BACKGROUND: Research supports integrated pediatric behavioral health (BH), but evidence gaps remain in ensuring equitable care for children of all ages. In response, an interdisciplinary team codeveloped a stepped care model that expands BH services at 3 federally qualified health centers (FQHCs). METHODS: FQHCs reported monthly electronic medical record data regarding detection of BH issues, receipt of services, and psychotropic medications. Study staff reviewed charts of children with attention-deficit/hyperactivity disorder (ADHD) before and after implementation. RESULTS: Across 47 437 well-child visits, >80% included a complete BH screen, significantly higher than the state’s long-term average (67.5%; P < .001). Primary care providers identified >30% of children as having BH issues. Of these, 11.2% of children <5 years, 53.8% of 5–12 years, and 74.6% >12 years were referred for care. Children seen by BH staff on the day of referral (ie, “warm hand-off”) were more likely to complete an additional BH visit than children seen later (hazard ratio = 1.37; P < .0001). There was no change in the proportion of children prescribed psychotropic medications, but polypharmacy declined (from 9.5% to 5.7%; P < .001). After implementation, diagnostic rates for ADHD more than doubled compared with baseline, follow-up with a clinician within 30 days of diagnosis increased (62.9% before vs 78.3% after; P = .03) and prescriptions for psychotropic medication decreased (61.4% before vs 43.9% after; P = .03). CONCLUSIONS: Adding to a growing literature, results demonstrate that integrated BH care can improve services for children of all ages in FQHCs that predominantly serve marginalized populations.

Objective Substance use is a significant and common problem among school-aged youths throughout Africa. Like other countries on this continent, the West-African nation of Liberia is recovering from civil war. A well-educated population of young people is critical to the recovery efforts and long-term success of Liberia. Substance use by school-aged youths has important public health consequences that could undermine Liberia’s post-conflict recovery efforts. We wanted to better understand the culturally significant themes and subthemes related to substance use among youths attending public schools in Monrovia, Liberia. Methods A qualitative research design was used to collect data from 72 students attending public school in Monrovia, Liberia. Nine focus groups of 6–8 students from three public schools were facilitated using a semi-structured format to guide discussions on substance use. Student narratives were translated and re-occurring themes and subthemes were coded and analyzed. Results Four emergent themes described in this study were: Behaviors associated with substance use Consequences associated with individual use Consequences of substance use that affected the school milieu School-related factors that were protective from substance use. Subthemes associated with substance use included concealment of substances, intoxication and disruption of the classroom environment, expulsion from school, school drop-out, and school as protective against substance use. Conclusion Liberian school-aged youths described important themes and subthemes associated with substance use occurring within the school milieu. These data have germane public health ramifications, and could help inform larger epidemiologic study methods and public health interventions for Liberia and countries with similar profiles.

Objective: To describe the barriers and facilitators to integrating behavioral health services and pediatric primary care in federally qualified health centers (FQHCs) during the early stages of implementation. Method: We conducted 34 semistructured interviews with primary care providers (n ϭ 11), behavioral health clinicians (n ϭ 12), community health workers, and other pediatric staff (n ϭ 11) at 3 FQHCs. Themes were identified inductively using methods informed by grounded theory; inductively identified themes were then deductively organized within the Consolidated Framework for Implementation Research. Results: Interviewees perceived that the adoption and sustainability of behavioral health integration (BHI) in the pediatric practices of FQHCs were most dependent on barriers and facilitators in the outer setting (the health