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The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
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201
Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: Purpose Mental health issues in perinatal adolescents are well documented and studies have shown high rates of depressive disorders among this population. Treatment is challenging because pregnant adolescents are poorly adherent with mental health services. We describe a novel integrated mental health care program for pregnant and parenting adolescent mothers and their children. Methods The Colorado Adolescent Maternity Program (CAMP) is a comprehensive, multidisciplinary teen pregnancy and parenting medical home program serving an ethnically diverse and low socioeconomic status population in the Denver metro area. We describe the Healthy Expectations Adolescent Response Team (HEART), an embedded mental health care program focused on improving identification of mental health symptoms and increasing rates mental health treatment in adolescent mothers. Results From January 1, 2011-January 16 2014, 894 pregnant adolescents were enrolled in CAMP and 885 patients were screened for mental health issues. Prior to HEART's inception, 20 % of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 % of identified patients. Following the creation of HEART, 41 % of patients were identified as needing mental health services. Nearly half of the identified patients (47 %) engaged in mental health treatment with the psychologist. Demographic factors including age, parity, ethnicity, and parent and partner involvement did not have a significant impact on treatment engagement. Trauma history was associated with lower treatment engagement. Conclusion Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Key components of the program include universal screening, intensive social work and case management involvement, and ready access to onsite mental health care providers. Limitations of the program are discussed as well directions for future research.
Topic(s):
Healthcare Disparities
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, Medical Home
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Reference Links: 
View the DOI record for Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home
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View the PubMed citation for Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home202
Improved outcomes associated with medical home implementation in pediatric primary care
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: OBJECTIVE: The medical home model with its emphasis on planned care, care coordination, family-centered approaches, and quality provides an attractive concept construct for primary care redesign. Studies of medical home components have shown increased quality and reduced costs, but the medical home model as a whole has not been studied systematically. This study tested the hypothesis that increased medical homeness in primary care practice is associated with decreased utilization of health services and increased patient satisfaction. METHODS: Forty-three primary care practices were identified through 7 health plans in 5 states. Using the Medical Home Index (MHI), each practice's implementation of medical home concepts "medical homeness" was measured. Health plans provided the previous year's utilization data for children with 6 chronic conditions. The plans identified 42 children in each practice with these chronic conditions and surveyed their families regarding satisfaction with care and burden of illness. RESULTS: Higher MHI scores and higher subdomain scores for organizational capacity, care coordination, and chronic-condition management were associated with significantly fewer hospitalizations. Higher chronic-condition management scores were associated with lower emergency department use. Family survey data yielded no recognizable trends with respect to the medical home measurement. CONCLUSIONS: Developing an evidence base for the value of the primary care medical home has importance for providers, payers, policy makers, and consumers. Reducing hospitalizations through enhanced primary care provides a potential case for new reimbursement strategies supporting medical home services such as care coordination. Larger-scale studies are needed to further develop/examine these relationships.
Topic(s):
Healthcare Policy
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, Medical Home
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Reference Links:
View the DOI record for Improved outcomes associated with medical home implementation in pediatric primary care
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View the PubMed citation for Improved outcomes associated with medical home implementation in pediatric primary care203
Improvement in psychological wellbeing among adolescents with a substance use disorder attending an outpatient treatment programme
Type: Journal Article
Year: 2021
Publication Place: England
Abstract:
OBJECTIVES: Adolescents with substance use disorders (SUDs) exhibit high rates of comorbid psychological problems. This study aimed to examine the impact of an outpatient substance use treatment programme upon the psychological wellbeing of adolescents. METHODS: A prospective study was carried out examining psychological symptoms in a group of adolescents attending the Youth Drug and Alcohol (YoDA) Addiction Service in Dublin. Participants were treated with evidenced based psychological models such as cognitive behavioural therapy, motivational interviewing and systemic family therapy. The Becks Youth Inventory was utilised to assess psychological symptoms at treatment entry and repeated three months later at follow up. RESULTS: Among 36 adolescents who were included in this study, poly-substance misuse was the norm. Almost three-quarter had a cannabis use disorder (CUD). There were significant reductions in mean subscale scores of depression (56.0 to 50.8, p = 0.003), anger (55.2 to 49.5, p < 0.001) and disruptive behaviour (61.6 to 56.5, p = 0.002) at follow up. Although there wasn't a statistically significant reduction in mean scores for anxiety, we observed a significant proportion of participants (p = 0.008) improving and moving out of a moderate to severe symptom range when examined by category. This was also the case for self-concept (p = 0.04). Furthermore this study revealed a positive correlation between the reduction in days of cannabis use and reduction in depressive scores (Pearson correlation 0.49, p = 0.01) among those with a CUD. CONCLUSION: The findings indicate that substance use treatment for adolescents is associated with important psychological and behavioural improvements.
