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    A Collaborative Care Model to Improve Access to Pediatric Mental Health Services

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    Authors
    Aupont, Onesky
    Doerfler, Leonard A.
    Connor, Daniel F.
    Stille, Christopher J.
    Tisminetzky, Mayra
    McLaughlin, Thomas J.
    UMass Chan Affiliations
    Center for Health Policy and Research
    Department of Quantitative Health Sciences
    Department of Pediatrics
    Department of Psychiatry
    Document Type
    Journal Article
    Publication Date
    2012-04-25
    Keywords
    Mental Health Services
    Child
    Pediatrics
    Mental health
    Collaborative care
    System enhancement
    Health Services Research
    Mental and Social Health
    Pediatrics
    Psychiatry
    Psychiatry and Psychology
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    http://dx.doi.org/10.1007/s10488-012-0413-0
    Abstract
    To examine if an innovative collaborative care model known as Targeted Child Psychiatric Services designed for primary care pediatricians (PCPs) and child psychiatrists (1) was associated with improved access to child psychiatry services, (2) had the potential to identify optimal care settings for pediatric mental health care and (3) examined if pediatricians appeared as likely to accept children back into their practices at discharge from TCPS depending upon diagnostic category, controlling for severity of illness and function. The diagnostic classes examined were ADHD (39%), depression (31%) and anxiety (13%). This prospective cohort design study collected medical records of 329 children referred to TCPS by 139 PCPs. To detect the likelihood of return to referring pediatricians for follow-up care at discharge from TCPS, we employed logistic regression models. Mean age was 12.3 (SD = 4.0); 43% were female. Ninety-three percent of parents complied with pediatricians' recommendations to have their child assessed by a child psychiatrist. A total of 28.0% of referrals returned to PCPs for follow-up care; the remainder were followed in mental health. Regression findings indicated that children with major depression (OR = 7.5) or anxiety disorders (OR = 5.1) were less likely to return to PCPs compared to ADHD even though severity of psychiatric illness and functional levels did not differ across diagnostic groups. Families widely accepted pediatricians' recommendations for referral to child psychiatrists. Depression and anxiety were strong correlates of retention in mental health settings at discharge from TCPS though children with these disorders appeared to be no more severely ill or functionally limited than peers with ADHD. These children possibly could be managed in a less intensive and expensive primary care treatment setting that could access mental health specialty services as needed in a collaborative model of care. TCPS is contrasted with the well-known collaborative model for adult depression in primary care. TCPS could serve as a feasible model of care that addresses the daunting barriers in accessing pediatric mental health services.
    Source

    Adm Policy Ment Health. 2012 Apr 18. Link to article on publisher's site

    DOI
    10.1007/s10488-012-0413-0
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/43869
    PubMed ID
    22527709
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1007/s10488-012-0413-0
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