Literature Collection

Increased life expectancy for individuals with complex pediatric-onset conditions means most of this population survive into adulthood. While this is great news for individuals and their families, the traditional adult medical model must adapt to extend the care provided by specialty pediatric practices to primary care. In this paper, we introduce a model of integrated behavioral health (IBH) in a primary care practice for adults with childhood onset medical and developmental conditions. Our discussion includes the role of IBH providers (i.e., psychologists, psychiatrists, and social workers) as members of the integrated team, patient engagement and response to treatment, and innovative ways we strive to meet patient needs. Our review of electronic health records of patients seen at the UR Medicine Complex Care Center suggest that IBH is feasible and highly utilized, with 216 patients (40%) having had contact with an IBH provider on the team at least once. We discuss the challenges of meeting the longer-term needs of this complex patient population and our directions for future growth including creating peer and caregiver support networks, expanding services offered, and continued collaboration with community partners.

IMPORTANCE: Studies evaluating integrated pediatric behavioral health care using electronic medical record data are limited. OBJECTIVE: To evaluate the association of receipt of integrated behavioral health services with changes in psychosocial symptoms among children receiving care at federally qualified health centers with behavioral health integration. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used electronic medical record data (June 2020 to April 2023) from children aged 4 to 18 years with an identified behavioral health concern at 4 Massachusetts federally qualified health centers with integrated behavioral health care. Data were analyzed in October 2024. EXPOSURES: Receipt of integrated behavioral health services, categorized into 3 treatment groups: (1) receipt of behavioral health clinician (BHC) encounters, (2) community health worker encounters, and (3) psychotropic prescriptions. The control group included similar children who did not receive any of these treatments. MAIN OUTCOMES AND MEASURES: The primary outcome was psychosocial symptom score based on the 17-item Pediatric Symptom Checklist (PSC-17). After applying propensity scores to match children receiving treatment and control groups on their baseline characteristics, associations of receiving a treatment with psychosocial symptoms were estimated by comparing scores before vs after treatment using linear regression models. RESULTS: Of 942 unique children, 542 (57.5%) received any type of treatment and 400 (42.5%) were in the control group. Children with a BHC encounter and children without any treatment had similar baseline characteristics (female sex: 206 children [58.7%] vs 204 children [56.7%]; mean [SD] age, 11.8 [3.5] vs 11.7 [3.4] years). After having at least 1 encounter with a BHC, PSC-17 scores among children in the treatment group were 1.51 (95% CI, -2.65 to -0.37) points lower compared with the control group. After receiving a psychotropic prescription, PSC-17 scores among children in the treatment group were 2.21 (95% CI, -3.89 to -0.54) points lower compared with the control group. No statistically significant changes were observed among children with at least 1 community health worker encounter (-0.53 points; 95% CI, -1.86 to 0.80 points). CONCLUSIONS AND RELEVANCE: In this cohort study of children at federally qualified health centers implementing behavioral health integration, receipt of encounters with BHCs and psychotropic prescriptions were associated with improved psychosocial symptoms, suggesting that expanding integrated pediatric behavioral health care might enhance behavioral health outcomes among marginalized pediatric populations.