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Gerson R, Sharma P, Lohr WD, Larson J. Strengthening Support for Community Mental Health Programs Through Partnership and Collective Impact. Child Adolesc Psychiatr Clin N Am 2024; 33:355-367. [PMID: 38823809 DOI: 10.1016/j.chc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Effective partnerships can profoundly impact outcomes for youth with behavioral health concerns. Partnerships occur at multiple levels - at the individual, organizational, state, and national levels. The Systems of Care (SOC) framework helps to conceptualize and articulate the skills necessary for forming partnerships in youth's mental health. This article explores values in the SOC framework and makes the case that the framework can help develop a "road map" to develop the skills needed to achieve successful partnerships. Impediments to effective partnerships are also discussed. Several case examples are given to illustrate the principles and impediments to partnership formation.
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Affiliation(s)
- Ruth Gerson
- Department of Child and Adolescent Psychiatry NYU Grossman School of Medicine, 1 Park Avenue, New York, NY 10016, USA
| | - Pravesh Sharma
- Mayo Clinic Health System, 1221 Whipple Street, Eau Claire, WI 54703, USA
| | - William David Lohr
- Division of Child and Adolescent Psychiatry and Pediatric Psychology, Department of Pediatrics, University of Louisville School of Medicine, Bingham Clinic, 200 E. Chestnut Street, Louisville, KY 40202, USA
| | - Justine Larson
- Sheppard Pratt Rockville, 4915 Aspen Hill Road, Rockville, MD 20853, USA.
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2
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Godoy L, Williams R, Druskin L, Fleece H, Bergen S, Avent G, Robb A, Biel MG, Wissow LS, Beers LS, Long M. Linking Primary Care to Community-Based Mental Health Resources via Family Navigation and Phone-Based Care Coordination. J Clin Psychol Med Settings 2024; 31:471-492. [PMID: 38265697 DOI: 10.1007/s10880-023-09987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/25/2024]
Abstract
Family navigation (FN) and phone-based care coordination may improve linkages from primary care to community-based mental health referrals, but research on their differential impact is limited. This mixed-methods study compared FN and phone-based care coordination in connecting families to mental health services from primary care. Families of children (56.3% male, mean age = 10.4 years, 85.4% Black) were sequentially assigned to either receive FN through a family-run organization or phone-based coordination via the child psychiatry access program (CPAP). Caregiver-reported children's mental health improved in both groups and both groups were satisfied with services. More families in the CPAP group had appointments made or completed (87%) than families in the FN group (71%) though the difference was not statistically significant. Future research with a larger sample that matches family needs and preferences (e.g., level and type of support) with navigation services would be beneficial.
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Affiliation(s)
- Leandra Godoy
- Children's National Hospital, Washington, DC, USA.
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Child Health Advocacy Institute, Children's National Hospital, 1 Inventa Place, Silver Spring, MD, 20910, USA.
| | | | | | | | | | - Gail Avent
- Total Family Care Coalition, Washington, DC, USA
| | - Adelaide Robb
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Matthew G Biel
- Georgetown University Medical Center/MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Lee Savio Beers
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Melissa Long
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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3
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Crespo-Gonzalez C, Hodgins M, Zurynski Y, Meyers Morris T, Le J, Wheeler K, Khano S, Germano S, Hiscock H, Lingam R. Advancing integrated paediatric care in Australian general practices: Qualitative insights from the SC4C GP-paediatrician model of care. PLoS One 2024; 19:e0302815. [PMID: 38771818 PMCID: PMC11108132 DOI: 10.1371/journal.pone.0302815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/14/2024] [Indexed: 05/23/2024] Open
Abstract
The Strengthening Care for Children (SC4C) is a general practitioner (GP)-paediatrician integrated model of care that consists of co-consulting sessions and case discussions in the general practice setting, with email and telephone support provided by paediatricians to GPs during weekdays. This model was implemented in 21 general practices in Australia (11 Victoria and 10 New South Wales). Our study aimed to identify the factors moderating the implementation of SC4C from the perspectives of GPs, general practice personnel, paediatricians and families. We conducted a qualitative study as part of the mixed-methods implementation evaluation of the SC4C trial. We collected data through virtual and in-person focus groups at the general practices and phone, virtual and in-person interviews. Data was analysed using an iterative hybrid inductive-deductive thematic analysis. Twenty-one focus groups and thirty-seven interviews were conducted. Overall, participants found SC4C acceptable and suitable for general practices, with GPs willing to learn and expand their paediatric care role. GPs cited improved confidence and knowledge due to the model. Paediatricians reported an enhanced understanding of the general practice context and the strain under which GPs work. GPs and paediatricians reported that this model allowed them to build trust-based relationships with a common goal of improving care for children. Additionally, they felt some aspects, including the lack of remuneration and the work and effort required to deliver the model, need to be considered for the long-term success of the model. Families expressed their satisfaction with the shared knowledge and quality of care jointly delivered by GPs and paediatricians and highlighted that this model of care provides easy access to specialty services without out-of-pocket costs. Future research should focus on finding strategies to ensure the long-term Implementation of this model of care with a particular focus on the individual stressors in general practices.
