Literature Collection

The integration of behavioral health (BH) services within pediatric primary care has been utilized as a way to address young children's social-emotional needs. This study aimed to examine whether linking at-risk young children to BH services is associated with a reduction in "non-urgent" emergency department (ED) visits. BH teams integrated in a pediatric clinic conducted socio-emotional screening in children 6-65 months of age and tracked ED utilization for children with positive screening. The results indicated that children with positive screening are less likely to have a non-urgent ED visit than children with negative screening with concerns (NWC) and are more likely to be connected to services. Among children in the NWC group, those connected to services were less likely to have non-urgent ED visits than those not connected to services. These findings suggest that integrated behavioral health care has the potential to reduce non-urgent ED visits among at-risk children.

BACKGROUND: Child wellness is a multidimensional construct encompassing physical, mental, and social well-being, and schools are recognized as critical settings for integrated health promotion. School nurses play a central role within these systems; however, evidence regarding the scope, contextual variability, and effectiveness of nurse-led interventions remains fragmented. The Whole School, Whole Community, Whole Child (WSCC) framework provides a comprehensive model for understanding how school health services contribute to child wellness across multiple domains. OBJECTIVE: This systematic review aimed to synthesize recent evidence on school nurse-led interventions and evaluate their contributions to multidimensional child wellness within the WSCC framework. METHODS: A systematic review was conducted following PRISMA 2020 guidelines. Five databases (PubMed, CINAHL, Scopus, Web of Science, and PsycINFO) were searched for studies published between January 2020 and June 2025. Studies were screened independently by two reviewers using predefined inclusion criteria. Methodological quality was assessed using Joanna Briggs Institute tools. Due to heterogeneity in study designs and outcomes, a narrative thematic synthesis was performed, and findings were mapped onto WSCC components. RESULTS: Seventeen studies met the inclusion criteria. Interventions were categorized into five domains: health education (n = 9), mental health support (n = 6), chronic disease management (n = 7), hygiene and infection control (n = 5), and interdisciplinary collaboration (n = 8). Interventions were associated with improvements in health knowledge, behavioral outcomes, mental health indicators, and disease management. However, substantial variability in nurse roles and health system contexts limited comparability, and several WSCC components remained underrepresented. CONCLUSION: School nurses play a critical role in promoting multidimensional child wellness. Nevertheless, limited evidence and contextual heterogeneity constrain generalizability, highlighting the need for standardized, context-sensitive, and longitudinal research.

ObjectivesCentral government has been promoting closer integration between the National Health Service (NHS) and local government social services in England for more than five decades. Improved coordination between primary, hospital, community health and social services has been advocated as a cost-effective response to growing care needs in an ageing population. This paper concentrates on one of the principal local care coordination mechanisms: community-based multidisciplinary teams (MDTs) involving NHS and social services staff. It reports local leaders' perceptions of MDTs' current and future contributions to more coordinated care and support systems in two integrated care Pioneer sites.MethodsThirty-two qualitative semi-structured interviews with 25 local system leaders and operational managers in two contrasting Integrated Care and Support Pioneer areas were conducted between October 2018 and April 2021, as part of a wider evaluation of the Integrated Care and Support Pioneer Programme. Eight of those interviews took place after the start of the COVID-19 pandemic and between lockdowns. Interviews were analysed thematically.ResultsLocal leaders in both areas broadly shared a vision of integrated care in which MDTs were essential mechanisms for coordinating improvements in health and wellbeing, especially for older people who are frail, experience falls and have long-term health conditions. Organisational differences between and within sites influenced local decisions about the purpose and structure of MDTs, but, despite such variations, interviewees identified similar challenges to implementation. Staff turnover, often linked to funding uncertainties, and the lack of shared information systems, were among the most frequent operational challenges noted. System leaders valued national policy frameworks as potential enablers of integrated care but also recognised the role of local contexts in shaping local implementation decisions. Interviewees highlighted benefits emerging from multidisciplinary working, including its potential to deliver more holistic care, fewer instances of work duplication, speedier access to care and enhanced home care provision. However, they were concerned such benefits were not always captured by commonly used performance indicators and thus the value of MDTs could be under-estimated.ConclusionsLocal contextual variables and local understandings of these variables appeared to be the main influences on variations in local responses to national expectations of improvements in care integration. Local leaders in both areas broadly shared a vision of integrated care in which MDTs provided essential mechanisms for securing interdependent improvements in both the health and wellbeing of local populations and improvements in workforce job satisfaction.