Colocated Mental Health/Developmental Care

Abstract

The inadequacy of mental health and developmental services for children is a widely recognized and growing problem. Although a variety of solutions have been proposed, none has been generally successful or feasible. This research describes models of colocation that have evolved in primary care settings in Massachusetts and reports on pediatricians' and their colocated colleagues' impressions of their benefits and challenges. Pediatricians in 18 practices that included a colocated mental health/developmental specialist (MH/DS) were identified through a survey administered through the state American Academy of Pediatrics Chapter, and interviewed. Practices varied widely in the professional expertise/training and roles of the MH/DSs, communication among providers, and financial arrangements. The majority of pediatricians and MH/DSs reported being pleased with their colocated arrangements, despite the costs rarely being supported by billing revenues. This study suggests that further development of such systems hold promise to meet the growing need for accessible pediatric mental and developmental health care.

Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers

“…Importantly, most BHS providers reported that their primary work settings were mental health settings, rather than physical health settings. This suggests that BHS providers delivered clinical services in several settings, which may be consistent with the 31% colocation rate found in the survey by Levy et al 2 Thus, most of the current providers were probably colocated, rather than fully integrated, in the medical practice.…”

“…At the time of data collection, there was limited information on which to base a power analysis to estimate needed sample size. The few existing surveys of adult or pediatric providers had samples of 39, 33 72, 34 and 84, 35 and later studies also had modest samples of 36 participants 2 and 89 participants, 8 with 2 exceptions (n = 305, 381) that obtained 3 samples collected over a 3-year period. 7,36 Based on these sample sizes, we sought to recruit a minimal sample of 250 surveys.…”

“…Despite these benefits, descriptive reports and outcome studies also note several barriers to care integration, such as the challenges of organizing health care practice environments to incorporate BH procedures or workflows, receiving comprehensive training opportunities, maintaining BH sources in the practice, obtaining sufficient fiscal reimbursement to train entire practices and support all BH resources, and incorporating care monitoring and supervisory processes to enhance the quality of care over time. 1,2,11,21,22 Furthermore, empirical support for effective implementation strategies to promote care integration is mixed. 10,23-26…”

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The availability of coordinated, integrated, and evidence-based practices in routine health care settings has the potential to significantly improve children's behavioral health (BH). [1][2][3] BH concerns are among the top reasons families seek care in primary care medical homes. 4 Care integration offers several advantages, including increasing access to BH care for children in their medical home, 5 allowing families to work with a familiar provider, and providing practical, user-friendly materials to address child and caregiver BH.

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Using the Multiphase Optimization Strategy (MOST) Framework to Test Intervention Delivery Strategies: A Study Protocol

“…FN is a care management strategy designed to reduce disparities in care (12). Traditional models utilize trained community health workers who assist families in overcoming systems and patient barriers to services over a time-limited period.FN is rooted in the Chronic Care Model (13) and has evidence in multiple diseases as a means to reduce disparities by shortening the interval between discovery of risk (e.g., a positive screening mammogram for breast cancer) and diagnostic ascertainment (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”