Heather J Walter1,2,3, Louis Vernacchio2,3,4, Emily K Trudell2, Jonas Bromberg5,2,3, Ellen Goodman2,6, Jessica Barton2,6, Gregory J Young2,3,4, David R DeMaso5,3, Glenn Focht7. 1. Departments of Psychiatry, heather.walter@childrens.harvard.edu. 2. Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts. 3. Harvard Medical School, Boston, Massachusetts; and. 4. Pediatrics, and. 5. Departments of Psychiatry. 6. Social Work, Boston Children's Hospital, Boston, Massachusetts. 7. Connecticut Children's Medical Center, Hartford, Connecticut.
Abstract
BACKGROUND AND OBJECTIVES: In the context of protracted shortages of pediatric behavioral health (BH) specialists, BH integration in pediatric primary care can increase access to BH services. The objectives of this study were to assess the structure and process of pediatric BH integration and outcomes in patient experience (access and quality), cost, and provider satisfaction. METHODS: In 2013, we launched a multicomponent, transdiagnostic integrated BH model (Behavioral Health Integration Program [BHIP]) in a large pediatric primary care network in Massachusetts. Study participants comprised the first 13 practices to enroll in BHIP (Phase-1). Phase-1 practices are distributed across Greater Boston, with ∼105 primary care practitioners serving ∼114 000 patients. Intervention components comprised in-depth BH education, on-demand psychiatric consultation, operational support for integrated practice transformation, and on-site clinical BH service. RESULTS: Over 5 years, BHIP was associated with increased practice-level BH integration (P < .001), psychotherapy (P < .001), and medical (P = .04) BH visits and guideline-congruent medication prescriptions for anxiety and depression (P = .05) and attention-deficit/hyperactivity disorder (P = .05). Total ambulatory BH spending increased by 8% in constant dollars over 5 years, mainly attributable to task-shifting from specialty to primary care. Although an initial decline in emergency BH visits from BHIP practices was not sustained, total emergency BH spending decreased by 19%. BHIP providers reported high BH self-efficacy and professional satisfaction from BHIP participation. CONCLUSIONS: Findings from this study suggest that integrating BH in the pediatric setting can increase access to quality BH services while engendering provider confidence and satisfaction and averting substantial increases in cost.
BACKGROUND AND OBJECTIVES: In the context of protracted shortages of pediatric behavioral health (BH) specialists, BH integration in pediatric primary care can increase access to BH services. The objectives of this study were to assess the structure and process of pediatric BH integration and outcomes in patient experience (access and quality), cost, and provider satisfaction. METHODS: In 2013, we launched a multicomponent, transdiagnostic integrated BH model (Behavioral Health Integration Program [BHIP]) in a large pediatric primary care network in Massachusetts. Study participants comprised the first 13 practices to enroll in BHIP (Phase-1). Phase-1 practices are distributed across Greater Boston, with ∼105 primary care practitioners serving ∼114 000 patients. Intervention components comprised in-depth BH education, on-demand psychiatric consultation, operational support for integrated practice transformation, and on-site clinical BH service. RESULTS: Over 5 years, BHIP was associated with increased practice-level BH integration (P < .001), psychotherapy (P < .001), and medical (P = .04) BH visits and guideline-congruent medication prescriptions for anxiety and depression (P = .05) and attention-deficit/hyperactivity disorder (P = .05). Total ambulatory BH spending increased by 8% in constant dollars over 5 years, mainly attributable to task-shifting from specialty to primary care. Although an initial decline in emergency BH visits from BHIP practices was not sustained, total emergency BH spending decreased by 19%. BHIP providers reported high BH self-efficacy and professional satisfaction from BHIP participation. CONCLUSIONS: Findings from this study suggest that integrating BH in the pediatric setting can increase access to quality BH services while engendering provider confidence and satisfaction and averting substantial increases in cost.
Authors: Nicole A Stadnick; Martina G Penalosa; Kassandra Martinez; Lauren Brookman-Frazee; Daniel P Gizzo; Timothy Sahms; Cynthia L Kuelbs; Gregory A Aarons Journal: Evid Based Pract Child Adolesc Ment Health Date: 2021-02-05
Authors: Nicole A Stadnick; Gregory A Aarons; Kassandra Martinez; Marisa Sklar; Karen J Coleman; Daniel P Gizzo; Elizabeth Lane; Cynthia L Kuelbs; Lauren Brookman-Frazee Journal: Autism Date: 2022-01-27
Authors: Megan B Cole; Qiuyuan Qin; Radley C Sheldrick; Debra S Morley; Megan H Bair-Merritt Journal: Health Serv Res Date: 2019-12 Impact factor: 3.402