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Rybak TM, Herbst RB, Stark LJ, Samaan ZM, Zion C, Bryant A, McClure JM, Maki A, Bishop E, Mack A, Ammerman RT. Provider Perspectives on an Integrated Behavioral Health Prevention Approach in Pediatric Primary Care. J Clin Psychol Med Settings 2023; 30:741-752. [PMID: 36828991 PMCID: PMC9957689 DOI: 10.1007/s10880-023-09947-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
The purpose of this study was to use qualitative interviews to ascertain the perspective of pediatric primary care providers on the implementation of Integrated Behavioral Health (IBH) as provided by psychologists within an expanded HealthySteps™ model, and with a particular focus on prevention of behavioral health symptoms in the first five years. A semi-structured interview guide was used to assess medical providers' perceptions of behavioral health integration into their primary care clinics. A conventional qualitative content analysis approach was utilized to identify patterns of meaning across qualitative interviews. Four themes were identified: (1) practice prior to IBH and initial concerns about integration, (2) psychologist's role and perceived added value, (3) what integration looks like in practice, and (4) perceived families' response to and experiences with IBH. Despite initial concerns about potential disruptions to clinic flow, providers indicated that adoption of IBH was seamless. The distinct roles of the psychologist were clear, and both treatment and prevention services provided by IBH were valued. Multidisciplinary collaboration and real-time response to family needs was seen as especially important and primary care providers reported that families were accepting of and highly valued IBH.
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Affiliation(s)
- Tiffany M Rybak
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Rachel B Herbst
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lori J Stark
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zeina M Samaan
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cynthia Zion
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Alyssa Bryant
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Jessica M McClure
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Aileen Maki
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Elizabeth Bishop
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
| | - Aimee Mack
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert T Ammerman
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7039, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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2
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Buchanan G, Sullivan E, Berkel C, Breitenstein S, Feinberg E, Valado T, Willis D. Implementing Parenting Programs in Primary Care: A Framework and a Call for Action. Acad Pediatr 2023; 23:1315-1325. [PMID: 37088132 DOI: 10.1016/j.acap.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Healthy parent-child relationships are clearly critical to healthy child development. Parenting programs develop caregivers' skills to support the health and well-being of children. Rigorous evidence has demonstrated the efficacy of these programs. Rising rates of child and youth depression, anxiety, grief, and suicide, both prior to and compounded by the COVID-19 pandemic, provide further reasons to implement parenting programs that support all parents in their essential roles. Parents can act as a buffer to stressors and support for children's well-being when they have the knowledge and skills to do so. Pediatric primary care practices are a natural setting for parenting programs, but challenges, including stigma, technology, workflow issues, and funding, have prevented their broad dissemination, implementation, and sustainability. In this article, we develop a framework for implementing parenting programs in primary care and present key considerations for selecting programs that fit the needs of parents, providers, patients, and the practice. We offer lessons from our experiences in overcoming these challenges, using the updated Consolidated Framework for Implementation Research to structure our discussion. We also provide an initial stepwise process which readers may use to plan their own parenting program implementation. Pediatric clinicians and practices can use this article and associated resources to plan, implement, and evaluate parenting programs in their practices as a strategy to help address the growing youth mental health crisis. Improving parenting behaviors can reduce the need for current or future mental health interventions by supporting optimal child development, emotional regulation, and parent-child relationships.
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Affiliation(s)
- Gretchen Buchanan
- Center for Mental Health Services Research and Brown School of Social Work (G Buchanan), Washington University in St. Louis, MO.
| | | | - Cady Berkel
- College of Health Solutions (C Berkel), Arizona State University, Tempe
| | - Susie Breitenstein
- College of Nursing (S Breitenstein), The Ohio State University, Columbus
| | - Emily Feinberg
- Department of Pediatrics (E Feinberg), Chobanian and Avedisian School of Medicine and Department of Community Health Sciences, Boston University School of Public Health, Boston University School of Medicine, MA
| | - Trenna Valado
- ZERO TO THREE National Center for Infants, Toddlers, and Families (T Valado), Washington, D.C
| | - David Willis
- Center for the Study of Social Policy (D Willis), Washington, D.C
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Cummings AD, Van Horne B, Correa N, Schwarzwald H, Chapman S. Can Pediatric Primary Care Practices Afford Integrated Behavioral Health? A Comparison of 5 Pediatric Practices. Clin Pediatr (Phila) 2022; 61:850-858. [PMID: 35773977 DOI: 10.1177/00099228221106621] [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: 11/15/2022]
Abstract
Licensed behavioral health providers (LBHPs) were integrated into 5 pediatric primary care practices in southeast and east Texas from October 2018 through March 2020. LBHPs Licensed behavioral health providers across the sites were 3 licensed clinical social workers (LCSW), 1 psychologist, and 1 nurse practitioner (NP). Practices provided data for 6 to 15 months. Overall, 2769 units of behavioral health services were provided to 746 children over 2243 hours. Across 4 sites, 44.3% of behavioral health patients were diagnosed with trauma disorders, 22.1% with anxiety, 19.3% with attention-deficit hyperactivity disorder, 15.1% with depression, and 10.9% with disruptive behavior disorders. Overall, the model was financially successful at 2 sites (LCSWs) and unsuccessful at 1 site (NP). The other 2 sites demonstrated potential for financial sustainability with increased behavioral health patient volume. Overall, this model is a financially viable option for pediatric primary care practices with adequate patient volumes to provide integrated behavioral health services.
