Effectiveness in Regular Practice of Collaborative Care for Depression Among Adolescents: A Retrospective Cohort Study

Abstract

Collaborative care for adolescents in regular practice led to better remission and treatment response than usual care. Future studies could examine which groups might benefit most and flexible payment models to support these services.

What’s known about implementing co-located paediatric integrated care: a scoping review

“…Thirteen studies included an integrated child psychiatrist or psychiatry trainee, who were most often part of a team with other integrated mental health providers (Briggs et al, 2016;Goodfriend et al, 2006;Levy et al, 2017;Horwitz et al, 2016;Moore et al, 2018;Rousseau et al, 2017;Schlesinger et al, 2017;Schlesinger, 2017;Subotsky & Brown, 1990;Talmi et al, 2016;German et al, 2017;Richardson et al, 2009;Shippee et al, 2018;Aguirre et al, 2013). Six studies evaluated an intervention delivered by members of the medical team (RNs, NPs, or midwives) with no prior mental health training (Kolko et al, 2010;Kolko et al, 2012;Kozlowski et al, 2015;Westerlund et al, 2017;Richardson et al, 2009;Shippee et al, 2018). No studies reported on the implementation of an integrated pediatric behavioral health intervention delivered exclusively by community health workers or other bachelor'slevel health care workers in primary care, and only one paper mentioned a parent partner (degree unspecified) who was included in care delivery in partnership with an LICSW (Yogman et al, 2018).…”

“…While many studies reported interventions for children of all age ranges, others reported on interventions specific for certain age ranges, including early childhood, grade school-age children, and adolescents. Only three of the observational studies were disorder-specific, with two focused on ADHD (Moore et al, 2018;Olufs et al, 2016) and one (Shippee et al, 2018) on depression. Other observational studies were inclusive of all children within the target population (which at times was age-restricted) identified as needing mental health support.…”

“…Acceptability was most often measured with PCP surveys or interviews (Aguirre et al, 2013;Hine et al, 2017;Kolko et al, 2014;Kolko et al, 2010;Kolko et al, 2012;Levy et al, 2017;Mufson et al, 2018;Adams et al, 2016;German et al, 2017), frequently measured with parent and/or patient surveys (Gomez et al, 2014;Kolko et al, 2014;Kolko et al, 2010;Kolko et al, 2012;Subotsky & Brown, 1990;Yogman et al, 2018;Adams et al, 2016;Richardson et al, 2009), and less often through interviews or surveys of embedded mental health providers (Aguirre et al, 2013;Levy et al, 2017;Mufson et al, 2018;Rousseau et al, 2017;Schlesinger et al, 2017). Three RCTs reported on fidelity to the treatment protocol or manual in addition to other implementation outcomes (Kolko et al, 2014;Kolko et al, 2010;Mufson et al, 2018); one observational study (Shippee et al, 2018) reported on fidelity to the treatment/intervention protocol.…”

“…However, often a relatively high proportion of families referred still did not engage in services offered despite the relative ease of access within the primary care setting (Briggs et al, 2016;Briggs et al, 2007;Briggs et al 2012;Godoy et al,, 2014;Valleley et al, 2007;Adams et al, 2016;Rapp et al, 2017;Smith et al, 2016). Several authors speculated that warm hand-offs (meeting at the time of referral with the integrated mental health professional) would facilitate initial treatment engagement (Godoy et al, 2014;Valleley et al, 2007;Shippee et al, 2018), but only one study measured this and found a modest increase in treatment initiation following warm hand-offs (63% vs. 53%) (Briggs et al, 2016). Several authors commented that having the integrated care provider coemployed in both the primary care setting as well as a specialty setting was helpful for facilitating referrals to the specialty setting treatment when indicated (Briggs et al, 2012;Levy et al, 2017;Subotsky & Brown, 1990;Ward-Zimmerman &Cannata, 2012) Hacker andcolleagues (2015) reported an unexpected significant increase in the use of psychiatric emergency services as a result of integrated care implementation.…”

Financing for Collaborative Care—a Narrative Review

“…To date, the efficacy and effectiveness of CoCM have been shown in more than eighty RCTs 1,2 . Additionally, using its core principles, others have extended CoCM to the treatment of individuals: (1) in a variety of treatment settings (e.g., inpatient treatment 3 and specialty medical care 4 ), (2) with a number of mental health diagnoses (e.g., anxiety 1 , bipolar disorder 5 and post-traumatic stress disorder 6–8 ) and (3) of different age ranges (e.g., adolescents 9 ). Despite its robust evidence base and extensive use, payment for this care model has remained a challenging task for states, municipalities, payers and healthcare systems.…”