Practice-Based Models of Pediatric Mental Health Care.

Pediatric primary care is widely available in the United States and can help address the growing public health crisis in child and adolescent mental health by providing integrated behavioral health services. This article provides an overview of 3 common models of behavioral health integration in pediatric primary care settings: 1) the Child Psychiatry Access Program model, 2) the Primary Care Behavioral Health model, and 3) the Collaborative Care Model. Pediatric primary care practices may evaluate the different features of each model before adopting an approach for integration and consider tailoring it to their practice environments.

Comparison of Use of the Massachusetts Child Psychiatry Access Program and Patient Characteristics Before vs During the COVID-19 Pandemic.

This cross-sectional study compares the number of encounters at the Massachusetts Child Psychiatry Access Program, patient characteristics, and mental health diagnoses before vs during the COVID-19 pandemic.

Ethical Imperatives for Participation in Integrated/Collaborative Care Models for Pediatric Mental Health Care.

The significant and ongoing shortage of child and adolescent psychiatrists has limited access to mental health care in the pediatric population. In response to this problem, integrated/collaborative care models have been established. These models, as all imperfect things in medicine, have their own set of challenges.

Accentuate the Positive: Strengths-Based Therapy for Adolescents.

Purpose: The field of psychiatry has conventionally employed a medical model in which mental health disorders are diagnosed and treated. However, the evidence is amassing that using a strengths-based approach that promotes wellness by engaging the patient's assets and interests may work in synergy with the medical model to promote recovery. This harmonizes with the patient-centered care model that has been promoted by the Institute of Medicine.

Measurement-Based Care in the Pediatric Primary Care Setting.

Challenges associated with the integration of pediatric mental health care in the primary care setting include limitations of training and time, high volume of patients, need for coordination with external specialists, limited infrastructure, and limited funding. All of these issues can negatively influence the quality of mental health service delivery. Measurement-based care (MBC) processes have the potential to mitigate many of these challenges and generate data, allowing practices to evaluate and improve the performance of integrated mental health processes.

Impact of Child Psychiatry Access Programs on Mental Health Care in Pediatric Primary Care: Measuring the Parent Experience.

Objective: This study aimed to assess parents' satisfaction with the primary care provider (PCP) in the treatment of their child's mental health problems after the PCP consulted with the Massachusetts Child Psychiatry Access Program (MCPAP). It studied how parental satisfaction may vary across factors, including service utilization, parental perception of the child's illness, and parental perception of certain PCP attributes.

Methods: The study analyzed 374 telephone consultations made from PCPs to MCPAP between March 2010 and June 2012.

Evaluating Integrated Mental Health Care Programs for Children and Youth.

Evaluations of integrated care programs share many characteristics of evaluations of other complex health system interventions. However, evaluating integrated care for child and adolescent mental health poses special challenges that stem from the broad range of social, emotional, and developmental problems that need to be addressed; the need to integrate care for other family members; and the lack of evidence-based interventions already adapted for primary care settings. Integrated care programs for children's mental health need to adapt and learn on the fly, so that evaluations may best be viewed through the lens of continuous quality improvement rather than evaluations of fixed programs.

Massachusetts Child Psychiatry Access Project 2.0: A Case Study in Child Psychiatry Access Program Redesign.

The Massachusetts Child Psychiatry Access Program is a statewide public mental health initiative designed to provide consultation, care navigation, and education to assist pediatric primary care providers in addressing mental health problems for children and families. To improve program performance, adapt to changes in the environment of pediatric primary care services, and ensure the program's long-term sustainability, program leadership in consultation with the Massachusetts Department of Mental Health embarked on a process of redesign. The redesign process is described, moving from an initial strategic assessment of program and the planning of structural and functional changes, through transition and implementation.

Implementing Integrated Care in Pediatric Mental Health: Principles, Current Models, and Future Directions.

Traditional models of health care delivery are inadequate for addressing all the needs of the child and adolescent population that has mental illness. The integrated care model seeks to partner pediatric mental health specialists with primary providers to better meet these needs. The authors outline the core principles guiding integrated care for youths and describe key characteristics of the team members involved.

Integrating Mental and Physical Health Services Using a Socio-Emotional Trauma Lens.

This article provides a synthesis of the lessons learned from the Pediatric Integrated Care Collaborative (PICC), a SAMHSA-funded project that is part of the National Child Traumatic Stress Network. The high prevalence of trauma exposure in childhood and shortage of mental health services has informed efforts to integrate mental and behavioral health services in pediatric primary care. This article outlines strategies to integrate care following the six goals of the PICC change framework: create a trauma/mental health informed office; involve families in program development; collaborate and coordinate with mental health services; promote resilience and prevent mental health problems through a particular focus on trauma-related risks; assess trauma-related somatic and mental health issues; and address trauma-related somatic and mental heath issues.

The Use of Health Information Technology Within Collaborative and Integrated Models of Child Psychiatry Practice.

There is a consistent need for more child and adolescent psychiatrists. Despite increased recruitment of child and adolescent psychiatry trainees, traditional models of care will likely not be able to meet the need of youth with mental illness. Integrated care models focusing on population-based, team-based, measurement-based, and evidenced-based care have been effective in addressing accessibility and quality of care.

Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms.

Objective: Perinatal depression is common and associated with poor birth, infant and child outcomes. Screening for perinatal depression alone does not improve treatment rates or patient outcomes. This paper describes the development, implementation and outcomes of a new and low-cost population-based program to help providers address perinatal depression, the Massachusetts Child Psychiatry Access Project (MCPAP) for Moms.

Behavioral health care for children: the massachusetts child psychiatry access project.

Access to behavioral health care for children is essential to achieving good health care outcomes. Pediatric primary care providers have an essential role to play in identifying and treating behavioral health problems in children. However, they lack adequate training and resources and thus have generally been unable to meet children's need for behavioral health care.

Medico-legal risk associated with pediatric mental health telephone consultation programs.

Clinicians providing consultation through mental health telephone consultation programs express concern about the potential legal risk of the practice. In this survey of six state mental health telephone consultation program directors, we report the annual number of children referred for consultation and the number of lawsuits against consultant clinicians. Between 2004 and 2010, 3,652 children per year were referred nationally, and there were no medical malpractice lawsuits against clinicians related to telephone consultation program activity.