Key Points Question What type of primary care practices join the Comprehensive Primary Care Plus program, and which patient populations do those practices serve? Findings This comparative cross-sectional study of 756 areas eligible for the Comprehensive Primary Care Plus program found that a diverse set of primary care practices joined the program. Practices located in wealthier areas with higher education levels and less use of inpatient services were more likely to join. Meaning Voluntary advanced primary care medical home models, such as the Comprehensive Primary Care Plus program, may leave behind practices serving vulnerable populations.

PURPOSEIn the United States, primary care practices rely on scarce resources to deliver evidence-based care for children with behavioral health disorders such as depression, anxiety, other mental illness, or substance use disorders. We estimated the proportion of practices that have difficulty accessing these resources and whether practices owned by a health system or participating in Medicaid accountable care organizations (ACOs) report less difficulty. METHODSThis national cross-sectional study examined how difficult it is for practices to obtain pediatric (1) medication advice, (2) evidence-based psychotherapy, and (3) familybased therapy. We used the National Survey of Healthcare Organizations and Systems 2017-2018 (46.9% response rate), which sampled multiphysician primary and multispecialty care practices including 1,410 practices that care for children. We characterized practices' experience as "difficult" relative to "not at all difficult" using a 4-point ordinal scale. We used mixed-effects generalized linear models to estimate differences comparing systemowned vs independent practices and Medicaid ACO participants vs nonparticipants, adjusting for practice attributes. RESULTSMore than 85% of practices found it difficult to obtain help with evidence-based elements of pediatric behavioral health care. Adjusting for practice attributes, the percent experiencing difficulty was similar between system-owned and independent practices but was less for Medicaid ACO participants for medication advice (81% vs 89%; P = .021) and evidence-based psychotherapy (81% vs 90%; P = .006); differences were not significant for family-based treatment (85% vs 91%; P = .107).CONCLUSIONS Most multiphysician practices struggle to obtain advice and services for child behavioral health needs, which are increasing nationally. Future studies should investigate the source of observed associations.

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