Topic(s):
Healthcare Disparities
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, Measures
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, Opioids & Substance Use
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204
Improvement in psychopathology among opioid-dependent adolescents during behavioral-pharmacological treatment
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: OBJECTIVE: To examine changes in behavioral and emotional problems among opioid-dependent adolescents during a 4-week combined behavioral and pharmacological treatment. METHODS: We examined scales of behavioral and emotional problems in youth using the Youth Self-Report measure at the time of substance abuse treatment intake and changes in scale scores during treatment participants were 36 adolescents (aged 13-18 years, eligible) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for opioid dependence. Participants received a 28-day outpatient, medication-assisted withdrawal with either buprenorphine, or clonidine, as part of a double-blind, double dummy comparison of these medications. All participants received a common behavioral intervention, composed of 3 individual counseling sessions per week, and incentives contingent on opioid-negative urine samples (collected 3 times/week) attendance and completion of weekly assessments. RESULTS: Although a markedly greater number of youth who received buprenorphine remained in treatment relative to those who received clonidine, youth who remained in treatment showed significant reductions during treatment on 2 Youth Self-Report grouping scales (internalizing problems and total problems) and 4 of the empirically based syndrome scales (somatic, social, attention, and thought). On Youth Self-Report competence and adaptive scales, no significant changes were observed. There was no evidence that changes in any scales differed across medication condition. CONCLUSIONS: Youth who were retained demonstrated substantive improvements in a number of clinically meaningful behavioral and emotional problems, irrespective of pharmacotherapy provided to them.
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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Reference Links:
View the DOI record for Improvement in psychopathology among opioid-dependent adolescents during behavioral-pharmacological treatment
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View the PubMed citation for Improvement in psychopathology among opioid-dependent adolescents during behavioral-pharmacological treatment205
Improving child and parent mental health in primary care: A cluster-randomized trial of communication skills training
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: OBJECTIVE: We examined child and parent outcomes of training providers to engage families efficiently and to reduce common symptoms of a range of mental health problems and disorders. METHODS: Training involved three 1-hour discussions structured around video examples of family/provider communication skills, each followed by practice with standardized patients and self-evaluation. Skills targeted eliciting parent and child concerns, partnering with families, and increasing expectations that treatment would be helpful. We tested the training with providers at 13 sites in rural New York, urban Maryland, and Washington, DC. Children (5-16 years of age) making routine visits were enrolled if they screened "possible" or "probable" for mental disorders with the Strengths and Difficulties Questionnaire or if their provider said they were likely to have an emotional or behavioral problem. Children and their parents were then monitored for 6 months, to assess changes in parent-rated symptoms and impairment and parent symptoms. RESULTS: Fifty-eight providers (31 trained and 27 control) and 418 children (248 patients of trained providers and 170 patients of control providers) participated. Among the children, 72% were in the possible or probable categories. Approximately one half (54%) were white, 30% black, 12% Latino, and 4% other ethnicities. Eighty-eight percent (367 children) completed follow-up monitoring. At 6 months, minority children cared for by trained providers had greater reduction in impairment (-0.91 points) than did those cared for by control providers but no greater reduction in symptoms. Seeing a trained provider did not have an impact on symptoms or impairment among white children. Parents of children cared for by trained providers experienced greater reduction in symptoms (-1.7 points) than did those cared for by control providers. CONCLUSION: Brief provider communication training had a positive impact on parent mental health symptoms and reduced minority children's impairment across a range of problems.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Improving child and parent mental health in primary care: A cluster-randomized trial of communication skills training
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View the PubMed citation for Improving child and parent mental health in primary care: A cluster-randomized trial of communication skills training206
Improving GPs' skills and competencies in child psychiatry
Type: Journal Article
Year: 2005
Publication Place: Norway
