Four innovations: A robust integrated behavioral health program in pediatric primary care.

Herbst, Rachel Becker; McClure, Jessica M.; Ammerman, Robert T.; Stark, Lori J.; Kahn, Robert S.; Mansour, Mona; Burkhardt, Mary Carol

doi:10.1037/fsh0000537

Cited by 14 publications

(15 citation statements)

References 24 publications

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“…In our adaptation of the HealthySteps™ model, an HealthySteps™ specialist provided integrated behavioral health as a prevention or treatment service. IBH prevention encounters targeted all families of children 0–5 years (not just those with an elevated score on a behavioral health screen) and consisted of a 15-min visit with the family as part of the well-child visit (Ammerman et al, 2021 ; Herbst et al, 2020 ). In some cases, the visit was extended to 30 min or longer at the discretion of the psychologist based on family need.…”

Section: Methodsmentioning

confidence: 99%

“…In some cases, the visit was extended to 30 min or longer at the discretion of the psychologist based on family need. Delivered by a doctoral-level pediatric psychologist, intervention focused on four areas: (1) assessment of emotional and tried to found book review sample under 10441behavioral health of the child and caregiver, (2) education on important supports for child emotional and behavioral health, (3) modeling and guidance on nurturing and responsive parenting, and (4) addressing parental concerns about and promoting child development (Herbst et al, 2020 ). The encounters used trauma-informed and relationship building methods, such as motivational interviewing.…”

Section: Methodsmentioning

confidence: 99%

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Provider Perspectives on an Integrated Behavioral Health Prevention Approach in Pediatric Primary Care

Rybak

Herbst

Stark

et al. 2023

J Clin Psychol Med Settings

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The purpose of this study was to use qualitative interviews to ascertain the perspective of pediatric primary care providers on the implementation of Integrated Behavioral Health (IBH) as provided by psychologists within an expanded HealthySteps™ model, and with a particular focus on prevention of behavioral health symptoms in the first five years. A semi-structured interview guide was used to assess medical providers’ perceptions of behavioral health integration into their primary care clinics. A conventional qualitative content analysis approach was utilized to identify patterns of meaning across qualitative interviews. Four themes were identified: (1) practice prior to IBH and initial concerns about integration, (2) psychologist’s role and perceived added value, (3) what integration looks like in practice, and (4) perceived families’ response to and experiences with IBH. Despite initial concerns about potential disruptions to clinic flow, providers indicated that adoption of IBH was seamless. The distinct roles of the psychologist were clear, and both treatment and prevention services provided by IBH were valued. Multidisciplinary collaboration and real-time response to family needs was seen as especially important and primary care providers reported that families were accepting of and highly valued IBH.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Provider Perspectives on an Integrated Behavioral Health Prevention Approach in Pediatric Primary Care

Rybak

Herbst

Stark

et al. 2023

J Clin Psychol Med Settings

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“…IBH-P has significantly increased behavioral health access for thousands of young children and caregivers (Ammerman et al, 2021). The development of this model has been extensively described in the literature (Ammerman et al, 2021; Herbst et al, 2020).…”

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confidence: 99%

Learnings from the implementation of standardized content and processes for integrated behavioral health prevention visits.

Meister¹,

Ryan²,

Austin³

et al. 2023

Families, Systems, & Health

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Introduction: Integrated behavioral health (IBH) in pediatric primary care has spread significantly over the past two decades. However, a crucial component of advancing the state of science is articulating specific intervention models and their associated outcomes. Foundational to this research is the standardization of IBH interventions; however, limited scholarship exists. This is particularly true for IBH prevention (IBH-P) interventions, which pose unique challenges to standardization. The present study presents the development of a standardized IBH-P model, processes to ensure fidelity, and fidelity outcomes. Method: The IBH-P model was delivered by psychologists in two large, diverse pediatric primary care clinics. Extant research and quality improvement processes supported the development of standardized criteria. Fidelity procedures were developed through an iterative process, resulting in two measures: provider self-rated fidelity and independent rater fidelity. These tools assessed fidelity to IBH-P visits and comparison of self and independently rated fidelity. Results: Data from both self and independent ratings indicated 90.5% of items were completed across all visits. The agreement between independent rater coding and provider self-coding was high (87.5%). Discussion: Results indicated a high level of concordance between provider self-ratings and independent coder ratings of fidelity. Findings suggest that a prevention-based, universal, standardized model of care with a psychosocially complex population was feasible to develop and adhere to. Learnings generated from this study may guide other programs seeking to develop standardization interventions and fidelity processes that can ensure high-quality, evidencebased care. Public Significance StatementStandardizing integrated behavioral health (IBH) preventative interventions is challenging but crucial to ensuring high-quality, evidence-based care. This article demonstrates how one program achieved this standardization and offers guidance to other programs seeking to develop and implement processes to standardize IBH interventions.

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“…An encouraging development, however, is the increasing appreciation of the need for integrated behavioral health and the value of physician extenders. 3,4 Embedded care management is also valuable in facilitating help. Such team-based care offers good opportunities to provide more comprehensive care and help tackle the problems raised…”

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confidence: 99%

“…This context inhibits broadening the scope of work to include issues such as probing family relationships or a child’s school environment. An encouraging development, however, is the increasing appreciation of the need for integrated behavioral health and the value of physician extenders . Embedded care management is also valuable in facilitating help.…”

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confidence: 99%

Addressing Children’s Exposure to Violence and the Role of Health Care

Dubowitz

2021

JAMA Netw Open

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Many children experience abuse, neglect, and other forms of violence, jeopardizing their physical and emotional health and their social and cognitive development. The study by Finkelhor and colleagues 1 characterizes children and youth evaluated medically following their experience of some type of violence. The nationally representative sample consisted of 8503 children and youth aged 2 to 17 from 2 surveys conducted in 2011 and 2014. Caregivers responded via telephone interviews for children aged 9 years or younger regarding possible exposure to violence, other adversities, and trauma symptoms; the youth aged 10 years and older reported on themselves. There were follow-up probes regarding injury and medical treatment for those with any of the 16 types of violence. As many as 5187 were reported to have been exposed to violence; 3.4% had had a medical visit related to the experience, 1.9% in the past year. Those with a recent medical visit had more trauma

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Four innovations: A robust integrated behavioral health program in pediatric primary care.

Abstract: to address behavioral health programs in primary care. We share learnings about how four innovations have made our program novel and successful in scaling and spreading.

Cited by 14 publications

References 24 publications

Provider Perspectives on an Integrated Behavioral Health Prevention Approach in Pediatric Primary Care

Provider Perspectives on an Integrated Behavioral Health Prevention Approach in Pediatric Primary Care

Learnings from the implementation of standardized content and processes for integrated behavioral health prevention visits.

Addressing Children’s Exposure to Violence and the Role of Health Care

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