Literature Collection

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.

AIM: Our objective was to integrate lessons learned from perinatal collaborative care programs across the United States, recognizing the diversity of practice settings and patient populations, to provide guidance on successful implementation. BACKGROUND: Collaborative care is a health services delivery system that integrates behavioral health care into primary care. While efficacious, effectiveness requires rigorous attention to implementation to ensure adherence to the core evidence base. METHODS: Implementation strategies are divided into three pragmatic stages: preparation, program launch, and program growth and sustainment; however, these steps are non-linear and dynamic. FINDINGS: The discussion that follows is not meant to be prescriptive; rather, all implementation tasks should be thoughtfully tailored to the unique needs and setting of the obstetric community and patient population. In particular, we are aware that implementation on the level described here assumes commitment of both effort and money on the part of clinicians, administrators, and the health system, and that such financial resources are not always available. We conclude with synthesis of a survey of existing collaborative care programs to identify implementation practices of existing programs.

OBJECTIVE: A process evaluation of the Children and Young People's Health Partnership (CYPHP) model of integrated care for the interpretation of trial findings and building evidence on the implementation of integrated care for children. DESIGN: A mixed-methods process evaluation. SETTING: CYPHP was implemented at scale across two inner-city London boroughs in South London, England, as a pragmatic cluster-randomised controlled trial involving nearly 98 000 children, with a nested process evaluation. PARTICIPANTS: Linked data were available from 73 000 participants. Qualitative data collection was through 102 interviews (group and 1:1) and observations. INTERVENTIONS: Local child health clinics delivered by paediatricians and general practitioners and a nurse-led early intervention service for children with tracer conditions (asthma, eczema and constipation), decision support, a primary care hotline, self-management support and health promotion. MAIN OUTCOME MEASURES: Five domains of the RE-AIM implementation framework: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS: Implementation varied depending on resource availability, competing priorities and natural changes over time. Successful implementation drivers included cohesive interprofessional and partnership collaboration. CONCLUSIONS: Integrated care for children can be implemented at scale, but variability, particularly low reach, may limit measurable impact at the population level. Significant health system strengthening, implementation plasticity and contextual tailoring are crucial for ensuring the efficacy and sustainability of impactful integrated care for children. TRIAL REGISTRATION NUMBER: NCT03461848.

INTRODUCTION: The Centers for Disease Control and Prevention Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022 emphasizes the need to establish referral options for patients with opioid use disorder. The purpose of this quality improvement (QI) project was to determine the effectiveness of the integration of Webster and Webster's Opioid Risk Tool (ORT) into current opioid prescribing practices to improve identification of patients at risk for opioid use disorder for appropriate referrals and pain treatment. METHODS: A QI design was used to compare referral rates to pain management, behavioral health, and substance use disorder treatment facilities before and after the implementation of the ORT among patients with chronic noncancer pain in an integrated primary care clinic in a rural region of Arizona. This article is a report of the project and compares pre- and postimplementation data to assess outcomes of a practice change. RESULTS: There were 375 participants in the project, including 212 in the preimplementation group and 163 in the postimplementation group. There were 46 referrals (22%) in the preimplementation group compared with 55 referrals (34%) in the postimplementation group. CONCLUSION: In this project, referral rates to pain management, behavioral health, and substance use disorder treatment facilities increased after integration of the ORT. Providers can use the ORT to identify at-risk patients and provide a network of treatment options.