Which Model Fits? Evaluating Models of Integrated Behavioral Health Care in Addressing Unmet Behavioral Health Needs among Underserved Sociodemographic Groups

Chakawa, Ayanda; Belzer, Leslee Throckmorton; Perez-Crawford, Trista; Brei, Natalie

doi:10.1080/23794925.2020.1796549

Cited by 8 publications

(14 citation statements)

References 41 publications

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“…Visits were scheduled for 30 min, with 15 min between each consultation to communicate recommendations and manage care. Expanded details on the IPC consultation model can be found in previous work by Chakawa et al (2020) , including information on the collaborative care model that is embedded in the consultation model to co-manage diagnostic impressions, treatment needs, and treatment progress.…”

Section: Methodsmentioning

confidence: 99%

“…In the IPC setting, the medical provider is the first point of contact to address behavioral health needs and to connect patients to needed services amidst mounting logistical and perceptual barriers. Pre-pandemic, IPC often involved in-clinic warm hand-offs via live paging or scheduled joint visits between a primary care provider (PCP) and a behavioral health specialist who diagnosed, treated, or referred to additional resources ( Chakawa et al, 2020 ; Germán et al, 2017 ). Mid-pandemic as physical distancing protocols proved essential to mitigate coronavirus spread, clinic space limits reduced the number of staff and children onsite.…”

Section: The Critical Need For Ipc During Covid-19 Despite Barriers To Service Deliverymentioning

confidence: 99%

“…A growing strategy to increase mental health care access for children is providing behavioral health services through integrated primary care (IPC; Chakawa et al, 2020 ; Schlesinger, 2017 ; Zima & Wissow, 2019 ). In response to COVID-19, the provision of IPC in many settings changed to a telehealth modality due to several factors (e.g., limited clinic space due to physical distancing protocols, work and/or school closures, and public health directives to shelter in place).…”

Section: Introductionmentioning

confidence: 99%

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COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

Chakawa

Belzer

Perez-Crawford

2021

Journal of Pediatric Psychology

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Objective The coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups. Methods A comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1–19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables. Results Service delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children. Conclusion Though telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.

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Section: Methodsmentioning

confidence: 99%

Section: The Critical Need For Ipc During Covid-19 Despite Barriers To Service Deliverymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

Chakawa

Belzer

Perez-Crawford

2021

Journal of Pediatric Psychology

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“…However, accessibility and utilization based on sociodemographic status has shown variation by service provision type. More highly integrated IPC service options such as consultation (i.e., joint visits or in-the-moment warm handoffs from the primary care provider (PCP) to the behavioral health provider (BHP)) have been shown to facilitate significantly more timely access, initial, and short-term service utilization (38,39). However, other levels of service that are typically provided through less directly integrated care or through specialty care options external to the IPC setting are often required when chronic or high acuity concerns are present, or when there is a need for comprehensive evaluation (38,40).…”

Section: Introductionmentioning

confidence: 99%

Disparities in accessing specialty behavioral health services during the COVID-19 pandemic and why we need pediatric integrated primary care