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Affiliation(s)
- A D Cummings
- Public Health Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - B Van Horne
- Public Health Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - N Correa
- Public Health Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - H Schwarzwald
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - S Chapman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Department of Psychology, Texas Children's Hospital, Houston, TX, USA
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Stuckey H, Hivner EA, Kraschnewski JL, Molinari AM, Costigan HJ, Sekhar DL. "I wouldn't even know what to do," Adolescent and Parent Perspectives on Identifying, Understanding, and Seeking Help for Adolescent Depression. Psychiatr Q 2021; 92:1459-1472. [PMID: 33909227 PMCID: PMC8542576 DOI: 10.1007/s11126-021-09918-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 11/27/2022]
Abstract
Within the context of a randomized clinical trial (RCT) of school-based depression screening, the study objective was to understand parent and adolescent perspectives on school-based depression screening and barriers to help-seeking for adolescent depression. From May-Nov. 2019, separate focus groups were held with adolescents (8 groups, n = 52) and parents (6 groups, n = 36). Two coders individually coded 20% of transcripts to establish interrater reliability (adolescent k = 0.76 and parent k = 0.80). Remaining transcripts were then separately coded and reviewed to develop three themes: (1) Both recognized depression as a serious issue that needed to be addressed in schools, but had confidentiality and communication concerns; (2) Both parents and adolescents believed the majority of adolescents would seek help with depression from friends more than any other source; and (3) Neither adolescents nor parents could clearly describe steps to take if their peers (adolescents) or adolescents (parents) were depressed. We intend to address identified barriers and concerns in the context of the larger RCT.
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Affiliation(s)
- Heather Stuckey
- Department of Medicine, Penn State College of Medicine, Hershey, PA, 17033, USA
| | - Elizabeth A Hivner
- Department of Pediatrics, Penn State College of Medicine, 500 University Drive, HS83, Hershey, PA, 17033, USA
| | | | - Alissa M Molinari
- Department of Pediatrics, Penn State College of Medicine, 500 University Drive, HS83, Hershey, PA, 17033, USA.
- Penn State PRO Wellness, Penn State College of Medicine, Mail Code A145, 90 Hope Drive, Suite 1103, Hershey, PA, 17033, USA.
| | - Heather J Costigan
- Department of Pediatrics, Penn State College of Medicine, 500 University Drive, HS83, Hershey, PA, 17033, USA
| | - Deepa L Sekhar
- Department of Pediatrics, Penn State College of Medicine, 500 University Drive, HS83, Hershey, PA, 17033, USA
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5
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Friedberg RD. Pediatrician-friendly perspectives on cognitive behavioral therapy for anxious youth: Current status and clinical implications for the next normal. World J Clin Pediatr 2021; 10:112-123. [PMID: 34868888 PMCID: PMC8603637 DOI: 10.5409/wjcp.v10.i6.112] [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: 05/03/2021] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
Pediatric anxiety disorders are common and often debilitating conditions. Cognitive is a psychosocial intervention that represents a potentially powerful antidote to these disorders. This article reviews data from treatment outcome studies, meta-analyses, and systematic reviews as well as from moderation/mediational investigations. The literature supports the efficacy, effectiveness, and durability of positive treatment outcomes for pediatric anxiety disorders. Recommendations for clinical applications are suggested.
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Affiliation(s)
- Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, San Jose, CA 95136, United States
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Lewis FJ, Rappleyea D, Didericksen K, Sira N, Byrd J, Buton A. Bringing Inclusion Into Pediatric Primary Health Care: A Systematic Review of the Behavioral Health Treatment of Racial and Ethnic Minority Youth. J Pediatr Health Care 2021; 35:e32-e42. [PMID: 34083102 DOI: 10.1016/j.pedhc.2021.04.002] [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] [Received: 02/02/2021] [Revised: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Currently, pediatric behavioral health care accounts for one of the fastest growing health care expenditures. Children representing racial and ethnic minority groups are still found to experience significant behavioral health needs. Primary health care represents the first level of contact with the health care system. METHOD The purpose of this systematic review was to synthesize articles discussing the behavioral health needs and treatment of racial and ethnic minority in primary care settings. RESULTS Results yielded 40 articles meeting the inclusion criteria. Themes included: provider screening, provider selected treatments, prevalence and need, and stigma and patient-provider communication. CONCLUSIONS Themes were discussed through the Ecological Systems Theory lens. Study limitations included its exclusion of intellectual disabilities like Autism Spectrum Disorder, lack of literature utilizing large minority samples, and lack of attention to the intersection between race and/or ethnicity alongside other demographics of concern like gender, age, social class, and geographical location.
