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Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M, Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry 2023; 62:91-119. [PMID: 35779696 DOI: 10.1016/j.jaac.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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2
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Stadnick NA, Aarons GA, Martinez K, Sklar M, Coleman KJ, Gizzo DP, Lane E, Kuelbs CL, Brookman-Frazee L. Implementation outcomes from a pilot of "Access to Tailored Autism Integrated Care" for children with autism and mental health needs. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1821-1832. [PMID: 35083919 PMCID: PMC9325918 DOI: 10.1177/13623613211065801] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Children with autism frequently experience co-occurring mental health needs. The "Access to Tailored Autism Integrated Care (ATTAIN)" model was co-created with caregivers, pediatric providers, and health care leaders to identify mental health needs and link to mental health care for autistic children. This article describes outcomes from a pilot study of Access to Tailored Autism Integrated Care with 36 pediatric primary care providers from seven clinics within three healthcare systems. Providers participated in an initial Access to Tailored Autism Integrated Care training and received ongoing online support over 4 months with autistic patients ages 4-16 years old. Survey and interview assessments measured provider perceptions of feasibility, acceptability, and intentions to continue using Access to Tailored Autism Integrated Care after the pilot. Providers reported that Access to Tailored Autism Integrated Care was feasible, acceptable, that the initial training was helpful in their implementation but that more specific and tailored implementation support was needed. Results show that Access to Tailored Autism Integrated Care is a promising model to support mental health screening and linkage for children with autism in primary care. Findings provide information on specific areas of the Access to Tailored Autism Integrated Care model that could be benefit from additional refinement to support more widespread use in primary care settings.
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Affiliation(s)
- Nicole A Stadnick
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
| | - Gregory A Aarons
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
| | - Kassandra Martinez
- Child and Adolescent Services Research Center, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Marisa Sklar
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
| | | | | | - Elizabeth Lane
- University of California San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, USA
| | - Cynthia L Kuelbs
- University of California San Diego, La Jolla, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
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3
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McLeigh JD, Malthaner L, Winebrenner C, Stone KE. Paediatric integrated care in the primary care setting: A scoping review of populations served, models used and outcomes measured. Child Care Health Dev 2022; 48:869-879. [PMID: 35288973 DOI: 10.1111/cch.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paediatric integrated care (PIC), which involves primary care and behavioural health clinicians working together with patients and families, has been promoted as a best practice in the provision of care. In this context, behavioural health includes behavioural elements in the care of mental health and substance abuse conditions, chronic illness and physical symptoms associated with stress, and addressing health behaviours. Models of and contexts in which PIC has been applied vary, as do the outcomes and measures used to determine its value. Thus, this study seeks to better understand (1) what paediatric subpopulations are receiving integrated care, (2) which models of PIC are being studied, (3) what PIC outcomes are being explored and what measures and strategies are being used to assess those outcomes, and (4) whether the various models are resulting in positive outcomes. These questions have significant policy and clinical implications, given current national- and state-level efforts aimed at promoting integrated health care. METHODS This study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews to identify relevant articles published between January 1994 and 30 June 2020. The search utilized three databases: PubMed, PsycInfo and CINAHL. A total of 28 articles met the eligibility criteria for inclusion. RESULTS Overall, acceptability of PIC appears to be high for patients and providers, with access, screening and engagement generally increasing. However, several gaps in the knowledge base on PIC were uncovered, and for some studies, ascertaining which models of integrated care were being implemented proved difficult. CONCLUSION PIC has the potential to improve access to and quality of behavioural health care, but more research is needed to understand what models of PIC prove most beneficial and which policies and conditions promote cost efficiency. Rigorous evaluation of patient outcomes, provider training, institutional buy-in and system-level changes are needed.
