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Clozapine toxicity developed in 3 patients admitted to a medical setting suspected to be related to infection and/or inflammation. Clinicians should be aware of this potential adverse drug event with clozapine.

Objective: Referrals initiated via the "warm handoff" (HO) common to consultationbased models of integrated primary care are theorized to add value for patient outcomes relative to referral as usual (RAU) processes often used in colocated service models. The current evaluation tested this assumption in terms of impact on patient engagement, medical system utilization, and behavioral health system utilization. Method: Shortterm longitudinal data were extracted for 175 integrated behavioral health referrals across urban pediatric primary care patients. A retrospective cohort design was used to assess differences between patients exposed to an HO immediately following referral versus RAU (control). Results: Analyses revealed significant differences for patients referred via HO at different time points, including fewer primary care provider appointment no-show/same-day cancellations, greater total behavioral health encounters, and fewer days from referral to any scheduled or completed follow-up behavioral health encounter. Conclusions: Consultation via HOs was associated with some shortterm benefits on patient engagement and systems utilization for urban pediatric primary care patients compared to RAU. Preliminary findings may help stakeholders leverage the need for integrated (vs. colocated) models of pediatric integrated primary care to help inform economic-or value-based decisions on program development and promote care approaches that increase the likelihood of families staying engaged in care. Implications for Impact Statement"Warm handoffs" for immediate behavioral health consultation were associated with better pediatric patient engagement compared to referral as usual. Findings can help guide improvement with integrated primary care services, although future investigations are needed to further support or refute these preliminary results.

No abstract

Baseline substance abuse and anxiety assessments may have utility in identifying depressed adolescents who are less likely to maintain remission and graduate from a collaborative care program, suggesting that these patients may need additional intervention to achieve sustained remission.