Abstract: Concerned at the poor availability of psychiatric services for children and adolescents, the Finnish Parliament allocated extra funds for their development during 2000 and 2001. With this subsidy, a project was set underway to update general practitioners' (GPs') skills and knowledge in child psychiatry. The problem-based learning (PBL) method was used, combined with multidisciplinary teamwork. The present paper reports on changes Finnish GPs' perceptions of their knowledge and skills in child psychiatry over a 1-year period. The study sample comprised 761 physicians working in health centres in the area of Tampere University Hospital, with a catchment population of one million. GPs' self-assessments of their skills in child psychiatry in 16 areas were collected by postal questionnaire in 2000 and 2001. The response rates were 66.1% and 57.1%, respectively. Those who answered in both years were included in the analysis (n=371). Some GPs felt that their skills and competencies had improved and some that they had declined, while the majority reported no changes. According to logistic regression analysis, the only factor explaining a marked positive change was participation in child psychiatric training. In two areas of competence, GPs who had attended child psychiatric training rated their skills as significantly better than those who had not attended such training. We conclude that the effect of this undertaking was modest when implemented as a one-off training event.
Topic(s):
Education & Workforce
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Reference Links: View the PubMed citation for Improving GPs' skills and competencies in child psychiatry
207
Improving Integration of Behavioral Health Into Primary Care for Adolescents and Young Adults
Type: Journal Article
Year: 2020
Publication Place: United States
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Disparities
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Improving Integration of Behavioral Health Into Primary Care for Adolescents and Young Adults
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View the PubMed citation for Improving Integration of Behavioral Health Into Primary Care for Adolescents and Young Adults210
Improving lifetime health by promoting behavioral health in children
Type: Journal Article
Year: 2015
Publication Place: United States
Topic(s):
General Literature
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Reference Links:
View the DOI record for Improving lifetime health by promoting behavioral health in children
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View the PubMed citation for Improving lifetime health by promoting behavioral health in children211
Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Healthcare Disparities
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Reference Links: View the PubMed citation for Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting
212
Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: a controlled before and after study
Type: Journal Article
Year: 2014
Abstract: Implementation of clinical guidelines for diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents is a challenge in practice due to insufficient availability of mental health specialists and lack of effective cooperation with primary care physicians. The Tornado program aims to reduce time between referral and start of treatment in eligible patients. This study aims to assess the effectiveness and efficiency of this program.Methods/designThis is a non-randomized controlled before-after study involving 90 outpatients (6 inverted question mark18 years old) suspected of uncomplicated ADHD, which were recruited by ten mental health teams. The Tornado program, provided by three teams, combines accelerated-track diagnosis and treatment planning. This is followed by psychoeducation at a mental health center and pharmacological treatment by primary care physicians, who received an online e-learning module for this purpose. The control group consists of patients of seven other teams, who receive care as usual. Primary outcome is the patients inverted question mark time between referral to the mental health or pediatric center and start of treatment. Secondary outcomes include severity of ADHD symptoms; functional status; health-related quality of life; treatment adherence; indicators of diagnostic procedures and treatments; patient, parent, and professional experiences and satisfaction with care; and an economic evaluation. The study is powered to detect a difference of 36 days.DiscussionThis study will provide insight into the effectiveness and efficiency of the Tornado program, an accelerated-track program in mental healthcare.Trial registrationNetherlands Trial Register NTR2505. Trial status: active data collection.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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213
Improving practice in community-based settings: a randomized trial of supervision - study protocol
Type: Journal Article
Year: 2013
Publication Place: England
Abstract: BACKGROUND: Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes 'gold standard' supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes. METHODS/DESIGN: The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment. DISCUSSION: This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01800266.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Improving practice in community-based settings: a randomized trial of supervision - study protocol
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View the PubMed citation for Improving practice in community-based settings: a randomized trial of supervision - study protocol214
Improving primary health care services for young people experiencing psychological distress and mental health problems: a personal reflection on lessons learnt from Australia and England
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: BACKGROUND: Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people. AIM: To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model. METHODS: The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published. FINDINGS: Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access. CONCLUSIONS: The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a priority for us all.