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Affiliation(s)
- Carmen Crespo-Gonzalez
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
| | - Michael Hodgins
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Tammy Meyers Morris
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Jane Le
- Murdoch Children’s Research Institute, Health Services and Economics Group, Parkville, Victoria, Australia
| | - Karen Wheeler
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
- Central and Eastern Sydney Primary Health Network, Sydney, NSW, Australia
| | - Sonia Khano
- Murdoch Children’s Research Institute, Health Services and Economics Group, Parkville, Victoria, Australia
| | - Stephanie Germano
- North Western Melbourne Primary Health Network, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children’s Research Institute, Health Services and Economics Group, Parkville, Victoria, Australia
- Professorial Fellow, Department of Paediatrics, The University of Melbourne
| | - Raghu Lingam
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
- Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia
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Richards MC, Benson NM, Kozloff N, Franklin MS. Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health. Psychiatr Serv 2024; 75:291-293. [PMID: 37711021 DOI: 10.1176/appi.ps.20220283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity.
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Affiliation(s)
- Misty C Richards
- Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Richards); McLean Hospital, Harvard Medical School, Belmont, Massachusetts (Benson); Department of Psychiatry, Faculty of Medicine, University of Toronto, and Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto (Kozloff); Department of Psychiatry and Behavioral Sciences and Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina (Franklin)
| | - Nicole M Benson
- Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Richards); McLean Hospital, Harvard Medical School, Belmont, Massachusetts (Benson); Department of Psychiatry, Faculty of Medicine, University of Toronto, and Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto (Kozloff); Department of Psychiatry and Behavioral Sciences and Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina (Franklin)
| | - Nicole Kozloff
- Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Richards); McLean Hospital, Harvard Medical School, Belmont, Massachusetts (Benson); Department of Psychiatry, Faculty of Medicine, University of Toronto, and Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto (Kozloff); Department of Psychiatry and Behavioral Sciences and Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina (Franklin)
| | - Michelle S Franklin
- Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Richards); McLean Hospital, Harvard Medical School, Belmont, Massachusetts (Benson); Department of Psychiatry, Faculty of Medicine, University of Toronto, and Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto (Kozloff); Department of Psychiatry and Behavioral Sciences and Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina (Franklin)
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5
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Lee CM, Jeung J, Yonek JC, Farghal M, Steinbuchel P. Using human-centered design to develop and implement a pediatric mental health care access program. Front Psychiatry 2024; 14:1283346. [PMID: 38260798 PMCID: PMC10802988 DOI: 10.3389/fpsyt.2023.1283346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
In 2019, the University of California at San Francisco (UCSF) launched the Child and Adolescent Psychiatry Portal (CAPP), a pediatric mental health care access (PMHCA) program providing remote mental health consultation services to pediatric primary care providers (PCPs) throughout Northern and Central California. The development and implementation of CAPP was guided by Human-Centered Design (HCD), an iterative, rapid-paced innovation process focusing on stakeholders' needs and experiences, which shaped the development of CAPP's programs. The resulting key programmatic elements are designed for pediatric workforce development: (1) PCP consultation with a child and adolescent psychiatrist via a telephone warmline; and (2) training and education for providers. CAPP has grown rapidly since its launch, having enrolled 1,714 providers from 257 practices spread across 36 counties and provided 3,288 consults on 2,703 unique lives as of August 2023. Preliminary evaluation findings indicate high PCP satisfaction with CAPP's services, despite continued challenges of integrating behavioral health into primary care. Throughout the HCD and implementation process, multidisciplinary partnerships have proven critical in providing end-user input to inform and improve program design. This growing network of partnerships, developed through the cultivation of personal relationships and trust over time, has also proven essential for CAPP's rapid growth and sustainability. Overall, this Community Case Study highlights the critical role of partnerships and the importance of taking a people-centered approach, as captured in CAPP's motto, "Connecting for Care."
