A randomized controlled trial was used to examine the impact of an attachment-based, teacher-child, dyadic intervention (Banking Time) to improve children's externalizing behavior. Participants included 183 teachers and 470 preschool children (3-4 years of age). Classrooms were randomly assigned to Banking Time, child time, or business as usual (BAU). Sparse evidence was found for main effects on child behavior. Teachers in Banking Time demonstrated lower negativity and fewer positive interactions with children compared to BAU teachers at post assessment. The impacts of Banking Time and child time on reductions of parent- and teacher-reported externalizing behavior were greater when teachers evidenced higher-quality, classroom-level, teacher-child interactions at baseline. An opposite moderating effect was found for children's positive engagement with teachers.

This study examined the relationship among baseline program and teacher characteristics and subsequent implementation of Banking Time. Banking Time is a dyadic intervention intended to improve a teacher's interaction quality with a specific child. Banking Time implementation was examined in the current study using a sample of 59 teachers and preschool children displaying disruptive behaviors in the classroom (~three children per classroom). Predictors included preschool program type, teacher demographic characteristics (personal and professional), and teacher beliefs (self-efficacy, authoritarian beliefs, and negative attributions about child disruptive behavior). Multiple measures and methods (i.e., teacher report, consultant report, independent observations) were used to assess implementation. We created three implementation composite measures (dosage, quality, and generalized practice) that had high internal consistencies within each composite but were only modestly associated with one another, suggesting unique constructs of implementation. We found that type of preschool program was associated with dosage and quality. Aspects of teacher demographics related to all three implementation composites. Teacher beliefs predicted dosage and generalized practice. Results suggest that the factors that predict the implementation of Banking Time vary as a function of the type of implementation being assessed.

Objective: Children are accompanied to primary care settings by caregivers who present with their own mental health and psychosocial distress. Primary care is an optimal place to identify negative impacts on child health. Clinics with integrated behavioral health (IBH) clinicians are well-positioned to implement and respond to caregiver screenings. Methods: Universal screening to address perinatal mood and anxiety disorders (PMADs) and psychosocial distress was implemented in 3 primary care clinics within 1 hospital system. Pediatric psychologists supported implementation across all clinics. Screening frequencies, average scores of elevated screeners, and most common treatment recommendations made by IBH clinicians were extracted from medical records. Results: Universal caregiver screening effectively identified mental health and psychosocial concerns and was a driver of increased behavioral health access in pediatric primary care. A total of 6,080 caregivers were screened over 3 years. Results showed 10% and 16.4% of caregivers had elevated PMADs screening results, 33% to 46% identified social determinants of health needs, and 6.6% to 11.5% identified mental health concerns. Responses to screeners including follow up with the IBH team, brief interventions, and caregiver referral to mental health services. Conclusions: Caregiver screening is an essential component of comprehensive well-child care. Without universal screening processes, caregiver mental health and psychosocial concerns may go undetected and unaddressed.

The purpose of this study was to (a) describe the development and implementation of Behavioral Health in Pediatric Populations:0 -5 (BHIPP:0 -5), an initiative designed to increase the capacity of primary care practices to deliver early childhood behavioral health (ECBH) integration activities; and (b) examine practice transformation changes in ECBH services for three types of primary care settings (federally qualified health care centers-FQHCs, private practices, nonprofit/community practices). Methods: BHIPP:0 -5 pediatric psychologists and interdisciplinary TA professionals provided monthly technical assistance sessions and quarterly cohort learning collaboratives to nine diverse primary care practices. Changes in ECBH activity implementation were examined across and within three practice type groupings. Results: All BHIPP:0 -5 practice types expanded their capacity to provide ECBH services from baseline to the end of Year 2. Prevention/health promotion activities evidenced the most growth (from 16% in baseline to 40% in Year 2). Practice types differed in implementation of ECBH services. FQHCs accounted for 75% of the total prevention/health promotion services, private practices provided the most case-based consultation/intervention (54%), and nonprofit/community practices accounted for 86% of the total care coordination/systems navigation services. Conclusions: Primary care settings are uniquely suited to address early childhood mental health in the context of routine care. The BHIPP:0 -5 initiative supports practice transformation in early childhood behavioral health integration while simultaneously advancing systems-level policies and practices that promote high quality care, increase efficiency, improve utilization of preventive services, and decrease overall costs in alignment with health care systems goals. Implications for Impact StatementThis study describes the development and implementation of a practice transformation initiative focused on early childhood behavioral health integration activities in a diverse group of primary care practices. The initiative was designed and delivered by pediatric psychologists in order to build the capacity of primary care settings to provide services aimed at addressing the complex needs of young children and their families. The data indicate that primary care practices successfully engaged in the initiative, benefitting from monthly technical assistance meetings and quarterly cohort learning collaboratives, and increased the amounts and types of early childhood services they provided to young children and their families.

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