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Integrating mental health services in pediatric practices is feasible and effective.

Brief behavioral and mental health programs for children can be effectively provided within pediatric practices as an alternative to being referred to a community specialist, researchers found in a randomized trial.

The behavioral health treatment provided in the pediatrician's office resulted in improved access to care, greater participation by both the child and their caregiver in treatment programs, and higher rates of treatment completion, without burdening the pediatric practice, researchers reported in the April issue of the journal Pediatrics.

The researchers recruited more than 300 children and their caregivers at eight community pediatric practices affiliated with Children's Hospital of Pittsburgh of the University of Pittsburgh's School of Medicine (UPMC). The children had been referred for treatment of behavioral problems, though many also had attention-deficit/hyperactivity disorder (ADHD) or anxiety. The participants averaged 8 years old and two-thirds were boys.

Half the children received "doctor office collaborative care," where a trained behavioral health clinician, known as a care manager, collaborated with the child's pediatrician to deliver mental health services in the pediatrician's office. The other half received "enhanced usual care," where the patients received educational materials and were referred to a local mental health specialist outside the pediatrician's office who accepted the child's health insurance.

In the program at the pediatrician's office, the child and their caregiver participated in six to 12 individual or family sessions within six months where the mental health clinician worked on individualized goals to address the behavioral health issue and reviewed educational materials to help achieve those goals. The clinician communicated with the pediatrician in regular meetings and through progress notes.

In both the in-office and outside specialist programs, the pediatrician was updated on the patient's care and could prescribe medication for the child when necessary.

Of the participants assigned to the care manager at the pediatrician's office, 99.4 percent began treatment programs and 76.6 percent completed them. Of those assigned to a specialist outside the office, 54.2 percent began treatment and 11.6 percent completed it.

The program in the pediatrician's office also was associated with higher rates of improvement in behavioral and hyperactivity problems, lowered parental stress, better treatment response, and consumer satisfaction.

"In fact, the participating pediatric practices in this clinical trial later hired their own mental health clinicians to continue delivering on-site services, after the trial had ended," said lead researcher David J. Kolko, PhD, professor of psychiatry, psychology, pediatrics, and clinical and translational science in the UPMC.

SOURCE: University of Pittsburgh School of Medicine press release: < newsreleases/2014/pages/pittnih-study-pediatric -mental-health-services.aspx>. Article: "Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial," Pediatrics, DOI: 10.1542/peds.2013-2516, published online 24 March 2014.


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Title Annotation:Research Findings
Author:McCarthy, Kathleen
Publication:The Advocate (American Mental Health Counselors Association)
Geographic Code:1USA
Date:May 1, 2014
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