TY - JOUR
AU - K. S. Hsiung
AU - J. Hart
AU - K. J. Kelleher
AU - D. J. Kolko
A1 - 
AB - OBJECTIVE: Pediatric primary care providers (PCPs) work in challenging environments and are increasingly called to implement complex interventions, such as behavioral health (BH) service integration. We explore how perceived stressful practice climates (1) change over time in and (2) influence provider perceptions of collaborative care versus usual care, 2 models of integrated BH care. METHODS: Secondary exploratory analysis using hierarchical linear modeling was performed on an 18-month cluster-randomized trial of 8 pediatric primary care practices to Doctor-Office Collaborative Care (DOCC), where an on-site care manager delivered BH services in coordination with PCPs, or Enhanced Usual Care (EUC), where a care manager facilitated referrals to local BH providers. Various indicators of PCP perceptions of BH services, including satisfaction with practice, burdens and beliefs regarding psychosocial problems, and effectiveness in treating behavioral problems, were assessed as outcomes. Moderators were 2 domains of stressful climates, role conflict and role overload. RESULTS: Role conflict and role overload stayed stable in both conditions. Role conflict strengthened the positive effect of DOCC on PCP perceived effectiveness in treating behavioral problems (beta [SE], 0.04 [0.02]; p = 0.04) and improvement in managing oppositional/aggressive behavior (0.02 [0.01]; p = 0.02). Role overload strengthened the positive effect of DOCC on PCP-perceived improvement in managing attention-deficit hyperactivity disorder (0.03 [0.01]; p = 0.01). Stressful climates did not influence perceptions for EUC providers. CONCLUSIONS: Providers experiencing more stressful practice climates developed more positive perceptions of collaborative care. This may encourage stressed providers to make effective practice changes and promote practice integration of BH services.
AD - Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA.; Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA.
BT - Journal of developmental and behavioral pediatrics : JDBP
C5 - Education & Workforce; Healthcare Disparities
CP - 9
CY - United States
DO - 10.1097/DBP.0000000000000712
IS - 9
JF - Journal of developmental and behavioral pediatrics : JDBP
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: Pediatric primary care providers (PCPs) work in challenging environments and are increasingly called to implement complex interventions, such as behavioral health (BH) service integration. We explore how perceived stressful practice climates (1) change over time in and (2) influence provider perceptions of collaborative care versus usual care, 2 models of integrated BH care. METHODS: Secondary exploratory analysis using hierarchical linear modeling was performed on an 18-month cluster-randomized trial of 8 pediatric primary care practices to Doctor-Office Collaborative Care (DOCC), where an on-site care manager delivered BH services in coordination with PCPs, or Enhanced Usual Care (EUC), where a care manager facilitated referrals to local BH providers. Various indicators of PCP perceptions of BH services, including satisfaction with practice, burdens and beliefs regarding psychosocial problems, and effectiveness in treating behavioral problems, were assessed as outcomes. Moderators were 2 domains of stressful climates, role conflict and role overload. RESULTS: Role conflict and role overload stayed stable in both conditions. Role conflict strengthened the positive effect of DOCC on PCP perceived effectiveness in treating behavioral problems (beta [SE], 0.04 [0.02]; p = 0.04) and improvement in managing oppositional/aggressive behavior (0.02 [0.01]; p = 0.02). Role overload strengthened the positive effect of DOCC on PCP-perceived improvement in managing attention-deficit hyperactivity disorder (0.03 [0.01]; p = 0.01). Stressful climates did not influence perceptions for EUC providers. CONCLUSIONS: Providers experiencing more stressful practice climates developed more positive perceptions of collaborative care. This may encourage stressed providers to make effective practice changes and promote practice integration of BH services.
PP - United States
PY - 2019
SN - 1536-7312; 0196-206X
SP - 686
EP - 695
EP - 
T1 - Impact of Stressful Climates on Provider Perceptions of Integrated Behavioral Health Services in Pediatric Primary Care: An Exploratory Study
T2 - Journal of developmental and behavioral pediatrics : JDBP
TI - Impact of Stressful Climates on Provider Perceptions of Integrated Behavioral Health Services in Pediatric Primary Care: An Exploratory Study
U1 - Education & Workforce; Healthcare Disparities
U2 - 31393319
U3 - 10.1097/DBP.0000000000000712
VL - 40
VO - 1536-7312; 0196-206X
Y1 - 2019
Y2 - Dec
ER -