A Collaborative Care Model to Improve Access to Pediatric Mental Health Services

Abstract

To examine if an innovative collaborative care model known as Targeted Child Psychiatric Services designed for primary care pediatricians (PCPs) and child psychiatrists (1) was associated with improved access to child psychiatry services, (2) had the potential to identify optimal care settings for pediatric mental health care and (3) examined if pediatricians appeared as likely to accept children back into their practices at discharge from TCPS depending upon diagnostic category, controlling for severity of illness and function. The diagnostic classes examined were ADHD (39%), depression (31%) and anxiety (13%). This prospective cohort design study collected medical records of 329 children referred to TCPS by 139 PCPs. To detect the likelihood of return to referring pediatricians for follow-up care at discharge from TCPS, we employed logistic regression models. Mean age was 12.3 (SD = 4.0); 43% were female. Ninety-three percent of parents complied with pediatricians' recommendations to have their child assessed by a child psychiatrist. A total of 28.0% of referrals returned to PCPs for follow-up care; the remainder were followed in mental health. Regression findings indicated that children with major depression (OR = 7.5) or anxiety disorders (OR = 5.1) were less likely to return to PCPs compared to ADHD even though severity of psychiatric illness and functional levels did not differ across diagnostic groups. Families widely accepted pediatricians' recommendations for referral to child psychiatrists. Depression and anxiety were strong correlates of retention in mental health settings at discharge from TCPS though children with these disorders appeared to be no more severely ill or functionally limited than peers with ADHD. These children possibly could be managed in a less intensive and expensive primary care treatment setting that could access mental health specialty services as needed in a collaborative model of care. TCPS is contrasted with the well-known collaborative model for adult depression in primary care. TCPS could serve as a feasible model of care that addresses the daunting barriers in accessing pediatric mental health services.

Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial

“…These findings demonstrating enhanced child and parent benefits associated with collaborative care extend those reported in quality improvement interventions for child behavior problems, 13,14 ADHD, 6-8 adolescent depression, 10,11 and other problems. 5 In the follow-up period, EUC showed significantly greater remission since posttreatment in behavior problems than DOCC, which may reflect DOCC patients having achieved greater remission by the end of treatment.…”

“…Recent models for enhancing mental health services in primary care [1][2][3][4] include outside psychiatric assessment and telephone consultation, 5 collaborative peer consultation, [6][7][8] mental health assessment skills training, 9 and collaborative care interventions. 10,11 As suggested in a recent review, these studies have revealed progress in improving provider care processes (eg, medication for attention-deficit/hyperactivity disorder [ADHD]; mental health assessment) and child symptoms (eg, ADHD, depression), but also call for larger and more rigorous trials.…”

Using Clinical Data to Predict Accurate ADHD Diagnoses Among Urban Children

“…12 (23) 19 (23) .94 Witness to domestic or community violence, n (%) 19 (35) 23 (28) .45 Victim of domestic or community violence, n (%) 4 (7) 7 (9) 1 Preterm birth, n (%)…”

Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care

“…This is a complex, multifaceted problem that may involve differential considerations of various levels of administration, real budgetary constraints, and temporally discounted valuation of future system or patient benefits in comparison to current financial expenditures (e.g., Raineri & Rachlin, 1993;Thaler, 2015). In addition, barriers to change exist in that the most common contemporary models of psychiatric integration have focused primarily on stand-alone assessment through telephone consultation (Aupont et al, 2013) and mental health assessment skills training for pediatricians (Asarnow et al, 2005;J. D. Brown & Wissow, 2012).…”