral health treats anxiety and refers back if symptoms persist. The pediatrician manages the middle and tries to hold the thread. Each provider does their piece. Nobody owns the whole picture. And the family, the mother with the binder, becomes the connective tissue between all of it. A role she was never trained for and never asked to take on.

This is not a rare edge case. It is how most of behavioral healthcare for children is structured in this country. Parallel tracks that run near each other but do not touch.

What happens in that gap? Kids wait. Families get exhausted. Symptoms that were manageable at seven become entrenched at twelve. The stomach pain becomes school avoidance. The anxiety becomes something harder to treat. By the time a family finds their way to integrated care, if they find it at all, there is often more to undo.

I spent years working inside systems I could not change. I adjusted my approach, pushed harder for communication across care teams, called pediatricians directly, and sent longer notes than anyone asked for. It helped at the margins. The structure remained.

Roya Health started from a simple question: what if the structure itself were different?

Not a referral network. Not a warm handoff. An actual integrated practice in which the psychologist, psychiatric provider, and medical team are in the same building, working from the same clinical picture and making decisions together. Where a parent does not have to be the one carrying information between providers who have never met.

The model we built is not complicated. It is just not how most outpatient behavioral health is set up, because building it requires solving problems that are easier to avoid. Shared documentation. Coordinated scheduling. Clinical team meetings that happen regularly and actually change care plans. Billing structures that support collaboration rather than penalize it. None of this is revolutionary. All of it takes work to maintain.

What it produces, in practice: the seven-year-old with anxiety and stomach pain sees a psychologist and a medical provider in the same visit. They leave with one plan, not two parallel ones. The mother does not need the binder, because our team already has the information.

I want to be honest about what we are still figuring out. Roya Health operates across three locations in Arizona and is growing. Growth creates the same coordination pressures we were designed to solve. The larger we get, the more intentional we have to be about not drifting back toward the fragmented model that is easier to scale. That tension is real, and I think about it often.

What I no longer think about is whether integration is worth the effort. I have seen what it changes.

The families who come to us often arrive depleted. They have been through the referral circuit. They are braced for another partial solution. The shift that happens when they realize our team has already talked, that the psychologist and the prescriber and the pediatric provider have a shared picture of their child, is not dramatic. It is quiet. A kind of relief that has been building for a long time.

That is what we built Roya for. Not the idea of integration, which is easy to put in a mission statement. The experience of it on an ordinary Tuesday for a family that has been carrying a binder for two years.

We have a long way still to go. But we know what we are building toward.

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Dr. Shar Najafi-Piper, PhD is the founder and CEO of Roya Health, an integrated behavioral health practice serving children and families in the Greater Phoenix area.