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Affiliation(s)
- Jill D McLeigh
- Children's Health, Rees-Jones Center for Foster Care Excellence, Dallas, Texas, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Dallas Campus, Dallas, Texas, USA
| | - Lauren Malthaner
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Dallas Campus, Dallas, Texas, USA
| | | | - Kimberly E Stone
- Children's Health, Rees-Jones Center for Foster Care Excellence, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
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4
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Garbutt J, Dodd S, Rook S, Ericson L, Sterkel R, Plax K. Primary care experiences of providing mental healthcare for children in the USA during the COVID-19 pandemic: a qualitative study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001497. [PMID: 36053621 PMCID: PMC9272128 DOI: 10.1136/bmjpo-2022-001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The increased demand for mental healthcare associated with the COVID-19 pandemic adds to the already high unmet mental health needs among paediatric patients, resulting in a declared 'mental health emergency'. The study objective was to describe paediatric primary care providers (PCPs') experience of meeting their patients' needs for mental healthcare during the pandemic and to identify opportunities to optimise care. METHODS 19 paediatricians and 2 nurse practitioners completed a 30 min video interview in May 2021. Interviews were recorded and transcribed, and transcripts were analysed using consensual qualitative research methods. RESULTS Participants reported marked increases in patient mental health needs during the COVID-19 pandemic. These included new diagnoses of anxiety and depression and increased treatment needs for patients with a prior mental health diagnosis. They identified that the mental health needs of their patients were greater, more severe and more challenging to manage with the resources currently available. While they were frustrated with the lack of communication and support from their mental health colleagues, and felt isolated and overwhelmed, they approached the increased demand for mental healthcare with a growth mindset. This outlook included providing care, seeking help to improve their skills and engaging with local resources such as the Child Psychiatry Access Project (CPAP). CONCLUSIONS Our findings suggest that urgent action is needed to better support paediatric PCPs to provide mental healthcare in our community. Providers identified an ongoing need for timely access to and effective communication with mental health providers to guide care in the medical home. This need could be addressed immediately by providing training for new and experienced clinicians, expanding the scope of CPAP programmes to include patient assessment and supporting implementation of integrated behavioural health programmes into the medical home.
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Affiliation(s)
- Jane Garbutt
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sherry Dodd
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Shannon Rook
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lauren Ericson
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randall Sterkel
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Katie Plax
- Medicine and Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
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5
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Stadnick NA, Penalosa MG, Martinez K, Brookman-Frazee L, Gizzo DP, Sahms T, Kuelbs CL, Aarons GA. Pre-Implementation Organizational Environment Associated with Pediatric Integrated Care Readiness in Primary Care. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:5-11. [PMID: 35284636 PMCID: PMC8916715 DOI: 10.1080/23794925.2021.1875344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To characterize pre-implementation organizational factors associated with Access To Tailored Autism Integrated Care (ATTAIN), an integrated care model for children with autism and identified or suspected co-occurring mental health needs. Methods Pediatric primary care providers (n=36) completed surveys as part of a pilot study testing ATTAIN feasibility. Measures assessed: background characteristics; implementation climate; organizational readiness; evidence-based practice (EBP) attitudes; knowledge, confidence and comfort caring for children with autism. Results Compared to providers from a network of primary care practices and an integrated healthcare system, providers from a Federally Qualified Health Center (FQHC) reported less positive perceptions of climate supportive of EBP implementation and, specifically, selection for openness and rewards for EBPs. Implementation climate was associated with autism knowledge, comfort with mental health referral and follow up, and organizational change efficacy. Conclusions Findings advance understanding of pre-implementation organizational context factors important to assess for EBP implementation in diverse pediatric care settings.
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Affiliation(s)
- Nicole A. Stadnick
- University of California San Diego, Department of Psychiatry, San Diego, CA,Child and Adolescent Services Research Center, San Diego, CA,UC San Diego Dissemination and Implementation Science Center, San Diego, CA
| | | | - Kassandra Martinez
- Child and Adolescent Services Research Center, San Diego, CA,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Lauren Brookman-Frazee
- University of California San Diego, Department of Psychiatry, San Diego, CA,Child and Adolescent Services Research Center, San Diego, CA,UC San Diego Dissemination and Implementation Science Center, San Diego, CA
| | | | - Timothy Sahms
- University of California San Diego, Department of Pediatrics, San Diego, CA,San Ysidro Health, San Ysidro, CA
| | - Cynthia L. Kuelbs
- University of California San Diego, Department of Pediatrics, San Diego, CA,Rady Children’s Hospital, San Diego, CA
| | - Gregory A. Aarons
- University of California San Diego, Department of Psychiatry, San Diego, CA,Child and Adolescent Services Research Center, San Diego, CA,UC San Diego Dissemination and Implementation Science Center, San Diego, CA
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Chakawa A, Belzer LT, Perez-Crawford T, Yeh HW. COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use. J Pediatr Psychol 2021; 46:1063-1075. [PMID: 34343329 PMCID: PMC8385826 DOI: 10.1093/jpepsy/jsab077] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Objective The coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups. Methods A comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1–19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables. Results Service delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children. Conclusion Though telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.
