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

Kolko, David J.; Torres, Eunice; Rumbarger, Kevin; James, Everette; Turchi, Renee M.; Bumgardner, Cheryl; O’Brien, Connell

doi:10.1177/0009922818810881

Cited by 14 publications

(27 citation statements)

References 50 publications

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“…28 Beyond identifying implementation factors, this study addresses the paucity of research about the benefits of pediatric BHI for providers. 21 Similar to prior work, 32 participants described strong feelings of professional fulfillment from providing better care to children and families through BHI. Some participants noted that collaborating and sharing patient care with integrated team members helped prevent burnout from managing complex BH and psychosocial issues.…”

Section: Discussionmentioning

confidence: 61%

“…Despite the emergence of pediatric BHI as a promising strategy to improve access to child BH services, little research exists to guide BHI implementation. 21,22 Yet, understanding factors affecting implementation of new interventions is critical for achieving desired clinical outcomes. 23 Thus, we assessed the impact of BHI on clinical practice and identified facilitators and barriers to BHI implementation from the perspective of a multidisciplinary group of professionals involved in a comprehensive pediatric BHI initiative at 3 CHCs.…”

Section: Discussionmentioning

confidence: 99%

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Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Fong

Tamene

Morley

et al. 2019

Clin Pediatr (Phila)

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Pediatric behavioral health integration (BHI) represents a promising approach to address unmet child mental health need but little research exists to guide BHI implementation. Through in-depth interviews with 38 professionals involved in a comprehensive pediatric BHI initiative at 3 community health centers, we explored perceptions of the impact of BHI on clinical practice, and facilitators and barriers to BHI implementation. Professionals identified 2 overarching themes about the impact of BHI on clinical practice (greater interdisciplinary collaboration/communication and enhanced provider wellness); 5 themes about facilitators of BHI (staff buy-in for BHI, leadership support, staff belonging to the same team culturally and/or structurally, co-location with close physical proximity, and data-driven quality improvement); and 5 themes about barriers to BHI (inadequate clinician staffing, insufficient space, limited provider time, billing/reimbursement issues, and care coordination challenges). Future pediatric BHI efforts may consider these findings to develop strategies to promote facilitators and reduce barriers during implementation.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Fong

Tamene

Morley

et al. 2019

Clin Pediatr (Phila)

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“…Case studies in seven countries suggest that a lack of primary care engagement in most initiatives may be due to the hesitancy of primary care providers to share data about their patients and to play a proactive role in care delivery [13]. Other barriers to PCP engagement in integrated care initiatives have included availability of primary care physicians, reimbursement, legal liabilities and accountabilities, information technology, complexity of chronic disease management, as well as local contextual factors [14,15].…”

Section: Introductionmentioning

confidence: 99%

Factors Impacting Primary Care Engagement in a New Approach to Integrating Care in Ontario, Canada

Everall

Kokorelias

Sibbald

et al. 2022

International Journal of Integrated Care

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In 2019, Ontario's Ministry of Health (the Ministry) introduced Ontario Health Teams (OHTs) to provide population-based integrated healthcare. Primary care was foundational to this approach. We sought to identify factors that impacted primary care engagement during OHT formation from different perspectives.Methods: Interviews with 111 participants (administrators n = 80; primary care providers n = 17; patient family advisors = 14) from 11 OHTs were conducted following a semi-structured guide. Interviews were transcribed, coded, and thematically analyzed.Results: Participants felt that primary care engagement was an ongoing, continuous cycle. Four themes were identified: 1) 'A low rules environment': limited direction from the Ministry (system-level), 2) 'They're at different starting points': impact of local context (initiative-level); 3) 'We want primary care to be actively involved': engagement efforts made by OHTs (initiative-level); 4) 'Waiting to hear a little bit more': primary care concerns about the OHT approach (sector-level). Thirteen factors impacting primary care engagement were identified across the four themes. Discussion and Conclusion:The 13 factors influencing primary care engagement were interconnected and operated at health system, integrated care initiative, and sector levels. Future research should focus on integrated care initiatives as they mature, to address potential gaps in the involvement of primary care physicians.

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“…This study draws upon the EPIS framework to organize our understanding of barriers and facilitators (i.e., determinants) [ 32 , 33 ]. Common inner context determinants of CCMs include those related to individual provider characteristics (e.g., attitudes, self-efficacy), leadership, and organizational characteristics [ 20 , 25 – 30 , 34 ]. Team functioning is also a key determinant in team-based service settings like primary care [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial

et al. 2022

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Background Implementation facilitation is an effective strategy to support the implementation of evidence-based practices (EBPs), but our understanding of multilevel strategies and the mechanisms of change within the “black box” of implementation facilitation is limited. This implementation trial seeks to disentangle and evaluate the effects of facilitation strategies that separately target the care team and leadership levels on implementation of a collaborative care model in pediatric primary care. Strategies targeting the provider care team (TEAM) should engage team-level mechanisms, and strategies targeting leaders (LEAD) should engage organizational mechanisms. Methods We will conduct a hybrid type 3 effectiveness–implementation trial in a 2 × 2 factorial design to evaluate the main and interactive effects of TEAM and LEAD and test for mediation and moderation of effects. Twenty-four pediatric primary care practices will receive standard REP training to implement Doctor–Office Collaborative Care (DOCC) and then be randomized to (1) Standard REP only, (2) TEAM, (3) LEAD, or (4) TEAM + LEAD. Implementation outcomes are DOCC service delivery and change in practice-level care management competencies. Clinical outcomes are child symptom severity and quality of life. Discussion This statewide trial is one of the first to test the unique and synergistic effects of implementation strategies targeting care teams and practice leadership. It will advance our knowledge of effective care team and practice-level implementation strategies and mechanisms of change. Findings will support efforts to improve common child behavioral health conditions by optimizing scale-up and sustainment of CCMs in a pediatric patient-centered medical home. Trial registration ClinicalTrials.gov, NCT04946253. Registered June 30, 2021.

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

Cited by 14 publications

References 50 publications

Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Factors Impacting Primary Care Engagement in a New Approach to Integrating Care in Ontario, Canada

Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial

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