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

Abstract

Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs. their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. We systematically searched the literature for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. We included studies reporting on the following implementation outcomes: acceptability, adoption, appropriateness,

Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches

“…The literature key word search was conducted on articles published from January 2000 -July 2019 according to the original six-stage process (60) and updated modifications (61) for scoping reviews, and placed key words into concept areas (62). These reviews are typically undertaken to examine the extent, range, and nature of research in a topic area and identify gaps in knowledge rather than to examine more specific, narrow topics based on study designs of systematic reviews; both types of reviews use an approach based on concept, target population and health outcomes.…”

An Integrated Care Strategy for Pre-schoolers with Suspected Developmental Disorders: The Optimus Co-design Project that has Made it to Regular Care

“…Thus, it seems that a number of terms regarding organisational and personnel dynamics need to be in place to initiate, develop, trial, and evaluate new models of care. As the Optimus integrated care model moves to a stage of sustainability, new challenges, not unknown in providing paediatric integrated care [19], are likely to arise.…”

“…A scoping review found that components facilitating sustainability of integrated behavioural healthcare were: "interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics" [19]. The Optimus integrated care model features the first two of these, whereas co-employment is not the case, although it would certainly be desirable.…”

“…Another example is a team assessment model for children 2-10 years of age from Kerala, India [18]. A scoping review found certain components facilitating sustainability of integrated behavioural healthcare: process-related issues, such as the role of interprofessional communication and implementation support; content-related issues, such as the use of clear protocols; and organizational issues, such as co-employment of the care providers [19].…”

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth

“…Prior to the beginning of this century, very few pediatricians worked in close coordination with mental health professionals. Despite evidence that child/youth integrated care can be effective and practical, 17 , 18 still only about half of US pediatricians consider that they work in practices co-located with a behavioral health professional. 19 Integration continues to face significant barriers, including lack of consensus on how primary care and co-located mental health professionals should share roles, the need for substantial transformation in how practices operate if they are to provide mental health care, 20 financing schemes that do not incentivize treatment in primary care or collaboration with mental health providers, 21 and a lack of mental health practitioners trained to work in primary care settings (especially in linguistically and culturally diverse communities).…”