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Affiliation(s)
- Chuan Mei Lee
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Joan Jeung
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Juliet C. Yonek
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mahmoud Farghal
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Petra Steinbuchel
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Kanj G, Hallit S, Obeid S. The relationship between childhood emotional abuse and borderline personality disorder: the mediating role of difficulties in emotion regulation among Lebanese adults. Borderline Personal Disord Emot Dysregul 2023; 10:34. [PMID: 37986013 PMCID: PMC10662025 DOI: 10.1186/s40479-023-00241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE The present study investigates the mediating effect of difficulties in emotion regulation in the association between childhood emotional abuse and Borderline Personality Disorder (BPD) among Lebanese adults. METHOD This cross-sectional study, involving 411 participants, was conducted between March and August 2022. Lebanese individuals from all governorates of the country were recruited using the Snowball Sampling technique. Three self-report scales were utilized to complete this research; the 'Difficulties in Emotion Regulation Scale-Brief Version (DERS-16)' which evaluates the difficulties in emotion regulation of individuals, the 'Childhood Trauma Questionnaire-Short Form (CTQ-SF)' which grants a subjective evaluation of the general childhood environment of the participants, as well as the 'Borderline Personality Questionnaire (BPQ)' which measures Borderline Personality Disorder traits, that demonstrate significant convergence with the disorder. RESULTS The results indicate that DERS-16 played an indirect effect role between childhood emotional abuse scores and Borderline Personality Disorder. Higher emotional abuse scores were significantly associated with higher DERS-16 scores, which in turn was significantly associated with higher BPQ scores. Moreover, childhood emotional abuse was directly associated with higher BPQ scores. CONCLUSION This work suggests that, among the different forms of childhood abuse, emotional abuse may have a role in the development of Borderline Personality Disorder. Training on emotion regulation strategies would potentially benefit individuals in preventing BPD development and facilitating therapeutic processes.
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Affiliation(s)
- Gaelle Kanj
- School of Arts and Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
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Leppert ML, Bettencourt A, Harrison JN. Behavioral Concerns in Early Childhood Consultation: Diagnostic Overshadowing and Comorbidity. Clin Pediatr (Phila) 2023; 62:1315-1317. [PMID: 36908070 DOI: 10.1177/00099228231157960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Mary L Leppert
- Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amie Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joyce N Harrison
- Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Arora BK, Klein MJ, Yousif C, Khacheryan A, Walter HJ. Virtual Collaborative Behavioral Health Model in a Community Pediatric Network: Two-Year Outcomes. Clin Pediatr (Phila) 2023; 62:1414-1425. [PMID: 36988180 DOI: 10.1177/00099228231164478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Due to the pervasive shortage of behavioral health (BH) specialists, collaborative partnerships between pediatric primary care practitioners (PPCPs) and BH specialists can enhance provision of BH services by PPCPs. We aimed to create a new model of collaborative care that was mostly virtual, affordable, and scalable. The pilot program was implemented in 18 practices (48 PPCPs serving approximately 150 000 patients) in 2 consecutive cohorts. Outcomes were assessed by administering pre-program and post-program surveys. Across the 18 practices, PPCPs reported significantly increased confidence in their BH knowledge and skills, and significantly increased their provision of target BH services. Barriers to BH service provision (resources, time, and staff) were unchanged. This compact, mostly virtual model of BH collaboration appears to be beneficial to PPCPs while also offering convenience to patients and affordability and scalability to the practice network.