Chakawa,

Crawford,

Belzer

et al. 2024

Front. Psychiatry

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ObjectiveYouth unmet behavioral health needs are at public health crisis status and have worsened since the onset of the coronavirus disease 2019 pandemic (Covid-19). Integrating behavioral health services into pediatric primary care has shown efficacy in addressing youth behavioral health needs. However, there is limited guidance on facilitating equitable access to care in this setting, including in triaging access to co-located services (i.e., onsite outpatient behavioral health services with only the behavioral health provider) or to specialty behavioral health services in other clinics within larger health systems.MethodsA retrospective, comparative study was conducted to examine variability in access to co-located and specialty behavioral health (SBH) services for a pre-Covid-19 cohort (April 2019 to March 2020; n = 367) and a mid-Covid-19 cohort (April 2020 to March 2021; n = 328), while accounting for integrated primary care consultation services. The sample included children 1-18 years old served through a large, inner-city primary care clinic. Logistic regression models were used to examine the association between scheduled and attended co-located and SBH visits, pre- and mid-Covid-19 effects, and sociodemographic factors of race and ethnicity, language, health insurance (SES proxy), age, and sex.ResultsThe majority of youth were not directly scheduled for a co-located or SBH visit but the majority of those scheduled attended their visit(s). The odds of not being directly scheduled for a co-located or SBH visit were greater for the mid-Covid-19 cohort, Black youth, and older youth. Accounting for integrated primary care consultation visits addressed these disparities, with the exception of persisting significant differences in scheduled and attended co-located and SBH visits for Black youth even while accounting for IPC consultation.ImplicationFindings from the current study highlight the effective role of integrated primary care consultation services as facilitating access to initial behavioral health services, especially given that referrals to integrated primary care co-located and SBH services within the larger health system often involve barriers to care such as longer wait-times and increased lack of referral follow through. Ongoing research and equitable program development are needed to further this work.

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“…Considering Salient Mental Health Care Pathways for Black/African American Children Initiatives to better meet child mental health care needs have increasingly focused on integrated behavioral health in primary care (Asarnow et al, 2015;Dillon-Naftolin et al, 2017). While integrated behavioral health helps address unmet mental health needs among racial/ethnic minority children, including Black/African American children (Acri et al, 2016;Chakawa et al, 2020), racial disparities in service utilization still exist in integrated care (Cokley et al, 2014). Other initiatives to improve access to care include school-based mental health clinics (Bains & Diallo, 2016;Knopf et al, 2016), which have shown some promise in being better utilized by Black/African American children than outpatient clinics (Locke et al, 2017).…”

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confidence: 99%

Bridging the gap: A pilot study of a lay health worker model to decrease child mental health stigma and promote parents’ professional help-seeking for Black/African American children.

Chakawa¹

2023

Psychological Services

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Unmet mental health needs among children in the United States (U.S.) are at a critical status (Kimball & Miller, 2015;Perou et al., 2013), with less than half of children receiving needed care (Whitney & Peterson, 2019). Unmet mental health needs are especially pronounced for racial/ethnic minority children, including Black/African American children (Alegria et al., 2010;Cokley et al., 2014), whose rates of suicide among those aged 5-11 years has increased in the past two decades (Bridge et al., 2015). Culturally responsive strategies that build on common mental health help-seeking pathways for Black/African American families are needed to improve access to care. The Bridging the Gap pilot project described in this paper used an innovative lay health worker model embedded in faith-based networks to target child mental health stigma and promote professional help-seeking among 65 Black/African American parents of children 5-12 years old. A single-group, pretest, posttest, follow-up (PPF) design (with double pretest and double follow-up) was used to structure the delivery of the pilot program and data collection. Child mental health stigma significantly decreased after the intervention portion of the program but help-seeking attitudes stayed constant. Thirteen parents had children with clinically significant mental health needs. Of the eight parents reached for follow-up, five sought child mental health services based on individualized recommendations and the rest endorsed intentions to follow through on service recommendations. Parents endorsed satisfaction with the program and several program evaluation themes were identified through qualitative data. Recommendations and future directions are discussed. Impact StatementBlack/African American children have disproportionately high unmet mental health care needs. The help-seeking pathway for Black/African American families often includes faith-based networks. Establishing culturally responsive lay health worker models within faith-based networks may help address racial/ethnic disparities in care by reducing mental health stigma and helping connect Black/ African American children with mental health needs to evidence-based services.

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Which Model Fits? Evaluating Models of Integrated Behavioral Health Care in Addressing Unmet Behavioral Health Needs among Underserved Sociodemographic Groups

Cited by 8 publications

References 41 publications

COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

Disparities in accessing specialty behavioral health services during the COVID-19 pandemic and why we need pediatric integrated primary care

Bridging the gap: A pilot study of a lay health worker model to decrease child mental health stigma and promote parents’ professional help-seeking for Black/African American children.

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