TY - JOUR
AU - A. E. Spencer
AU - R. E. Platt
AU - A. F. Bettencourt
AU - E. Serhal
AU - M. D. Burkey
AU - J. Sikov
AU - C. Vidal
AU - J. Stratton
AU - S. Polk
AU - S. Jain
AU - L. Wissow
A1 - 
AB - BACKGROUND: As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care. METHODS: We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability). RESULTS: We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models. CONCLUSIONS: Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.
BT - Harvard review of psychiatry
C5 - Education & Workforce; Healthcare Disparities
CP - 6
CY - United States
DO - 10.1097/HRP.0000000000000239
IS - 6
JF - Harvard review of psychiatry
LA - eng
M1 - Journal Article
N2 - BACKGROUND: As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care. METHODS: We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability). RESULTS: We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models. CONCLUSIONS: Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.
PP - United States
PY - 2019
SN - 1465-7309; 1067-3229
SP - 342
EP - 353
EP - 
T1 - Implementation of Off-Site Integrated Care for Children: A Scoping Review
T2 - Harvard review of psychiatry
TI - Implementation of Off-Site Integrated Care for Children: A Scoping Review
U1 - Education & Workforce; Healthcare Disparities
U2 - 31714465
U3 - 10.1097/HRP.0000000000000239
VL - 27
VO - 1465-7309; 1067-3229
Y1 - 2019
Y2 - Nov/Dec
ER -