Impacting pediatric primary care: Opportunities and challenges for behavioral research in a shifting healthcare landscape.

Abstract

Behavior analysts have long recognized the potential of a partnership with pediatric medicine as an opportunity to expand the influence of behavior analysis and positively impact population health. Despite significant achievements in this domain, the impact of behavioral science on the daily practice of pediatrics has been limited. In this commentary, the authors argue that the current health care and research environments are ripe for a renewed focus on behavioral modification in pediatric primary care, with a particular emphasis on the study of high-frequency, low-intensity problems. They provide some analysis of why behavioral pediatrics has failed to gain traction in primary care, describe aspects of the current primary care practice and research landscapes that provide opportunities for an expanded portfolio of research, identify several exemplars from the behavior analytic literature that have influenced pediatric primary care or have the potential to do so, and make recommendations for producing influential data. Keywords integrated primary care; pediatric primary care; applied behavior analysis There has long been a strong argument for the benefits of merging of pediatric medicine and behavioral science to promote behavioral health (Smith, Rome, & Freedheim, 1967). This argument has varied some over time, but it generally hinges on a few well-established findings: (a) child behavior problems are quite common in pediatric settings (Arndorfer,

Physician Perspectives on Severe Behavior and Restraint Use in a Hospital Setting for Patients with Autism Spectrum Disorder

“…Both groups also identified a need for institutional policies that can help improve service delivery for patients with ASD. Importantly, even though the behavioral literature has widely examined behavioral interventions for increasing compliance with medical procedures (e.g., Kupzyk & Allen, 2019 ; Riley & Freeman, 2019 ), neither the medical trainees nor the physicians in this study demonstrated a strong understanding of behavioral function, as evidenced by attributing severe behavior to internal factors such as “maintaining inner peace.”…”

Introduction to the special issue on integrated pediatric primary care: Placing “how” in the context of now.

“…The collection of articles described above report on varied IPC models utilizing a range of qualitative and quantitative methodologies drawn from QI, implementation science, and health services research. Just as IPC clinicians must flexibly adapt interventions that were originally developed for specialty behavioral health settings, IPC researches must embrace a slew of scientific methods to adequately address the questions facing our field (Riley & Freeman, 2019). We need a workforce of clinicians and researchers with specialized knowledge and skills in implementation and evaluation that match the demands of the IPC setting.…”

Introduction to the special section on behavior analysis in integrated pediatric primary care.

“…These authors bring these issues to bear and remind us that historically, behavior analysts have not always paid enough attention to building rapport with patients and families. Riley and Freeman (2019) explore why the plethora of evidence-based treatments that have been developed to effectively treat child BH problems has not made their way into the primary care pediatric setting to date. The authors make the case that the demand for basic parent training techniques such as time-in and time-out remains robust, and despite all of the resources dedicated to addressing basic behavior problems in children, the problems are persisting and the demand remains strong.…”