From Theory to Action

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

“…Child psychologists, psychology trainees, and masters-level social workers were the most common mental health provider type integrated into the pediatric setting. 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).…”

“…A few studies also measured time spent or saved with the intervention (Gouge et al, 2016;Kolko et al, 2014;Kolko et al, 2010;Kolko et al, 2012). 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.…”

“…Notably, two of these studies (Kolko et al, 2014;Mufson et al, 2018;Rapp et al, 2017) were randomized controlled trials, and therefore may have had more supports, training, supervision, and ongoing support or funding than might be feasible or typical during usual clinical care; the other (Kozlowski et al, 2015) was a small (N=14), single-arm pilot study. Training for pediatricians and integrated providers on empirically supported interventions for internalizing disorders (Schlesinger et al, 2017;Schlesinger, 2017) and externalizing disorders (Olufs et al, 2016) was associated with increased utilization of these interventions in the primary care setting. In addition, lack of a clear protocol or plan for implementation of knowledge gained through a parent training program (for example, how much to adapt the intervention/knowledge to fit into existing clinic procedures) led to concern about exactly how and with whom the new knowledge would be used, as well as how to measure effectiveness (Westerlund et al, 2017).…”

“…Seven studies reported outcomes related to penetration (Briggs et al, 2016;Godoy, et al, 2014;Schlesinger, 2017;Talmi et al, 2016;Yogman et al, 2018;Shippee et al, 2018;Smith et al, 2016). On the clinic level, two studies described the spread of a co-located model to approximately 20 practices within a network (Schlesinger et al, 2017;Schlesinger, 2017;Talmi et al, 2016), but neither described systematic data collection related to factors influencing model spread. On the patient level, three studies reported that approximately 15-25% of children received at least one of a variety of available co-located mental health services (Briggs et al, 2016;Talmi et al, 2016;Yogman et al, 2018).…”

“…Although screening was not the focus of this review, this was an important way that many programs attempted to identify children in need of behavioral health services. Although a few programs achieved notably high screening rates (Schlesinger et al, 2017;Schlesinger, 2017;Smith et al, 2016), most reported challenges to the implementation of universal pediatric behavioral health screening (Briggs et al, 2016;Briggs et al, 2007;Briggs et al, 2012;Godoy et al, 2014;Hacker et al, 2015). Several authors noted that multiple team members (e.g.…”