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Affiliation(s)
- Ayanda Chakawa
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Leslee Throckmorton Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,The Beacon Program, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Trista Perez-Crawford
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Hung-Wen Yeh
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
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7
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Sanderson D, Braganza S, Philips K, Chodon T, Whiskey R, Bernard P, Rich A, Fiori K. "Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology". J Prim Care Community Health 2021; 12:21501327211023883. [PMID: 34109884 PMCID: PMC8202298 DOI: 10.1177/21501327211023883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Social and environmental factors have an outsized effect on one's health. Children are particularly impacted by the adverse effects of poverty. While social determinants of health (SDH) screening in healthcare settings has proliferated there remain gaps in best practices for screening processes. As research has shown that patient navigation leads to an improvement in unmet social needs and family-reported child health, warm handoffs may be a key factor in assuring that the social needs of families are effectively addressed. Using quality improvement (QI) methods our pediatric clinic worked to increase the warm handoff rate between Community Health Workers (CHWs) and patients with unmet social needs. CHW warm handoff rates increased two-fold over the intervention period. Our results illustrate that QI methods can be used to optimize workflows to increase warm handoffs with CHWs. This is important as health centers work to improve their social needs screening and referral programs.
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Affiliation(s)
- Dana Sanderson
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Group, Bronx, NY, USA
| | | | | | | | | | | | - Andrea Rich
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Group, Bronx, NY, USA
| | - Kevin Fiori
- Albert Einstein College of Medicine, Bronx, NY, USA
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8
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Hoff A, Hughes-Reid C, Sood E, Lines M. Utilization of Integrated and Colocated Behavioral Health Models in Pediatric Primary Care. Clin Pediatr (Phila) 2020; 59:1225-1232. [PMID: 32686481 DOI: 10.1177/0009922820942157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Integrating behavioral health services within pediatric primary care may help address barriers to these services for youth, especially the underserved. Models of primary care behavioral health include coordinated, colocated, integrated, and collaborative care. This study began exploring the comparative utility of these models by investigating differences in the demographics and diagnoses of patients seen for a behavioral health warm handoff (integrated model) and a scheduled behavioral health visit (colocated model) across 3 pediatric primary care sites. The 3 sites differed in their rates of warm handoff usage, and there were differences in certain diagnoses given at warm handoffs versus scheduled visits. Depression diagnoses were more likely to be given in warm handoffs, and disruptive behavior, trauma/adjustment, and attention-deficit/hyperactivity disorder-related diagnoses were more likely to be given in scheduled visits. These results have implications for the influence of office structure and standardized procedures on behavioral health models used in pediatric primary care.
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Affiliation(s)
| | | | - Erica Sood
- Nemours duPont Pediatrics, Wilmington, DE, USA
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9
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Parrish C, Bartolini E, Song Y, Hernandez E, Green K, Ostrander R. Pediatric medical psychology. Int Rev Psychiatry 2020; 32:284-297. [PMID: 32091271 DOI: 10.1080/09540261.2019.1705258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Paediatric medical psychology is a specialised field within clinical health psychology focussed on the behavioural, developmental, and psychological needs of children, adolescents, and families in healthcare contexts. Paediatric medical psychologists address a myriad of problems by employing evidence-based evaluations and interventions in order to support the well-being of paediatric patients and their families. In this paper, we provide an overview of paediatric medical psychology including the education and training required to be a paediatric psychologist followed by common problems addressed by paediatric psychology, the settings paediatric psychologists work in, and the services they provide. Discussion concludes with future application of integrating paediatric psychology throughout the continuum of care to optimise adjustment and health of paediatric patients.
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Affiliation(s)
- Carisa Parrish
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ellen Bartolini
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Youlim Song
- Department of Psychological and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Emily Hernandez
- College of Social and Behavioral Sciences, California State University Northridge, Northridge, CA, USA
| | - Katerina Green
- The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rick Ostrander
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
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10
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Walter HJ, Vernacchio L, Trudell EK, Bromberg J, Goodman E, Barton J, Young GJ, DeMaso DR, Focht G. Five-Year Outcomes of Behavioral Health Integration in Pediatric Primary Care. Pediatrics 2019; 144:peds.2018-3243. [PMID: 31186366 DOI: 10.1542/peds.2018-3243] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In the context of protracted shortages of pediatric behavioral health (BH) specialists, BH integration in pediatric primary care can increase access to BH services. The objectives of this study were to assess the structure and process of pediatric BH integration and outcomes in patient experience (access and quality), cost, and provider satisfaction. METHODS In 2013, we launched a multicomponent, transdiagnostic integrated BH model (Behavioral Health Integration Program [BHIP]) in a large pediatric primary care network in Massachusetts. Study participants comprised the first 13 practices to enroll in BHIP (Phase-1). Phase-1 practices are distributed across Greater Boston, with ∼105 primary care practitioners serving ∼114 000 patients. Intervention components comprised in-depth BH education, on-demand psychiatric consultation, operational support for integrated practice transformation, and on-site clinical BH service. RESULTS Over 5 years, BHIP was associated with increased practice-level BH integration (P < .001), psychotherapy (P < .001), and medical (P = .04) BH visits and guideline-congruent medication prescriptions for anxiety and depression (P = .05) and attention-deficit/hyperactivity disorder (P = .05). Total ambulatory BH spending increased by 8% in constant dollars over 5 years, mainly attributable to task-shifting from specialty to primary care. Although an initial decline in emergency BH visits from BHIP practices was not sustained, total emergency BH spending decreased by 19%. BHIP providers reported high BH self-efficacy and professional satisfaction from BHIP participation. CONCLUSIONS Findings from this study suggest that integrating BH in the pediatric setting can increase access to quality BH services while engendering provider confidence and satisfaction and averting substantial increases in cost.