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Riley AR, Walker BL, Ramanujam K, Gaultney WM, Cohen DJ. A Mixed-Method Investigation of Parent Perspectives on Early Childhood Behavioral Services in Primary Care. J Behav Health Serv Res 2021; 49:134-148. [PMID: 34599421 DOI: 10.1007/s11414-021-09772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
Primary care is a key setting for the delivery of parent-focused behavioral interventions. Various methods of intervention show promising efficacy but fail to engage adequate parental participation. This study used a sequential-explanatory mixed-method design to understand factors underlying parents' attitudes toward the content, sources, and delivery methods of behavioral guidance in primary care. Fifteen parents who previously participated in a larger survey study participated in interviews about their experiences and attitudes toward integrated primary care. Qualitative data were analyzed and sorted by quantitative data of interest to identify demographic, child, and parental factors that shape attitudes toward integrated care. Parents emphasized a need for tailored behavioral guidance, and multiple interconnected factors (e.g., trust of providers, perceived convenience of delivery modalities, stigma associated with behavioral health services) drove parents' attitudes toward behavioral primary care. These attitudes varied based on socioeconomic status, child behavior symptoms, and reported use of corporal punishment.
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Affiliation(s)
- Andrew R Riley
- Institute On Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, USA.
| | - Bethany L Walker
- Department of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Krishnapriya Ramanujam
- Institute On Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, USA
| | - Wendy M Gaultney
- Institute On Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Dickson C, Ramsay J, VandeBurgh J. Barriers for Ethnic Minorities and Low Socioeconomic Status Pediatric Patients for Behavioral Health Services and Benefits of an Integrated Behavioral Health Model. Pediatr Clin North Am 2021; 68:651-658. [PMID: 34044991 DOI: 10.1016/j.pcl.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hispanic families with low English proficiency and African Americans.
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Affiliation(s)
- Cheryl Dickson
- Associate Dean Health Equity and Community Affairs, 1000 Oakland Drive, Kalamazoo, MI 49009, USA.
| | - Jessica Ramsay
- Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49009, USA
| | - Joshua VandeBurgh
- Department of Neurology, University of Minnesota Medical Center, 516 Delaware Street, SE 12-100 Phillips Wangensteen Building, Minneapolis, MN 55455, USA
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Yogman MW, Betjemann S, Eppel A, Yuen N. Integrated Behavioral Health for Preschool Children in Pediatric Primary Care. J Behav Health Serv Res 2021; 48:625-633. [PMID: 33754287 PMCID: PMC7984500 DOI: 10.1007/s11414-021-09754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/28/2022]
Abstract
Behavioral problems in preschool children have led to increased rates of expulsion and suspension from preschool. This case report describes the management of children aged 0-5 with behavioral concerns in a pediatric practice. Identified children were referred to an integrated behavioral health provider who provided accessible evaluation and treatment to parents and children, as well as consultation to childcare providers. The report describes case examples of how these services prevented adverse outcomes at the preschool age for three children.
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Affiliation(s)
- Michael W Yogman
- Department of Pediatrics, Cambridge Hospital, Harvard Medical School, 14 Wyman Rd, Cambridge, MA, 02138, USA.
| | - Susan Betjemann
- Yogman Pediatric Associates, 14 Wyman Rd, Cambridge, MA, 02138, USA
| | - Amelia Eppel
- Department of Integrated Studies in Education, McGill University, Montreal, Canada
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Trafalis S, Giannini C, Joves J, Portera S, Toyama H, Mehta A, Basile K, Friedberg RD. A pediatrician-friendly review of three common behavioral health screeners in pediatric practice: Findings and recommendations. Pediatr Investig 2021; 5:58-64. [PMID: 33778429 PMCID: PMC7984009 DOI: 10.1002/ped4.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
Behavioral health concerns are surging in pediatric practices. Fortunately, integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings to help shoulder the clinical load. Routine screening of behavioral health problems in primary care facilities enables early identification and treatment. However, deciding on sound, efficient, and scalable screening measures is sometimes arduous. Accordingly, this article presents a clinician-friendly review of three common instruments useful in screening pediatric behavioral health concerns including anxiety, depression, and conduct problems. Psychometric findings and clinical applications of the Pediatric Symptom Checklist-17 (PSC-17), the Patient Health Questionnaire-9 (PHQ-9), and the Screen for Child Anxiety Related Emotional Disorders (SCARED) are delineated. Finally, clinical implications and recommendations for practicing pediatricians and child psychiatrists are offered.
