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Schweitzer J, Bird A, Bowers H, Carr-Lee N, Gibney J, Schellinger K, Holt JR, Adams DP, Hensler DJ, Hollenbach K. Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges. Front Psychiatry 2023; 14:1252037. [PMID: 38045623 PMCID: PMC10693412 DOI: 10.3389/fpsyt.2023.1252037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Children and adolescents often do not receive mental healthcare when they need it. By 2021, the complex impact of the COVID-19 pandemic, structural racism, inequality in access to healthcare, and a growing shortage of mental health providers led to a national emergency in child and adolescent mental health in the United States. The need for effective, accessible treatment is more pressing than ever. Interdisciplinary, team-based pediatric integrated mental healthcare has been shown to be efficacious, accessible, and cost-effective. Methods In response to the youth mental health crisis, Rady Children's Hospital-San Diego's Transforming Mental Health Initiative aimed to increase early identification of mental illness and improve access to effective treatment for children and adolescents. A stakeholder engagement process was established with affiliated pediatric clinics, community mental health organizations, and existing pediatric integrated care programs, leading to the development of the Primary Care Mental Health Integration program and drawing from established models of integrated care: Primary Care Behavioral Health and Collaborative Care. Results As of 2023, the Primary Care Mental Health Integration program established integrated care teams in 10 primary care clinics across San Diego and Riverside counties in California. Measurement-based care has been implemented and preliminary results indicate that patient response to therapy has resulted in a 44% reduction in anxiety symptoms and a 62% decrease in depression symptoms. The program works toward fiscal sustainability via fee-for-service reimbursement and more comprehensive payor contracts. The impact on patients, primary care provider satisfaction, measurement-based care, funding strategies, as well as challenges faced and changes made will be discussed using the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Discussion Preliminary results suggest that the Primary Care Mental Health Integration is a highly collaborative integrated care model that identifies the needs of children and adolescents and delivers brief, evidence informed treatment. The successful integration of this model into 10 primary care clinics over 3 years has laid the groundwork for future program expansion. This model of care can play a role addressing youth mental health and increasing access to care. Challenges, successes, and lessons learned will be reviewed.
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Affiliation(s)
- Jason Schweitzer
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Anne Bird
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Hilary Bowers
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
- Children’s Primary Care Medical Group, San Diego, CA, United States
| | - Nicole Carr-Lee
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Josh Gibney
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Kriston Schellinger
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Jasmine R. Holt
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Devin P. Adams
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Domonique J. Hensler
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Kathryn Hollenbach
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
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Lines MM. Pediatric Integrated Primary Care:: A Population Health Approach to Meeting the Behavioral Health Needs of Children and Families. Dela J Public Health 2022; 8:6-9. [PMID: 35692992 PMCID: PMC9162403 DOI: 10.32481/djph.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Addressing the behavioral health needs of the population is a growing public health concern; a significant portion of the population struggles with behavioral health challenges yet access to care is limited due to a multitude of barriers. Research has demonstrated that integration of behavioral health providers into the primary care team is an effective means of increasing care access and reducing barriers to care. While there has been an uptake in integrated primary care (IPC) in adult healthcare, there is significant opportunity for expanding IPC in pediatrics. Nemours Children's Health has developed a model IPC program to serve children and youth in Delaware and train future behavioral health professionals. Policy to support payment for IPC services and fund workforce development will be essential to sustaining the Nemours program as well as expanding this and other IPC models in order to serve more children and youth in Delaware and beyond.
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Affiliation(s)
- Meghan McAuliffe Lines
- Clinical Director, Integrated Primary Care & School-Based Behavioral Health, Nemours Children's Health, Delaware; Clinical Associate Professor of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University
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Lavigne JV, Meyers KM. Meta-Analysis: Association of Parent and Child Mental Health with Pediatric Health Care Utilization. J Pediatr Psychol 2020; 44:1097-1110. [PMID: 31233147 DOI: 10.1093/jpepsy/jsz049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the association of psychological factors and pediatric health care utilization. METHOD Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria. RESULTS There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38). CONCLUSIONS Child and parent MH problems are significantly associated with increased HCU.
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