The Starting Early Starting Smart Integrated Services Model: Improving Access to Behavioral Health Services in the Pediatric Health Care Setting for At-Risk Families with Young Children

Abstract

We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral health services (parenting, mental health, and drug treatment) into the pediatric health care setting for families with young children. Data are presented from five pediatric care (PC) sites, drawing from families at risk due to demographic and behavioral health factors, with infants less than 12 months of age (n = 612). Families were randomly assigned to either the SESS program or a standard care Comparison group. We utilized longitudinal analyses to estimate differences in utilization rates for parenting, mental health, and drug treatment over 6 follow-up time points (3, 6, 9, 12, 15 and 18 months). Our findings indicate that SESS caregiver participants were 4.6 times (p \ 0.001; CI = 3.33-6.26) more likely to receive parenting services, 2.1 times (p \ 0.001; CI = 1.48-2.86) more likely to receive outpatient mental health treatment, and 1.8 times (p = 0.025; CI = 1.08-3.14) more likely to receive drug treatment than Comparison group participants. Our results demonstrate the success of the SESS program in coordinating and improving access to behavioral health services for high-risk caregivers within the pediatric health care setting and highlight the importance of continuing to focus public health policy on the behavioral health care needs of families with young children.

Decreasing Harsh Discipline in Mothers at Risk for Maltreatment: A Randomized Control Trial

“…Dropouts appeared to be related to stressful life circumstances such as divorce/separation, involvement in child protection services, and/or severe medical clinical or psychiatric disorders. However, program retention after the pretest (80%) also was identical to that of other studies with high‐risk samples (e.g., Morrow et al., ; Moss et al., ). In addition, whereas other intervention studies generally allow for parents to miss some sessions, in our study, all mothers completed the full set of intervention sessions (all control group mothers also completed all scheduled telephone calls.)…”

Turning the Social Determinants of Health to Our Advantage: Policy Fundamentals for a Better Approach to Children's Health

“…A number of multidisciplinary care interventions have been shown to improve care coordination/access, particularly for children with special healthcare needs and at-risk mothers or children. For example, an evaluation of the Starting Early Starting Smart (SESS) initiative, an intervention to integrate behavioural health services (parenting, mental health and drug treatment) into the pediatric healthcare setting for families with young children, indicated that SESS caregiver participants were 4.6 times more likely to receive parenting services, 2.1 times more likely to receive outpatient mental health treatment and 1.8 times more likely to receive drug treatment than comparison group participants (Morrow et al 2009). Parent/patient satisfaction also appears to improve with multidisciplinary care.…”

“…This ranges from the provision of family help such as emotional support and encouragement (Farmer et al 2005;King et al 2009), to health education (see, for example, Harris et al 2003;Reece et al 2002), to intensive social work appraisal (Quinlivan and Evans 2004) and to information and education resources through websites, brochures and toll-free numbers (see, for example, Gilles et al 2007;Piotrowski et al 2009). Home visits were another common service provided in a number of these models (Farmer et al 2005;Morrow et al 2009;Piotrowski et al 2009;Reece et al 2002;Stevens-Simon et al 2001).…”

“…There is also an emphasis on providing patient-centred care in a number of studies, for example efforts to provide culturally sensitive and appropriate services (Gilles et al 2007;Harris et al 2003;Morrow et al 2009;Reece et al 2002). In models that focus on children with special healthcare needs, promoting family-centred aspects of care is also emphasized by providing a parent consultant or advocate (Farmer et al 2005;Morrow et al 2009;Palfrey et al 2004), sponsored outreach and social activities (Palfrey et al 2004) and collaboration between families and physicians (Farmer et al 2005;McMenamy and Perrin 2004).…”

Impact of COVID-19 on Referral Patterns and Service Delivery for an Integrated Behavioral Health Program

“…In one study by Morrow et al (2009) , caregiver–infant dyads were randomly assigned to either an integrated behavioral health services group which provided parenting education, mental health services, and drug treatment support or to a standard care group for comparison. Participants in the integrated behavioral health group were nearly 5 times more likely to receive parenting services, just over 2 times more likely to receive outpatient mental health services, and nearly 2 times more likely to receive drug treatment than participants in the comparison group.…”