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Affiliation(s)
- Sandra Trafalis
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Courtney Giannini
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Jeremy Joves
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Saige Portera
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Hannah Toyama
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Anika Mehta
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Krista Basile
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
| | - Robert D. Friedberg
- Center for the Study and Treatment of Anxious YouthPalo Alto UniversityPalo AltoCAUSA
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Hostutler CA, Ramtekkar U. Using Measurement-Based Care Data in Population Health Management. Child Adolesc Psychiatr Clin N Am 2020; 29:733-741. [PMID: 32891372 DOI: 10.1016/j.chc.2020.06.010] [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: 11/28/2022]
Abstract
Although screening can significantly improve the identification of youth with mental health needs in primary care, there is no evidence that screening improves outcomes. Measurement-based care using clinical mental health registries has been shown to improve screening outcomes in adult primary care populations and pediatric physical health needs; however, there is limited attention to pediatric mental health registries in primary care. This article describes clinical mental health registries, discusses the barriers to implementation with youth, and describes next steps in expanding the use of pediatric mental health registries in primary care.
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Affiliation(s)
- Cody A Hostutler
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital; Department of Pediatrics, The Ohio State University
| | - Ujjwal Ramtekkar
- Department of Child and Adolescent Psychiatry, Nationwide Children's Hospital; Department of Psychiatry, The Ohio State University.
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12
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Pediatric Mental Health and the Power of Primary Care: Practical Approaches and Validating Challenges. J Pediatr Health Care 2020; 34:e12-e20. [PMID: 31952900 DOI: 10.1016/j.pedhc.2019.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/11/2019] [Accepted: 09/25/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION With over 300 school shootings in the past 5 years, the unprecedented use of online social media, and the growing demands of academia, mental illness is quickly becoming one of the top causes of morbidity and mortality in the pediatric population. In the past year, 90% of children in the U.S. visited their pediatric primary care provider (PCP), giving PCPs a unique opportunity to address the mental health needs of their patients. METHODS The author conducted a comprehensive review of the literature. RESULTS This clinical paper seeks to validate the mental health competency of pediatric PCPs, identifies current challenges, and outlines practical approaches to care. DISCUSSION The consequences of untreated pediatric mental illness are indisputable. Pediatric PCPs have an obligation to address the growing pediatric mental health crisis directly. By utilizing standardized screening tools, referring to established clinical guidelines, seeking continuing education, and developing a comprehensive list of available resources, pediatric PCPs can incorporate mental health care into primary care.
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Cole MB, Qin Q, Sheldrick RC, Morley DS, Bair‐Merritt MH. The effects of integrating behavioral health into primary care for low-income children. Health Serv Res 2019; 54:1203-1213. [PMID: 31742687 PMCID: PMC6863244 DOI: 10.1111/1475-6773.13230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs. DATA SOURCES 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. STUDY DESIGN We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. PRINCIPAL FINDINGS After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. CONCLUSIONS Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.
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Affiliation(s)
- Megan B. Cole
- Department of Health Law, Policy, and ManagementBoston University School of Public HealthBostonMassachussets
| | - Qiuyuan Qin
- Department of PediatricsBoston Medical CenterBostonMassachussets
| | - Radley C. Sheldrick
- Department of Health Law, Policy, and ManagementBoston University School of Public HealthBostonMassachussets
| | - Debra S. Morley
- Department of PediatricsBoston Medical CenterBostonMassachussets
| | - Megan H. Bair‐Merritt
- Department of PediatricsBoston Medical CenterBostonMassachussets
- Department of PediatricsBoston University School of MedicineBostonMassachussets
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14
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Kolko DJ, Torres E, Rumbarger K, James E, Turchi R, Bumgardner C, O'Brien C. Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers. Clin Pediatr (Phila) 2019; 58:213-225. [PMID: 30450951 DOI: 10.1177/0009922818810881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study's limitations and empirical literature.
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Affiliation(s)
- David J Kolko
- 1 University of Pittsburgh School of Medicine, Psychiatry, Pittsburgh, PA, USA.,2 UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Eunice Torres
- 2 UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | | | - Everette James
- 3 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Renee Turchi
- 4 Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.,5 Drexel University College of Medicine, Philadelphia, PA, USA.,6 St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Cheryl Bumgardner
- 7 Pennsylvania Association of Community Health Centers, Wormleysburg, PA, USA
| | - Connell O'Brien
- 8 Rehabilitation and Community Providers Association, Harrisburg, PA, USA
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15
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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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