Two hundred seven students in Grades 1 through 5 who were at risk for severe behavior problems participated in a 2-year study of the effects of the Check, Connect, and Expect (CCE) program. The CCE program combined the essential intervention procedures of the Check & Connect Program and the Behavior Education Program . A stratified random sample of students based on school assignment was used to compare the outcomes of 121 CCE program students with 86 comparison students. Sixty percent of the CCE students (n = 73) graduated from the program and 40% (n = 48) did not. Linear growth analyses of eight different outcome measures found that three standardized problem behavior measures significantly decreased to normative levels for CCE graduates. Social skills and academic measures did not significantly change over time. The discussion focuses on the comparative efficacy of CCE as a targeted intervention for students at risk for severe behavior problems.

In the USA, the high cost and inefficiencies of the health care system have prompted widespread demand for a better value on investment. Reform efforts, focused on increasing effective, cost-efficient, and patient-centred practices, are inciting lasting changes to health care delivery. Integrated care, providing team-based care that addresses both physical and behavioural health needs is growing as an evidence-based way to provide improved care with lower overall costs. This in turn, is leading to an increasing demand for psychiatrists to work with primary care physicians in delivering integrated care. Telepsychiatry is an innovative platform that has a variety of benefits to patients, providers, and systems. Associated costs are changing as technology advances and policies shift. The purpose of this article is to describe the changing role of psychiatry within the environment of U.S. healthcare reform, and the benefits (demonstrated and potential) and costs (fixed, variable, and reimbursable) of telepsychiatry to providers, patients and systems.

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The ITM Model offers a needed union of integrated care and telemedicine through the combination of technology, business, and clinical processes. The success of MU as a tiered incentive program for EHRs, as well as the precedent of using waiver opportunities for incentive funding repayments, sets forth a strategic framework to successful implementation of ITM to address cost issues and improve quality and access to care in the healthcare system.