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Affiliation(s)
- Bhavana Kumar Arora
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Margaret J Klein
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Anesthesiology Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Heather J Walter
- Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Lee CM, Yonek J, Lin B, Bechelli M, Steinbuchel P, Fortuna L, Mangurian C. Systematic Review: Child Psychiatry Access Program Outcomes. JAACAP OPEN 2023; 1:154-172. [PMID: 38189028 PMCID: PMC10769201 DOI: 10.1016/j.jaacop.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Objective There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs. Method A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health. Results None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost(n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs. Conclusion Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs. Diversity & Inclusion Statement One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. Clinical trial registration information Child Psychiatry Access Programs: A Systematic Review; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410; CRD42020146410.
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Affiliation(s)
- Chuan-Mei Lee
- University of California, San Francisco
- Stanford University School of Medicine
| | | | | | | | | | | | - Christina Mangurian
- University of California, San Francisco
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital
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Tengelitsch E, Hughes-Krieger E, LePlatte D, Shaw-Johnston S, Marcus S. The integration of behavioral health consultants within a state-wide psychiatry consultation program: a community case study. Front Psychiatry 2023; 14:1187927. [PMID: 37663604 PMCID: PMC10471313 DOI: 10.3389/fpsyt.2023.1187927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
This paper describes the integration and role of masters-prepared behavioral health consultants (BHCs) within a state-wide psychiatry consultation program for children, adolescents, and perinatal women. Data from the Michigan Clinical Consultation and Care (MC3) program are reviewed, with attention to the role that BHCs play in the consultation process, integrated care, screening, and their dual roles with Community Mental Health Services Programs (CMHSPs) in Michigan. Approximately 82% of MC3 services are provided by the BHCs and involve resources or integrated care. BHCs play a role in managing provider consultations and connecting patients and providers to resources in the MC3 program.
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Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M, Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry 2023; 62:91-119. [PMID: 35779696 DOI: 10.1016/j.jaac.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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Shaligram D, Walter HJ. Utilization and Outcomes of Direct Consultation in a Child Psychiatry Access Program. Psychiatr Serv 2023; 74:100-103. [PMID: 36226370 DOI: 10.1176/appi.ps.20220093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The high prevalence of child and adolescent psychiatric disorders in the United States, coupled with the severe and pervasive shortage of child and adolescent psychiatrists, has led 46 states and territories to launch programs providing child psychiatry consultation to pediatricians. Although these programs aim to increase access to psychiatric expertise, evidence of favorable program outcomes beyond user satisfaction has been limited. Findings from the authors' child psychiatry consultation program suggest that such programs may enable pediatricians to manage most cases referred for consultation, thereby extending the behavioral health workforce to the primary care setting.
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Affiliation(s)
- Deepika Shaligram
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, and Harvard Medical School, Boston
| | - Heather J Walter
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, and Harvard Medical School, Boston
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13
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Godoy L, Hamburger S, Druskin LR, Willing L, Bostic JQ, Pustilnik SD, Beers LS, Biel MG, Long M. DC Mental Health Access in Pediatrics: Evaluating a Child Psychiatry Access Program in Washington, DC. J Pediatr Health Care 2022; 37:302-310. [PMID: 36529554 DOI: 10.1016/j.pedhc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Child psychiatry access programs (CPAPs) provide primary care providers (PCPs) with assistance in mental health diagnosis, management, and resource navigation. METHOD Data collected from DC Mental Health Access in Pediatrics (MAP) included PCPs and patient demographics, clinical encounter information, and provider satisfaction. RESULTS DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP. DISCUSSION DC MAP grew quickly, highlighting program impact and need. Demand for care coordination required flexible staffing and highlighted the need for coordination in pediatrics. Child psychiatry access programs offer an innovative way to enhance PCP management of their patients' mental health needs.
