Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement.

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ABSTRACT. Objective. To examine the implementation of a protocol for the assessment of attention-deficit/ hyperactivity disorder (ADHD) in rural pediatric practices. The protocol was designed to provide an efficient means for pediatricians to learn and use the ADHD guidelines put forth by the American Academy of Pediatrics (AAP).Methods. Primary care staff (physicians, nurses, etc) from 2 rural pediatric practices were trained to use the ADHD-assessment protocol. Medical records for 101 patients were reviewed from 1 to 2 years before the introduction of the protocol and for 86 patients during the subsequent 2 to 3 years to assess compliance with the AAP guidelines. In addition, 34% of the scales scored by the staff were rescored to check for scoring accuracy.Results. Before the availability of the AAP guidelines and the implementation of the assessment protocol, neither primary care site was consistently collecting the comprehensive information that is now recommended for an ADHD assessment. Parent and/or teacher rating scales were collected for only 0% to 21% of assessments across sites. When provided with brief training and supporting materials, medical records reflected significant improvement in the ascertainment of clinically necessary ADHD information, with parent and teacher rating scales present 88% to 100% of the time. Staff demonstrated an ability to score rating scales with a high degree of accuracy. The integrity of protocol collection and management was maintained 2 to 3 years after training.Conclusions. An efficient system for conducting ADHD assessments according to AAP guidelines in rural pediatrics clinics can be initiated and maintained with integrity. Additional research is needed to determine if this system improves diagnostic decision-making and patient outcomes. P hysicians have generally been identified as the gatekeepers of behavioral health services, and in pediatric primary care, attention-deficit/hyperactivity disorder (ADHD) has become an important focus. Pediatricians rate behavior problems, including ADHD, as the most common presenting concern. 1 Specialists in developmental and behavioral pediatrics estimate that referrals for ADHD comprise 50% to 75% of their practices. 2 Moreover, a recent study of 2 national surveys indicated that primary care diagnostic assessment services for children with ADHD increased threefold between 1989 and 1996. 3 To assist physicians in meeting this growing clinical demand, the American Academy of Pediatrics (AAP) has made a substantial effort to develop bestpractice guidelines for ADHD. In particular, a series of articles was published to describe specific empirically supported recommendations for assessment and treatment. 4 These guidelines were established by a panel of experts across a variety of relevant disciplines and underwent an extensive peer-review process both within the AAP and by outside organizations. The published guidelines provide recommendations, detail their application, and describe the strength of evidence for their use.With r...

Objective: It is critical to address the behavioral health (BH) needs of youth given the high prevalence of diagnosable BH concerns prior to age 18 and the barriers for accessing BH services. To improve access, integration of BH services with primary care is increasing. The colocated model is one proposed method for increasing access to BH services for children. The current study sought to provide demonstration data for colocated BH services within the pediatric medical home. Method: A retrospective review of 694 new BH patient charts ranging from 1–18 years from 9 primary care clinics across three states participated. Data on number of sessions attended with a BH provider, report of homework completion (where relevant), clinician rating of adherence, and improvement ratings were collected. Results: Across all sites, 85% of referred patients attended their first appointment, and 84% of patients showed improvement over a 6-month period. Conclusions: This study is among the first to provide outcome data demonstrating the effectiveness of the colocated model for delivering BH services in primary care. Data provide information on the relationship between patient outcomes and adherence to recommendations delivered during colocated BH treatment. High attendance rates at initial appointment and overall improvement ratings were observed, suggesting the colocated BH model is a feasible model to improve access and outcomes in pediatric BH services.

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