Literature Collection

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.

INTRODUCTION: Mental health and substance use disorders are common in the United States; however, only a portion of adults with these conditions receive treatment. Recent recommendations include using integrated behavioral health (IBH) models to increase patient access to care. Despite IBH's effectiveness, few psychiatry residents are trained in it. Considering the scarcity of evaluated curricula on IBH, we created a curriculum to teach different IBH models to psychiatry residents. METHODS: The curriculum was developed using the constructivism theoretical framework and aligned with the principles of competency-based medical education. The learning activities allowed learners to apply knowledge relevant to IBH models to critically appraise a clinical scenario while practicing different components of IBH, such as electronic consults. More specifically, the curriculum assignment prompted residents to examine a clinical practice, identify the model, make recommendations for changes, and discuss the advantages and barriers of the proposed changes. We employed Kirkpatrick model levels 1 and 2b to evaluate the curriculum. RESULTS: Thirty-three residents participated in this curriculum. Eleven residents completed the assignment, which was qualitatively coded to evaluate their learning. Results indicated that the participants were able to compare different IBH models and critically appraise clinical practice using knowledge of those models. Twenty-two additional residents completed an anonymous retrospective pre- and postrotation survey on their perceived level of proficiency. Survey results showed improved perceived level of proficiency at rotation completion. DISCUSSION: The developed curriculum was successful in teaching residents to acquire and apply knowledge relevant to IBH.

BACKGROUND: Integrated care interventions can improve patient outcomes and reduce the burden on acute health services, but need a strong evidence base to ensure their effectiveness. Understanding the meso and macro context in which care is delivered and determining whether patient needs are met are essential to successful implementation. Care coordination in New South Wales (NSW), Australia has evolved over time to meet the needs of an ageing population with chronic health conditions and multi-morbidity with the aim of reducing potentially preventable hospitalisations. OBJECTIVE: To examine how an integrated care coordination program was understood and implemented at state, district and clinician levels in NSW. The Integrated Care for People with Chronic Conditions (ICPCC) program was implemented statewide, however local implementation varied. Patients who were suitable for integrated care coordination were identified via a hospitalisation risk prediction algorithm and/or referrals from health professionals. METHODS: Understanding and implementation of ICPCC were assessed via interviews and a focus group with a range of health staff. Qualitative data were analysed using NVivo software and normalisation process theory. RESULTS: There was a strong sense of program coherence from management, clinicians and referrers. They viewed ICPCC as effective in coordinating care for patients at risk of hospitalisation and incorporating self-management at home. All health staff interviewed understood the program purpose and necessity, including the importance of achieving patient and systemic goals. Networking, linking services and program promotion were important, as was reporting on benefits. While the algorithm effectively identified previously hospitalised patients, it did not identify all suitable patients in the community with an increasing risk of requiring acute health care intervention. Referrals from health professionals familiar with patient needs and complexity were an important additional mechanism for patient selection. CONCLUSIONS: There was a shared sense of coherence and understanding of the ICPCC program among health staff at the three levels of implementation within NSW. The program played an important role in assisting patients with a range of chronic conditions to access and benefit from integrated care coordination, while increasing their capacity to self-manage at home. Program intake via hospitalisation risk prediction algorithm plus referrals from health professionals familiar with patient needs and complexity can effectively identify those who may benefit from integrated care coordination.