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14
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Bettencourt AF, Coble K, Reinblatt SP, Jadhav S, Khan KN, Riddle MA. Characteristics of Patients Served by a Statewide Child Psychiatry Access Program. Psychiatr Serv 2022:appips20220323. [PMID: 36475823 DOI: 10.1176/appi.ps.20220323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Maryland's Behavioral Health Integration in Pediatric Primary Care (BHIPP) is a child psychiatry access program offering child-adolescent psychiatry consultation, resource and referral networking, and direct-to-patient mental health intervention. This study investigated characteristics of patients for whom primary care providers sought BHIPP services. METHODS Data from 6,939 unique patient contacts between October 2012 and March 2020 were collected on service type, demographic characteristics, presenting concerns, clinical severity, clinicians' diagnostic impressions, current treatments, and BHIPP recommendations. Descriptive statistics and latent class analysis were used. RESULTS Of the 6,939 patient contacts, 38.6% were for direct-to-patient mental health intervention, 27.3% for child-adolescent psychiatry consultation, and 34.2% for resource and referral networking. In total, 50.3% of patients were female, 58.7% were White, and 32.7% were already receiving mental health services. Latent class analysis identified four classes of presenting concerns: anxiety only (44.2%); behavior problems only (30.7%); mood and anxiety (17.1%); and attention, behavior, and learning problems (8.0%). Compared with patients in the anxiety-only class, those in the attention, behavior, and learning problems class were more likely to receive direct-to-patient mental health intervention (OR=3.59), and BHIPP clinicians were more likely to recommend in-office behavioral interventions for those in the mood and anxiety class (OR=1.62) and behavior problems-only class (OR=1.55). CONCLUSIONS Patients supported through BHIPP varied in presenting concerns, condition severity and complexity, current receipt of services, and BHIPP utilization. Latent class analysis yielded more clinically useful information about the nature and complexity of patients' concerns than did consideration of individual presenting concerns.
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Affiliation(s)
- Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Kelly Coble
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Shauna P Reinblatt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Sneha Jadhav
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Kainat N Khan
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Mark A Riddle
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
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15
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Overstreet K, Derouin A. Improving Interprofessional Collaboration Between Behavioral Mental Health and Pediatric Primary Care Providers Through Standardized Communication. J Pediatr Health Care 2022; 36:582-588. [PMID: 35945101 DOI: 10.1016/j.pedhc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pediatric mental health crisis increases demand for integrated behavioral health and pediatric primary care providers (PPCP). Communication is key to successful integrated pediatric behavioral-mental health, but studies demonstrate gaps between existing and desired communication practices. Project aims to improve PPCP factors and patient outcomes by implementing standardized communication tool in the Electronic Health Record (EHR). METHOD Pre-post 20-week intervention. SETTING AND SAMPLE Pediatric primary care and affiliated pediatric behavioral-mental health clinic of academic health system. PBMH patients and referring PPCPs. MEASURES PPCP satisfaction with communication, comfort and confidence continuing mental health care pre-post PBMH consult, and patient appointment attendance. RESULTS PPCP confidence and comfort treating mental health in primary care increased. No significant change in PPCP satisfaction after implementing standardized communication. Identified factors associated with patient appointment continuity. DISCUSSION Standardized EHR communication tools and enhancing PPCP confidence in managing common pediatric mental health conditions are effective collaboration strategies.
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Affiliation(s)
- Kari Overstreet
- Kari Overstreet, Pediatric Nurse Practitioner, Department of Psychiatry and Behavioral Sciences, Child Division, Duke University Health System, Durham, NC; Anne Derouin, Professor & Assistant Dean Master of Science in Nursing Program, Duke University School of Nursing, Durham, NC.