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Affiliation(s)
- Heather J Walter
- Departments of Psychiatry, .,Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and
| | - Louis Vernacchio
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and.,Pediatrics, and
| | - Emily K Trudell
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts
| | - Jonas Bromberg
- Departments of Psychiatry.,Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and
| | - Ellen Goodman
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Jessica Barton
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Gregory J Young
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and.,Pediatrics, and
| | - David R DeMaso
- Departments of Psychiatry.,Harvard Medical School, Boston, Massachusetts; and
| | - Glenn Focht
- Connecticut Children's Medical Center, Hartford, Connecticut
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11
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Williams AA. The Next Step in Integrated Care: Universal Primary Mental Health Providers. J Clin Psychol Med Settings 2019; 27:115-126. [PMID: 31087238 DOI: 10.1007/s10880-019-09626-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Current models of mental health care often do not address three barriers to mental health: the binary view of mental illness (healthy vs. mentally ill), stigma, and prevention. Care models where some patients are selected for referral or consultation with a mental health professional can reinforce this binary view and the stigma associated with seeing mental health services. By only selecting patients who currently are experiencing mental health problems, current integrated care models do not offer sufficient avenues for prevention. To address these barriers, this article proposes building on current models through the development of primary mental health providers (PMHPs). PMHPs-like primary care providers-would provide regular check-ups, assessments, prevention interventions, first-line treatment, or referral to more specialized professionals. This universal approach will help decrease the binary view of mental health, decrease the stigma of seeing a mental health professional through universal access, and improve prevention efforts.
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Affiliation(s)
- Adrienne A Williams
- Department of Family Medicine, University of Illinois at Chicago College of Medicine, 1919 W Taylor St., MCC 663, Chicago, IL, 60612, USA.
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12
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Rinke ML, German M, Azera B, Heo M, Brown NM, Gross RS, Bundy DG, Racine AD, Duonnolo C, Briggs RD. Effect of Mental Health Screening and Integrated Mental Health on Adolescent Depression-Coded Visits. Clin Pediatr (Phila) 2019; 58:437-445. [PMID: 30623684 DOI: 10.1177/0009922818821889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Adolescent depression causes morbidity and is underdiagnosed. It is unclear how mental health screening and integrated mental health practitioners change adolescent depression identification. We conducted a retrospective primary care network natural cohort study where 10 out of 19 practices implemented mental health screening, followed by the remaining 9 practices implementing mental health screening with less coaching and support. Afterward, a different subset of 8 practices implemented integrated mental health practitioners. Percentages of depression-coded adolescent visits were compared between practices (1) with and without mental health screening and (2) with and without integrated mental health practitioners, using difference-in-differences analyses. The incidence of depression-coded visits increased more in practices that performed mental health screening (ratio of odds ratios = 1.22; 95% confidence interval =1.00-1.49) and more in practices with integrated mental health practitioners (ratio of odds ratios = 1.58; 95% confidence interval = 1.30-1.93). Adolescent mental health screening and integrated mental health practitioners increase depression-coded visits in primary care.
