Integrated Behavioral Health Care in Pediatric Primary Care: A Quality Improvement Project

Yogman, Michael W.; Betjemann, Susan; Sagaser, Anna; Brecher, Liza

doi:10.1177/0009922817730344

Cited by 21 publications

(26 citation statements)

References 46 publications

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“…Another recent study assessed how a single colocated behavioral health and care coordination integration model in a single urban pediatric primary care office was associated with changes in patient experience, provider experience, population health quality (eg, the Pediatric Symptom Checklist, PHQ‐9 Adolescent Depression Scale, Vanderbilt Assessment Scale), and medical expenditures. Results suggested that the intervention was associated with some measured improvements in population health quality and decreases in cost . However, the study was descriptive only; it did not report statistical significance nor did it include a comparison group.…”

Section: Discussionmentioning

confidence: 98%

“…Results suggested that the intervention was associated with some measured improvements in population health quality and decreases in cost. 65 However, the study was descriptive only; it did not report statistical significance nor did it include a comparison group. Our study serves as the first known study to assess the impact of a pediatric behavioral health integration model on health care utilization and cost using quasi-experimental methods.…”

Section: Discussionmentioning

confidence: 99%

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The effects of integrating behavioral health into primary care for low‐income children

Cole

Qin²,

Sheldrick

et al. 2019

Health Services Research

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Objective To evaluate the impact of TEAM UP—an initiative that fully integrates behavioral health services into pediatric primary care in three Boston‐area Community Health Centers (CHCs)—on health care utilization and costs. Data Sources 2014‐2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. Study Design We used a difference‐in‐difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014‐2016q2)‐ versus post (2016q3‐2017)‐intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. Principal Findings After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04‐1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. Conclusions Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low‐income children with MH needs.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

The effects of integrating behavioral health into primary care for low‐income children

Cole

Qin²,

Sheldrick

et al. 2019

Health Services Research

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“…11,12 The care integration model with the most evidence—collaborative care—emphasizes active collaboration and communication among care team members in collaboration with the pediatric primary care provider. 4 Indeed, numerous trials of collaborative care have documented improvements in mental and physical health outcomes for chronic adult psychiatric disorders (eg, depression, anxiety, bipolar disorder). 13,14 Adolescents and young adults with BH diagnoses have low BH treatment rates largely attributed to lack of integration.…”

Section: Benefits and Challenges Of Integrated Pediatric Health Carementioning

confidence: 99%

“…[1][2][3] BH concerns are among the top reasons families seek care in primary care medical homes. 4 Care integration offers several advantages, including increasing access to BH care for children in their medical home, 5 allowing families to work with a familiar provider, and providing practical, user-friendly materials to address child and caregiver BH. 6 Integration may also promote continuity of care by increasing the capacity of the indigenous workforce to engage families and deliver services, and reduce the risks for adverse family outcomes (eg, threats to child safety, need for more intensive services or placement).…”

mentioning

confidence: 99%

Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers

Kolko

Torres²,

Rumbarger³

et al. 2018

Clin Pediatr (Phila)

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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.

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“…Research shows that approximately 90% of children visit a pediatrician in any given year 2 . Pediatricians serve at the front‐line in identifying and treating behavioral health concerns in young patients 2‐5 . Most children with behavioral, developmental, and emotional problems are spotted first by pediatricians 6 .…”

Section: Introductionmentioning

confidence: 99%

A pediatrician‐friendly review of three common behavioral health screeners in pediatric practice: Findings and recommendations

Trafalis

Giannini

Joves

et al. 2021

Pediatric Investigation

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Behavioral health concerns are surging in pediatric practices. Fortunately, integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings to help shoulder the clinical load. Routine screening of behavioral health problems in primary care facilities enables early identification and treatment. However, deciding on sound, efficient, and scalable screening measures is sometimes arduous. Accordingly, this article presents a clinician‐friendly review of three common instruments useful in screening pediatric behavioral health concerns including anxiety, depression, and conduct problems. Psychometric findings and clinical applications of the Pediatric Symptom Checklist‐17 (PSC‐17), the Patient Health Questionnaire‐9 (PHQ‐9), and the Screen for Child Anxiety Related Emotional Disorders (SCARED) are delineated. Finally, clinical implications and recommendations for practicing pediatricians and child psychiatrists are offered.

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Integrated Behavioral Health Care in Pediatric Primary Care: A Quality Improvement Project

Abstract: The top 5 reasons for pediatric office visits in the United States today are behavioral health concerns. This article describes a colocated behavioral health and care coordination integration model in a pediatric primary care office to reduce barriers to behavioral health care.

Cited by 21 publications

References 46 publications

The effects of integrating behavioral health into primary care for low‐income children

The effects of integrating behavioral health into primary care for low‐income children

Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers

A pediatrician‐friendly review of three common behavioral health screeners in pediatric practice: Findings and recommendations

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