Background In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. Objective To conduct a pilot study comparing BMI changes between two arms: 1) PCP in-person clinic visits plus obesity specialist tele-visits (PCP visits + Specialist tele-visits) and 2) PCP in-person clinic visits only (PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Methods Patients (N=40, 10–17 years, BMI ≥95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + Specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Results Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + Specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (−0.11 vs. −0.05, P=0.049), following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (−0.11, P=0.0006) but not Group 2 (−0.06, P=0.08); however, decrease in BMI at 6 months did not differ between groups. After cross-over, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. Conclusion An integrated care model utilizing telehealth holds promise for treating children with obesity.

This paper describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for using partnerships as a basis for conducting mental health treatment research is presented. Finally, an ongoing partnership research project concerned with the adaptation of evidence-based mental health treatments for childhood internalizing problems in community settings is presented, with preliminary results of the ongoing effort discussed.Keywords effectiveness research; partnership research; children's mental health; evidence-based treatments Using Partnerships to Adapt Evidence-based Mental Health Treatments for use Outside LabsRecent findings suggest that up to 20% of youth experience a mental disorder and a large portion of these youth do not receive adequate treatment (Hoagwood & Olin, 2002;U.S. Public Health Service [USPHS], 2000). Many of the problems children experience can be classified as either internalizing or externalizing disorders. Internalizing disorders such as anxiety and depressive disorders (e.g., Gotlib, Lewinsohn, & Seeley, 1995; Lewinsohn, Hops, Roberts, Seely, & Andrews, 1993;Shaffer et al., 1996;Silverman & Ginsburg, 1998) cause considerable impairment and have been linked to psychopathology in adulthood (e.g., Costello, Angold, & Keeler, 1999;Pine, Cohen, Gurley, Brook, & Ma, 1998). Additionally, externalizing disorders such as childhood conduct problems affect between 5 to 10% of children (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003;Nolan, Gadow, & Sprafkin, 2001) and represent a majority of referrals to mental health clinics (Loeber, Burke, Lahey, Winters, & Zera, 2000;Wilens et al., 2002).Over the past three decades, clinical researchers have accumulated evidence in support of the efficacy of psychosocial treatments tested in research settings (Chorpita & Southam-Gerow, 2006;Compton, Burns, Egger, & Robertson, 2002 1995), and identifying evidence based therapies (EBTs) effective in treating childhood mental health problems has become a federal public health policy priority (USPHS, 2000). Unfortunately, EBTs are not usually used in "real-world" settings such as community mental health clinics (Weiss, Catron, & Harris, 2000;Weisz, Weiss, & Donenberg, 1992) and it is only recently that efforts have been made to deploy EBTs in such settings (Chorpita et al., 2002).Accounts for the discrepancy between the scientific support for EBTs and the paucity of their use by community clinics are numerous and thoroughly addressed elsewhere (e.g., Schoenwald & Hoagwood, 2001a;Southam-Gerow, 2004;Weisz, 2000). However, this paper will focus on one common explanation for this gap: EBTs have almost exclusively been developed and tested in university-based research settings that appear to differ from typical service clinic settings (e.g., Hammen...

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Previous research has revealed that youth seen at community clinics present with a higher frequency of externalizing problems and are demographically different from youth seen at research clinics. This study extends findings on these discrepancies by examining differences between youth at research and community clinics meeting criteria for two different primary disorders (anxiety and depression). Consistent with prior research, community clinic youth reported lower incomes, were more ethnically diverse, and had higher rates of externalizing problems compared to research clinic youth, regardless of primary diagnosis. Findings are discussed in terms of enhancing dissemination of evidence-based treatments for internalizing disorders in community settings.