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Affiliation(s)
- Michael L Rinke
- 1 The Children's Hospital at Montefiore, Bronx, NY, USA.,2 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Miguelina German
- 1 The Children's Hospital at Montefiore, Bronx, NY, USA.,2 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bridget Azera
- 1 The Children's Hospital at Montefiore, Bronx, NY, USA.,2 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Moonseong Heo
- 2 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole M Brown
- 1 The Children's Hospital at Montefiore, Bronx, NY, USA.,2 Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - David G Bundy
- 4 Medical University of South Carolina, Charleston, SC, USA
| | - Andrew D Racine
- 1 The Children's Hospital at Montefiore, Bronx, NY, USA.,2 Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Rahil D Briggs
- 1 The Children's Hospital at Montefiore, Bronx, NY, USA.,2 Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Platt RE, Spencer AE, Burkey MD, Vidal C, Polk S, Bettencourt AF, Jain S, Stratton J, Wissow LS. What's known about implementing co-located paediatric integrated care: a scoping review. Int Rev Psychiatry 2018; 30:242-271. [PMID: 30912463 PMCID: PMC6499629 DOI: 10.1080/09540261.2018.1563530] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. The literature was systematically searched for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. Studies reporting on the following implementation outcomes were included: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. This search identified 34 unique studies, including randomized controlled trials, observational studies, and survey/mixed method approaches. Components facilitating implementation of on-site integrated behavioural healthcare included interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Some studies found differences in service use by demographic factors, and others reported funding challenges affecting sustainability, warranting further study.
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Affiliation(s)
| | | | | | - Carolina Vidal
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sonal Jain
- New York Institute of Technology College of Osteopathic Medicine
| | - Julia Stratton
- Vancouver Coastal Health Authority, Pacific Spirit and Raven Song Child and Youth Mental Health Teams
| | - Lawrence S Wissow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Masten AS, Barnes AJ. Resilience in Children: Developmental Perspectives. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E98. [PMID: 30018217 PMCID: PMC6069421 DOI: 10.3390/children5070098] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
Advances in developmental resilience science are highlighted with commentary on implications for pediatric systems that aspire to promote healthy development over the life course. Resilience science is surging along with growing concerns about the consequences of adverse childhood experiences on lifelong development. Resilience is defined as the capacity of a system to adapt successfully to challenges that threaten the function, survival, or future development of the system. This definition is scalable across system levels and across disciplines, applicable to resilience in a person, a family, a health care system, a community, an economy, or other systems. Robust findings on resilience in childhood underscore the importance of exposure dose; fundamental adaptive systems embedded in the lives of individuals and their interactions with other systems; developmental timing; and the crucial role of healthcare practitioners and educators as well as family caregivers in nurturing resilience on the "front lines" of lived childhood experience. Resilience science suggests that human resilience is common, dynamic, generated through myriad interactions of multiple systems from the biological to the sociocultural, and mutable given strategic targeting and timing. Implications for pediatric practice and training are discussed.
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Affiliation(s)
- Ann S Masten
- Institute of Child Development, University of Minnesota Twin Cities, Minneapolis, MN 55455, USA.
| | - Andrew J Barnes
- Developmental-Behavioral Pediatrics, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
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15
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Malas N, Klein E, Tengelitsch E, Kramer A, Marcus S, Quigley J. Exploring the Telepsychiatry Experience: Primary Care Provider Perception of the Michigan Child Collaborative Care (MC3) Program. PSYCHOSOMATICS 2018; 60:179-189. [PMID: 30097288 DOI: 10.1016/j.psym.2018.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pediatric mental healthcare is a growing component of primary care practice. However, there is a lack of access to mental health services, particularly those provided by Child and Adolescent Psychiatrists. The Michigan Child Collaborative Care (MC3) Program is a telepsychiatry service that offers embedded behavioral health consultants within primary care practices, telephonic consultation, video consultation and embedded care. Primary care provider (PCP) utilization of telepsychiatry services is predicated on perceiving the consultation service as user-friendly, helpful, and feasible in their practice. OBJECTIVE A survey of PCPs was conducted over a 5-year period to assess PCP attitudes and perceptions regarding MC3 consultation, including measures of efficiency, user-friendliness, and confidence in providing mental healthcare. The survey contained 4 items, (2 quantitative and 2 qualitative), and took less than 2 minutes to complete. RESULTS 649 responses were received out of 1475 possible responses (44% response rate). Common themes elicited from the qualitative items included perception of improved patient care for youth with mental illness (45.3%), improved comfort and confidence in caring for youth with mental illness (30.9%), greater comfort with the prescribing and monitoring of psychotropics (25.9%) and improved access to mental healthcare for youth (23.1%). PCPs strongly agreed that MC3 was user-friendly, efficient, and enhanced their confidence in managing pediatric mental health concerns. CONCLUSIONS This study demonstrates that the MC3 Telepsychiatry Program is well accepted by PCPs with self-reported improvements in providing mental healthcare to patients. Future research should explore how PCP perception impacts PCP practice, knowledge, as well as outcomes for patients and families longitudinally.
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Affiliation(s)
- Nasuh Malas
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI.
| | - Edwin Klein
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Anne Kramer
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Sheila Marcus
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Joanna Quigley
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI
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