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Introduction One recently completed randomized controlled trial (RCT) demonstrated the effectiveness of a Doctor-Office Collaborative Care (DOCC), relative to Enhanced Usual Care (EUC), for pediatric behavior problems and attention-deficit/hyperactivity disorder. This study seeks to extend the literature by incorporating a cost analysis component at the conclusion of the aforementioned trial. To our knowledge, it is the first study that examines whether the DOCC model leads to lower costs of mental health services for children. Methods Financial records from the RCT provide cost information about all the 321 study children in the 6-month intervention period, and claims data from insurance plans provide cost information about community mental health services for 57 children, whose parents consented to release their claims data, in both pre and post-intervention periods. Both descriptive and multivariate analyses were performed. Results The DOCC group had higher intervention costs, but the cost per patient treated for the DOCC group was lower than the EUC group during the 6-month intervention period. In terms of costs of community mental health services, while the two groups had similar costs in the 6 months before the RCT intervention, the DOCC group had significantly lower costs in the 6-month intervention period, and in the 6 or 12 months after the intervention, but not in the 18 or 24 months after the intervention. Discussion The DOCC model has the potential for cost savings during the intervention period and the follow-up periods immediately after the intervention while improving clinical effectiveness.

This article describes an outpatient treatment program for adolescent sexual abusers that was established by a mental health agency in collaboration with a specialized probation program in the juvenile court. Individualized treatment is based on a comprehensive clinical assessment with the youth and guardian, for which examples are provided. Given the heterogeneity of this population, we describe several treatment strategies directed to various individual or family clinical targets, including psychiatric disorders, sexual deviance and sexuality, normal adolescent development and adaptive skills, and parent and family relationships. Ongoing collaborative and coordination issues are also reviewed. The integration of mental health and probationary services provides a balanced approach to the community management and treatment of the low-risk, primarily first-time, adolescent sexual offender.

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.

Bronchopulmonary dysplasia (BPD) is characterized by alveolar-capillary simplification and is associated with pulmonary hypertension (PH) in preterm infants. The contribution of left ventricle (LV) disease towards this severe BPD-PH phenotype is not well established. We aimed to describe the longitudinal trajectory of the LV function as measured by tissue Doppler imaging (TDI) and its association with BPD-PH. We retrospectively assessed prospectively acquired clinical and echocardiographic data from 77 preterm infants born between 2011 and 2013. We characterized the LV function by measuring systolic and diastolic myocardial velocities (s’, e’, a’), isovolumetric relaxation time (IVRT), and myocardial performance index with TDI at three time periods from 32 and 36 weeks, postmenstrual age through one year of age. We also measured post systolic motion (PSM), a marker of myocardial dysfunction that results from asynchronous movement of the ventricular walls, and not previously described in preterm infants. Patients were stratified into groups according to BPD severity and the presence of PH and compared over time. Conventional TDI measures of the LV function were similar between groups, but the septal PSM was significantly prolonged over the first year of age in patients with BPD-PH. PSM provides a novel objective way to assess the hemodynamic impact of lung and pulmonary vascular disease severity on LV function in preterm infants with BPD and PH.