Integrated Primary Medical-Behavioral Health Care for Adolescent and Young Adult Depression: Predictors of Service Use in the Youth Partners in Care Trial

Abstract

Results support the value of integrated medical-behavioral health care for improving rates of care. Findings highlight mechanisms by which integrated care may lead to improved rates of care and outcomes for AYA, an underserved and understudied group.

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

“…Two studies (Kozlowski et al, 2015;Richardson et al, 2009) reported results from a small, single-arm pilot study. Six studies (Kolko et al, 2014;Kolko et al, 2010;Kolko et al, 2012;Yu et al, 2017;Richardson et al, 2014;Wright et al, 2016;Rapp et al, 2017;Asarnow et al, 2005;Asarnow et al, 2009) reported implementation outcomes from randomized controlled trials (RCTs) of co-located interventions for mental health problems, although none of these randomized by implementation strategy. The remaining 7 studies (Hine et al, 2017;Levy et al, 2017;Horwitz et al, 2016;Rousseau et al, 2017;Aguirre & Carrion, 2013;Westerlund et al, 2017;Riley et al 2018) reported results from surveys or interviews with providers from pediatric practices that had implemented co-located behavioral health care.…”

“…Other observational studies were inclusive of all children within the target population (which at times was age-restricted) identified as needing mental health support. Contrasting with the observational studies, all six RCTs studied disorder or symptom-specific interventions within a targeted age range, including three for school-age children with disruptive behavior (Kolko et al, 2014;Kolko et al, 2010;Kolko et al, 2012) (two of which reported on studies using the same intervention), and three for adolescents with depression (Mufson et al, 2018;Richardson et al, 2014;Wright et al, 2016;Rapp et al, 2017;Asarnow et al, 2005;2009). Table 3 includes a list of implementation outcomes highlighted in each study, along with highlighted results, limitations, and "main lessons" on implementation based on our discussions.…”

“…Some studies reported that patients seen in the integrated setting were generally younger, suggesting earlier access to care (Schlesinger et al, 2017;Subotsky & Brown, 1990). 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).…”

The Role of the Patient-Centered Medical Home in Treating Depression

“…A meta-analysis on depression treatment in pediatric populations found small yet significant effects for primary care-based integrated care, with the strongest evidence found for collaborative care [ 68 ]. Adolescents enrolled in collaborative care programs have shown increased engagement in active treatment despite initial hesitation compared to those receiving treatment as usual [ 69 ]. Observational studies from our PCMH at the Mayo Clinic found that pediatric patients enrolled in collaborative care reported higher depression response and remission rates than patients receiving usual care [ 70 •].…”

Mixed‐Design Training Outcomes for Fellows Serving At‐Risk Youth Within Integrated Care Settings

“…2013). Thus, this approach allows increased access to services (Goodwin et al, 2017), lower redundancies in care (Rapp et al, 2017), and improved professional collaboration (Aitken & Curtis, 2004), all of which may enhance client outcomes and lower health care costs (Berwick et al, 2008;Kwan & Nease, 2013;Rapp et al, 2017).…”