| | - Anne Derouin
- Kari Overstreet, Pediatric Nurse Practitioner, Department of Psychiatry and Behavioral Sciences, Child Division, Duke University Health System, Durham, NC; Anne Derouin, Professor & Assistant Dean Master of Science in Nursing Program, Duke University School of Nursing, Durham, NC
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16
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Lee CM, Lutz J, Khau A, Lin B, Phillip N, Ackerman S, Steinbuchel P, Mangurian C. Pediatric Primary Care Perspectives of Mental Health Services Delivery during the COVID-19 Pandemic. CHILDREN 2022; 9:children9081167. [PMID: 36010056 PMCID: PMC9406881 DOI: 10.3390/children9081167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
Due to a national shortage of child and adolescent psychiatrists, pediatric primary care providers (PCPs) are often responsible for the screening, evaluation, and treatment of mental health disorders. COVID-19 pandemic stay-at-home orders decreased access to mental health care and increased behavioral and emotional difficulties in children and adolescents. Despite increased demand upon clinicians, little is known about mental health care delivery in the pediatric primary care setting during the pandemic. This focus group study explored the experiences of pediatric PCPs and clinical staff delivering mental health care during the pandemic. Transcripts from nine focus groups with San Francisco Bay Area primary care practices between April and August 2020 were analyzed using a thematic analysis approach. Providers expressed challenges at the patient-, provider-, and system-levels. Many providers reported increased patient mental health symptomatology during the pandemic, which was often intertwined with patients’ social determinants of health. Clinicians discussed the burden of the pandemic their own wellness, and how the rapid shift to telehealth primary care and mental health services seemed to hinder the availability and effectiveness of many resources. The findings from this study can inform the creation of new supports for PCPs and clinical staff providing mental health care.
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Affiliation(s)
- Chuan Mei Lee
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA;
- Clinical Excellence Research Center, School of Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
- Correspondence: ; Tel.: +1-415-476-7000 or +1-415-502-6361
| | - Jessica Lutz
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Allyson Khau
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Brendon Lin
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Nathan Phillip
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Sara Ackerman
- Department of Social and Behavioral Sciences, University of California San Francisco, 490 Illinois St., Floor 12, Box 0612, San Francisco, CA 94143, USA;
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd Floor, San Francisco, CA 94158, USA
| | - Petra Steinbuchel
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA;
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd Floor, San Francisco, CA 94158, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, 2789 25th St., San Francisco, CA 94110, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., San Francisco, CA 94158, USA
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17
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Clinical Update: Child and Adolescent Behavioral Health Care in Community Systems of Care. J Am Acad Child Adolesc Psychiatry 2022; 62:367-384. [PMID: 35690302 DOI: 10.1016/j.jaac.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of community systems of care as they pertain to the delivery of behavioral health care to children and adolescents METHOD: A search of the literature on this topic from 2002 was initially conducted in 2016 and repeated in 2019 and 2021, yielding 1,604 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 1,684 total citations, of which 1,184 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 156 based on relevance to the topic. RESULTS The systems of care approach, arising in the 1980s, expanded child and adolescent behavioral health care from the core services of psychotherapy, medication management, inpatient psychiatric services, and residential treatment to include home- and community-based treatment and support services; promotion, prevention, and early intervention programs; and specialized services for very young children and youth and young adults of transition age. These services and supports are delivered by a large multidisciplinary workforce and are governed by key principles, including a biopsychosocial case conceptualization; family-driven, youth-guided, strengths-based, and trauma-informed care. Services in the least restrictive setting; continuity of care across transitions; a public health framework for service delivery; promotion of wellness and resilience; and elimination of health disparities. Challenges to systems of care implementation include funding availability, workforce shortages, deficiencies in cross-systems collaboration, and variability in insurance coverage. Although controlled studies have failed to provide convincing evidence of favorable outcomes from the whole systems of care approach, uncontrolled research has demonstrated increased access to care, positive clinical and functional outcomes, improved family functioning, and reductions in costs, particularly when research is focused on specific behavioral health problems, specific interventions such as Wraparound care, or highly specified groups of youth. CONCLUSION Health professionals who are educated in the systems of care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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18
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Long M, Coates E, Price OA, Hoffman SB. Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches. J Pediatr 2022; 245:15-21. [PMID: 35151683 PMCID: PMC8828438 DOI: 10.1016/j.jpeds.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Melissa Long
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC.
