Citation

Grimes KE, Creedon TB, Webster CR, Coffey SM, Hagan GN, Chow CM. Psychiatr. Serv. 2018; 69(9): 986-992.

Affiliation

Dr. Grimes and Dr. Webster are with the Department of Psychiatry and Dr. Hagan is with the Department of Pediatrics, Harvard Medical School, Boston. Dr. Grimes is also with the Children's Health Initiative, Cambridge Health Alliance, Cambridge, Massachusetts. Mr. Creedon is a Ph.D. candidate with the Heller School for Social Policy and Management at Brandeis University, Waltham, Massachusetts, and is also with IBM Watson Health, Cambridge. Dr. Coffey is with the Department of Psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City. Dr. Chow is with Precision Medicine Group, Boston.

Copyright

(Copyright © 2018, American Psychiatric Association)

DOI

10.1176/appi.ps.201600228

PMID

30041586

Abstract

OBJECTIVE: This study examined mental health service use outcomes for children receiving integrated care via a collaborative-practice model (CPM). The study hypothesis was that the delivery of intensively integrated clinical care within pediatrics, combined with community-based parent support from family support specialists (FSSs), would facilitate mental health or substance use disorder treatment access and engagement for youths at risk of experiencing disparities.

METHODS: The study sample consisted of 228 children referred by pediatricians for outpatient child psychiatry evaluation within an urban safety-net hospital system in 2013. In the pilot clinic, 32 youths were referred to the CPM intervention. Among the remaining seven clinics, 196 youths were referred to usual care (control group). Differences in treatment access and engagement between the intervention and control groups were assessed using propensity-score weighted logistic regression models.

RESULTS: Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01).

CONCLUSIONS: Access and engagement were significantly higher for children receiving CPM than for usual care participants. This suggests that integrated CPM warrants further investigation as an approach for improving the odds that children and families will receive needed mental health or substance use disorder treatment.

Language: en

Keywords

Child psychiatry; collaborative practice model; engagement; family support specialists; integrated care; pediatrics