Topic(s):
Healthcare Disparities
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, Healthcare Policy
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216
Incorporating recognition and management of perinatal and postpartum depression into pediatric practice
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: Every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship. This system would have a positive effect on the health and well-being of the infant and family. State chapters of the American Academy of Pediatrics, working with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and maternal and child health programs, can increase awareness of the need for perinatal depression screening in the obstetric and pediatric periodicity of care schedules and ensure payment. Pediatricians must advocate for workforce development for professionals who care for very young children and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.
Topic(s):
General Literature
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Reference Links:
View the DOI record for Incorporating recognition and management of perinatal and postpartum depression into pediatric practice
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View the PubMed citation for Incorporating recognition and management of perinatal and postpartum depression into pediatric practice217
Increase in untreated cases of psychiatric disorders during the transition to adulthood
Type: Journal Article
Year: 2015
Publication Place: United States
Abstract: OBJECTIVE: During the transition to adulthood, youths face challenges that may limit their likelihood of obtaining services for psychiatric problems. The goal of this analysis was to estimate changes in rates of service use and untreated psychiatric disorders during the transition from adolescence to adulthood. METHODS: In a prospective, population-based study, participants were assessed up to four times in adolescence (ages 13-16; 3,983 observations of 1,297 participants, 1993-2000) and three times in young adulthood (ages 19, 21, and 24-26; 3,215 observations of 1,273 participants, 1999-2010). Structured diagnostic interviews were used to assess service need (participants meeting DSM-IV diagnostic criteria for a psychiatric disorder) and use of behavioral services in 21 service settings in the past three months. RESULTS: During young adulthood, 28.9% of cases of psychiatric disorders were associated with some treatment, compared with a rate of 50.9% for the same participants during adolescence. This decrease included a near-complete drop in use of educational and vocational services as well as declines in use of specialty behavioral services. Young adults most frequently accessed services in specialty behavioral or general medical settings. Males, African Americans, participants with substance dependence, and participants living independently were least likely to get treatment. For cases of psychiatric disorders among young adults, insurance and poverty status were unrelated to likelihood of service use. CONCLUSIONS: Young adults were much less likely to receive treatment for psychiatric problems than they were as adolescents. Public policy must address gaps in service use during the transition to adulthood.
Topic(s):
Healthcare Disparities
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Reference Links:
View the DOI record for Increase in untreated cases of psychiatric disorders during the transition to adulthood
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View the PubMed citation for Increase in untreated cases of psychiatric disorders during the transition to adulthood218
Increasing the screening and counseling of adolescents for risky health behaviors: A primary care intervention
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: OBJECTIVE: To determine whether a systems intervention for primary care providers resulted in increased preventive screening and counseling of adolescent patients, compared with the usual standard of care. METHODS: The intervention was conducted in 2 outpatient pediatric clinics; 2 other pediatric clinics in the same health maintenance organization served as comparison sites. The intervention was implemented in 2 phases: first, pediatric primary care providers attended a training workshop (N = 37) to increase screening and counseling of adolescents in the areas of tobacco, alcohol, drugs, sexual behavior, and safety (seatbelt and helmet use). Second, screening and charting tools were integrated into the intervention clinics. Providers in the comparison sites (N = 39) continued to provide the usual standard of care to their adolescent patients. Adolescent reports were used to assess changes in provider behavior. After a well visit, 13- to 17-year olds (N = 2628) completed surveys reporting on whether their provider screened and counseled them for risky behavior. RESULTS: Screening and counseling rates increased significantly in each of the 6 areas in the intervention sites, compared with rates of delivery using the usual standard of care. Across the 6 areas combined, the average screening rate increased from 58% to 83%; counseling rates increased from 52% to 78%. There were no significant increases in the comparison sites during the same period. The training component seems to account for most of this increase, with the tools sustaining the effects of the training. CONCLUSIONS: The study offers strong support for an intervention to increase clinicians' delivery of preventive services to a wide age range of adolescent patients.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Increasing the screening and counseling of adolescents for risky health behaviors: A primary care intervention
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View the PubMed citation for Increasing the screening and counseling of adolescents for risky health behaviors: A primary care intervention