| | - Erica Coates
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC
| | - Olga Acosta Price
- Department of Prevention and Community Health, Milken Institute School of Public Health, the George Washington University, Washington, DC
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19
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Sharma N, Asaf A, Vaivada T, Bhutta ZA. Delivery Strategies Supporting School-Age Child Health: A Systematic Review. Pediatrics 2022; 149:186937. [PMID: 35503326 DOI: 10.1542/peds.2021-053852l] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
CONTEXT School-aged children (SAC; 5-9 years) remain understudied in global efforts to examine intervention effectiveness and scale up evidence-based interventions. OBJECTIVE This review summarizes the available evidence describing the effectiveness of key strategies to deliver school-age interventions. DATA SOURCES We searched Medline, PsycINFO, Campbell Collaboration, and The Cochrane Library during November 2020. STUDY SELECTION Systematic reviews and meta-analyses that: target SAC, examine effective delivery of well-established interventions, focus on low- and middle-income countries (LMICs), were published after 2010, and focus on generalizable, rather than special, populations. DATA EXTRACTION Two reviewers conducted title and abstract screening, full-text screening, data extraction, and quality assessments. RESULTS Sixty reviews met the selection criteria, with 35 containing evidence from LMICs. The outcomes assessed and the reported effectiveness of interventions varied within and across delivery strategies. Overall, community, school, and financial strategies improved several child health outcomes. The greatest evidence was found for the use of community-based interventions to improve infectious disease outcomes, such as malaria control and prevention. School-based interventions improved child development and infectious disease-related outcomes. Financial strategies improved school enrollment, food security, and dietary diversity. LIMITATIONS Relatively few LMIC studies examined facility, digital, and self-management strategies. Additionally, we found considerable heterogeneity within and across delivery strategies and review authors reported methodological limitations within the studies. CONCLUSIONS Despite limited research, available information suggests community-based strategies can be effective for the introduction of a range of interventions to support healthy growth and development in SAC. These also have the potential to reduce disparities and reach at-risk and marginalized populations.
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Affiliation(s)
- Naeha Sharma
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Ayesha Asaf
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Center of Excellence in Women and Child Health, Institute for Global Health & Development, Aga Khan University Hospital, Karachi, Pakistan
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20
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Reinblatt SP, Coble K, Williams JLL, Cotton AM, Bettencourt AF. Characteristics of Primary Care Providers’ Consultations with a Statewide Child Psychiatry Access Program Regarding Autism Spectrum Disorder. J Acad Consult Liaison Psychiatry 2022; 63:463-473. [DOI: 10.1016/j.jaclp.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/08/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
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21
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Bettencourt AF, Ferro RA, Williams JLL, Khan KN, Platt RE, Sweeney S, Coble K. Pediatric Primary Care Provider Comfort with Mental Health Practices: A Needs Assessment of Regions with Shortages of Treatment Access. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:429-434. [PMID: 33786779 PMCID: PMC8009637 DOI: 10.1007/s40596-021-01434-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Nearly 50% of children with a mental health concern do not receive treatment. Child Psychiatry Access Programs like Behavioral Health Integration in Pediatric Primary Care (BHIPP) address regional shortages of mental health treatment access by providing training and consultation to primary care providers (PCPs) in managing mental health concerns. This study assessed PCPs' comfort with mental health practices to inform expansion of BHIPP services. METHODS Pediatric PCPs in 114 practices in three rural regions of Maryland were recruited to participate in a survey about their comfort with mental health practices and access to mental health providers for referral. Descriptives, Friedman's test, and post hoc pairwise comparisons were used to examine survey responses. RESULTS Participants were 107 PCPs. Most respondents were physicians (53.3%) or nurse practitioners/physician's assistants (39.3%). Friedman's test, χ2(7)= 210.15, p<.001, revealed significant within and between-group differences in PCP comfort with mental health practices. Post hoc pairwise comparisons indicated greater comfort providing mental health screening and referrals compared to prescribing psychiatric medications, providing psychoeducation or in-office mental health interventions. A Wilcoxon-signed rank test showed significantly more respondents agreed they could find a therapist than a psychiatrist in a timely manner, Z= -5.93, p<.001. CONCLUSIONS Pediatric PCPs were more comfortable with providing mental health assessment and referrals than treatment. However, PCPs reported difficulty finding therapists and psychiatrists for their patients. Findings underscore the need for longitudinal training to increase PCP comfort with mental health treatment. Additionally, strategies such as telepsychiatry are needed to address the disproportionate need for child psychiatrists.
