Key Components of Effective Pediatric Integrated Mental Health Care Models

Abstract

IMPORTANCEEmerging evidence suggests that integrated care models are associated with improved mental health care access and outcomes for youths (children Յ12 years and adolescents 12-21 years) served in pediatric primary care settings. However, the key components of these complex models remain unexamined.OBJECTIVE To identify and describe the key components of effective pediatric integrated mental health care models. EVIDENCE REVIEWThe PubMed, Embase, PsycINFO, and Cochrane Controlled Register of Trials electronic databases were searched for relevant peer-reviewed articles published between January 1, 1985, and April 30, 2019. Articles were restricted to those published in the English language. Eligible articles reported original data on youths 17 years or younger, implemented an integrated mental health care model in a pediatric primary care setting, and assessed the model's association with primary outcomes (eg, mental health symptom severity) and secondary outcomes (eg, functional impairment and patient satisfaction). Articles that specified some degree of systematic coordination or collaboration between primary care and mental health professionals were included in the final review. Two independent reviewers extracted data on study design, model type, model components, level of integration, and outcomes. Study quality was assessed using the Jadad scale. Data were analyzed between January 1, 2018, and May 31, 2019.FINDINGS Eleven randomized clinical trials involving 2190 participants were included. Three studies focused on youths with depression, 3 on youths with attention-deficit/hyperactivity disorder, and 5 on youths with behavioral disorders. Most studies (9 of 11) implemented either the collaborative care model (n = 3), a slightly modified version of the collaborative care model (n = 2), or colocated care (n = 4). The most commonly reported components of effective pediatric integrated mental health care models were population-based care, measurement-based care, and delivery of evidence-based mental health services; all 3 components were present in studies reporting clinical improvement of mental health symptoms. Other model components, such as treatment-to-target or team-based care, were common in studies reporting specific outcomes, such as functional impairment. CONCLUSIONS AND RELEVANCEThis review is the first to date to systematically search and qualitatively synthesize information on the key components of effective pediatric integrated mental health care models. This knowledge may be especially useful for pediatric primary care administrators in the selection of an integrated care model for their setting.

Prioritising Interventions for Preventing Mental Health Problems for Children Experiencing Adversity: a Modified Nominal Group Technique Australian Consensus Study

“…However, the interventions were selected on rigorous evidence, which is important for promoting evidence-based practice to improve population mental health (50). Furthermore, the NGT method promoted the collection of rich qualitative data alongside the quantitative consensus ratings which allowed us to better understand the experiences and perspectives of participants.…”

A Team-Based Collaborative Care Model for Youth With Attention-Deficit Hyperactivity Disorder in Education and Health Care Settings

“…These professionals include primary care providers, care or case managers, teachers, mental health specialists, and social workers (Kolko et al, 2014). Mental health services delivered through a collaborative care model with pediatric and mental health providers have resulted in improved clinical outcomes for children ages 17 and younger with depression, ADHD, and behavioral disorders in a systematic review of 11 randomized controlled trials (Yonek et al, 2020). Researchers in health care have adopted a collaborative care approach to the delivery of mental health services, due to the many desirable features of this system, such as the presence of familiar providers in a local context and the absence of stigma that can be associated with mental health care (Kolko & Perrin, 2014).…”

“…Collaborative care models in medicine have been successful in improving mental health outcomes for children and youth (see Kolko et al, 2012, 2014; Power et al, 2014; Yonek et al, 2020). The time is right to systematically extend these models through the TBCCM to education, which represents, along with health care, one of two local, universal systems best positioned to deliver mental health services to youth with ADHD from a range of backgrounds and communities.…”

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis

“…Obviously, some assets are especially important when the access to conventional mental health care services for youth with CC is even further reduced – as observed during the Covid-19 crisis ( Torous and Wykes, 2020 ). Regardless of contemporary circumstances, IMIs can be implemented as stand-alone interventions, as part of blended-therapy approaches or within a framework of stepped and collaborative care ( Andersson et al, 2019 ; Domhardt et al, 2018 ; Domhardt and Baumeister, 2018 ; Ebert et al, 2018 ; Yonek et al, 2020 ). Of note, interventions with accompanying human support evince consistently higher effect sizes than pure self-help interventions for depression and anxiety symptoms in adults ( Baumeister et al, 2014 ; Domhardt et al, 2019 ), reaching even comparable effect sizes to face-to-face psychotherapies in some instances ( Carlbring et al, 2018 ).…”