Literature Collection

OBJECTIVE: Child psychiatry access programs (CPAPs) address the mental health treatment access gap by providing training, consultation, and referral support to primary care providers (PCPs). Research has documented provider use of and satisfaction with CPAPs, but less work has examined how usage relates to provider practice change. This qualitative study examines PCPs' perceptions about the use of CPAP services (ie, consultations, referral support, training) and resulting changes in their practice behaviors. METHODS: The population of CPAP users was purposively sampled based on variation in geography and frequency of use: frequent (N=16), moderate (N=10), and infrequent (N=11) users. Semistructured interviews were conducted with 37 providers. PCPs were asked about their use of CPAP services, and if/how these services influenced patient care and practice change. Interviews were recorded, transcribed, and analyzed using content analysis. RESULTS: Regardless of frequency of CPAP use, all providers indicated medication management and need for patient referrals as primary reasons for calling the CPAP. All providers described practice change behaviors, with increased confidence/comfort in providing mental health care and medication management identified predominantly by frequent users. Providers consistently reported a positive attitude toward CPAP consultations. CONCLUSIONS: Providers perceive CPAP services as helpful and related to improvements in their ability to address patient mental health needs. Providers reported making changes to their practice behaviors, regardless of their level of CPAP use. This study provides preliminary support that participation in CPAP services contributes to improved PCP practice in addressing child mental health concerns.

PURPOSE: The juncture of integrated care and professional identity is an under-researched yet critical intersection. This study aims to support the development of integration by gaining further understanding about the professional identity of integrated care team members. DESIGN/METHODOLOGY/APPROACH: Qualitative case study methodology using observations, semi-structured interviews and focus groups was used to explore professional identity in three UK newly integrated, community teams. The cases were nursing (n = 17), therapy (n = 13) and mental health nursing (n = 3) professions. FINDINGS: All professions identified with their own professional group. Some new identification with the integrated teams was evident, although individual professional group identity was always salient. Key themes were professional role, perceived lack of understanding, defensiveness and security. Participants employed tactics to prove their worth, strengthen their professional identity and counteract perceived threats against their profession. PRACTICAL IMPLICATIONS: Profession specific identities should be recognised and nurtured to reduce defensiveness and counteract threat. Differences between professions should be acknowledged and space given to improve understanding between professions. When individual professional identity is supported, team members can start to form a new, additional identity within their integrated team. ORIGINALITY/VALUE: Identification with professional in-groups was based on security, not discrimination against other professions. Professional groups didn't feel understood by other professional groups but still maintained respect and recognition for their expertise. Tactics employed to counteract professional identity threat included proving how busy they were.