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Affiliation(s)
| | | | | | - Kainat N Khan
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Sarah Sweeney
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelly Coble
- University of Maryland School of Medicine, Baltimore, MD, USA
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22
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Walter HJ, Vernacchio L, Correa ET, Bromberg J, Goodman E, Barton J, Young GJ, DeMaso DR, Focht G. Five-Phase Replication of Behavioral Health Integration in Pediatric Primary Care. Pediatrics 2021; 148:peds.2020-001073. [PMID: 34210739 DOI: 10.1542/peds.2020-001073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Because of severe and protracted shortages of pediatric behavioral health (BH) specialists, collaboration between pediatric primary care practitioners (PCPs) and BH specialists has the potential to increase access to BH services by expanding the BH workforce. In a previous study, we demonstrated that phase 1 of a behavioral health integration program (BHIP) enrolling 13 independently owned, community-based pediatric practices was associated with increased access to BH services while averting substantial cost increases and achieving high provider self-efficacy and professional satisfaction. The current study was undertaken to assess whether the initial access findings were replicated over 4 subsequent implementation phases and to explore the practicality of broad dissemination of the BHIP model. METHODS After phase 1, BHIP was extended over 4 subsequent phases in a stepped-wedge design to 46 additional pediatric practices, for a total cohort of 59 practices (354 PCPs serving >300 000 patients). Program components comprised BH education and consultation and support for integrated practice transformation; these components facilitated on-site BH services by an interprofessional BH team. Outcomes were assessed quarterly, preprogram and postprogram launch. RESULTS Across combined phases 1 to 5, BHIP was associated with increased primary care access to BH services (screening, psychotherapy, PCP BH visits, psychotropic prescribing) and performed well across 7 standard implementation outcome domains (acceptability, appropriateness, feasibility, fidelity, adoption, penetration, and sustainability). Emergency BH visits and attention-deficit/hyperactivity disorder prescribing were unchanged. CONCLUSIONS These findings provide further support for the potential of integrated care to increase access to BH services in pediatric primary care.
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Affiliation(s)
- Heather J Walter
- Departments of Psychiatry .,Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Louis Vernacchio
- Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Boston, Massachusetts
| | | | - Jonas Bromberg
- Departments of Psychiatry.,Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | | | - Jessica Barton
- Social Work, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gregory J Young
- Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Boston, Massachusetts
| | | | - Glenn Focht
- Connecticut Children's Medical Center, Hartford, Connecticut
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23
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Bettencourt AF, Plesko CM. A Systematic Review of the Methods Used to Evaluate Child Psychiatry Access Programs. Acad Pediatr 2020; 20:1071-1082. [PMID: 32673763 DOI: 10.1016/j.acap.2020.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/12/2020] [Accepted: 07/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a well-documented gap between the need for and availability of mental health services for children nationwide. To address this gap, over 30 regional Child Psychiatry Access Programs (CPAPs) provide psychiatric consultation and other services to primary care providers. OBJECTIVE Summarize the methods used to evaluate CPAPs in the United States. DATA SOURCES PubMed, PsychInfo, CINAHL, and reference checking. STUDY APPRAISAL METHODS A systematic literature review was conducted searching 3 databases. The search produced 307 unique articles, 278 were excluded for irrelevance, leaving 29 for data extraction. Data extracted included author(s), publication year, provider types, CPAP formats, study sample, design, outcomes examined, results, and limitations. Articles were also appraised for quality using the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide. RESULTS The 29 articles evaluated 13 unique CPAPs. Most evaluations used nonexperimental observational designs (68.9%), 6.9% used quasi-experimental designs, and none used true experimental designs. Evaluations examined the following outcomes: usage of program services (82.8%), provider satisfaction (48.3%), provider comfort/confidence with managing mental health concerns (31.0%), provider practice change (24.1%), patient outcomes (13.7%), and family satisfaction (6.9%). Outcomes were measured using surveys, qualitative interviews, or insurance claims data. LIMITATIONS Review was limited to articles published in English in 3 databases or identified by reference checking. CONCLUSIONS Evaluations of CPAPs have largely been descriptive in nature, focusing primarily on program usage and provider satisfaction. Few studies have examined the impact of CPAPs on patients, families, or health systems. Future studies should evaluate the broader impacts of CPAPs.
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