A systematic review and meta-analysis of pediatric integrated primary care for the prevention and treatment of physical and behavioral health conditions.

Objective: To evaluate the effects of behavioral health interventions delivered within pediatric integrated primary care models on clinical outcomes.

Methods: We searched Medline, EMBASE, CENTRAL, PsycINFO, and SCOPUS for studies published from January 1, 1998, to September 20, 2023. We included studies that evaluated onsite behavioral health integration in pediatric primary care using a comparator condition (usual, enhanced usual care, or waitlist).

Increasing Access to and Utilization of Behavioral Health Care Through Integrated Primary Care.

Objectives: To evaluate changes in access to and utilization of behavioral health (BH) services after the integration of psychologists into primary care clinics compared with clinics without integrated psychologists.

Methods: We integrated 4 of 12 primary care clinics within our academic health system. We used the median wait time for BH services as a proxy for changes in access and defined BH utilization as the percentage of primary care visits that resulted in contact with a BH clinician within 180 days.

Parents' Preferences for Primary Care-Based Behavioral Services and the COVID-19 Pandemic: A Mixed Method Study.

Objective: This study examined how family factors impacted parents' attitudes toward integrated behavioral health (IBH) in pediatric primary care during the COVID-19 pandemic. We hypothesized that COVID-19 impact would predict family functioning challenges, and that pre-existing familial contextual factors would predict parents' interest in IBH modalities.

Methods: Parents of children ages 1.

Child health equity and primary care.

Child health disparities in terms of access to high-quality physical and behavioral health services and social needs supports are rampant and pernicious in the United States. These disparities reflect larger societal health inequities (social injustice in health) and lead to preventable population-specific differences in wellness outcomes with marginalized children facing substantial and systematically disproportionate health burdens. Primary care, and specifically the pediatric patient-centered medical home (P-PCMH) model, is a theoretically well-positioned platform to address whole-child health and wellness needs, yet often does so in a way that is inequitable for marginalized populations.

Pediatric mental health crisis: Propelling the Surgeon General's advice to action.

The nation is facing a pediatric mental health crisis that is years in the making. The pandemic potentiated the crisis by isolating youth and compounding family stressors. In response, the US Surgeon General issued an advisory in late 2021 recommending actions that health care and other sectors should take to improve youth well-being.

ACEs screening in adolescent primary care: Psychological flexibility as a moderator.

Purpose: Screening for adverse childhood experiences (ACEs) is increasingly recommended in medical settings; however, there is more to learn about which patients experience negative outcomes following ACEs and how to intervene. This study sought to determine whether psychological flexibility moderated the relationship between ACEs and 2 important health outcomes: depression and elevated body mass index (BMI). Specifically, we hypothesized that as psychological flexibility increased, the relationship between ACEs and these mental and physical health outcomes would weaken.

Improving Primary Care Adolescent Depression Screening and Initial Management: A Quality Improvement Study.

Unlabelled: Although recommended, adolescent depression screening with appropriate initial management is challenging. This project aimed to improve adolescent depression screening rates during preventive care visits in 12 primary care clinics from 65.4% to 80%, increase the proportion of documented initial management for those with a positive screen from 69.

COVID-19 distress, negative parenting, and child behavioral problems: The moderating role of parent adverse childhood experiences.

Background: Heightened familial stress and distress during the COVID-19 pandemic may lead to increased negative parenting practices, particularly for parents with substantial adverse childhood experiences (ACES).

Objective: To determine whether families' COVID-19-related distress is associated with young children's emotional/behavioral functioning via negative parenting, and whether these relationships vary based on parents' ACEs.

Participants And Setting: Participants were 267 parents of children ages 1.

Parents' Preferences for Behavioral Services in Primary Care During the COVID-19 Pandemic.

Objective: Pediatric primary care is an ideal setting to provide behavioral health services to young children and their families during the COVID-19 pandemic. However, it is unclear how the pandemic altered parents' priorities and preferences to obtain behavioral services in this setting.

Method: Between July 2020 and January 2021, 301 parents of young children in 5 pediatric sites across the United States completed survey measures on their preferences for behavioral topics and service delivery methods in primary care.

Screening for Anxiety in Pediatric Primary Care: A Systematic Review.

Context: Anxiety is common, screening tools are available, and treatment can be effective. Recently, anxiety screening has been recommended for adolescent girls beginning at 13 years of age.

Objective: To evaluate the evidence regarding anxiety screening test accuracy in primary care for children and adolescents and assess the effectiveness of treatment of individuals identified through screening.

Development and functionality of a pediatric behavioral health registry for integrated and collaborative care models.

Using clinical registries to collect and monitor individual, case-level, and population health-relevant variables has been found to be effective at improving outcomes in adult populations. However, due to multiple barriers unique to pediatric care, there are limited available registries for youth and limited studies investigating their effectiveness for pediatric populations. This paper describes a process to develop clinical BH registries to address the BH needs of youth.

Clinician's corner: Response to Gormley et al.

Comments on article by Gormley et al. (2020). The current author discusses the original article's relevance to their professional experience as a clinician at Nationwide Children's Hospital in Columbus, Ohio.

Using Measurement-Based Care Data in Population Health Management.

Although screening can significantly improve the identification of youth with mental health needs in primary care, there is no evidence that screening improves outcomes. Measurement-based care using clinical mental health registries has been shown to improve screening outcomes in adult primary care populations and pediatric physical health needs; however, there is limited attention to pediatric mental health registries in primary care. This article describes clinical mental health registries, discusses the barriers to implementation with youth, and describes next steps in expanding the use of pediatric mental health registries in primary care.

Improving Pediatrician's Behavioral Health Competencies Through the Project ECHO Teleconsultation Model.

Project ECHO (Extension for Community Healthcare Outcomes) is a teleconsultation model for enhancing the treatment of underserved patients in primary care. Previous behavioral health (BH) adaptations of Project ECHO have primarily focused on adults or specific diagnoses and have relied on self-reported outcomes. The purpose of this pilot was to adapt Project ECHO to support pediatric primary care providers in addressing common BH needs and to conduct an initial evaluation of its effectiveness.

Integrated Behavioral Health in Pediatric Primary Care.

(Reprinted with permission from (2016) 18: 106).

Integrated Behavioral Health in Pediatric Primary Care.

There are multiple barriers to accessing high quality, evidence-based behavioral health care for children and adolescents, including stigma, family beliefs, and the significant paucity of child and adolescent psychiatrists. Although equal access continues to be an unmet need in the USA, there is growing recognition that integrated behavioral health services in pediatric primary care have the potential to reduce health disparities and improve service utilization. In a joint position paper, the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) highlighted the multiple benefits of children receiving initial behavioral health screening, assessment, and evidence-based behavioral health treatments in the medical home.