A Collaborative Care Model to Improve Access to Pediatric Mental Health Services
Authors
Aupont, OneskyDoerfler, Leonard A.
Connor, Daniel F.
Stille, Christopher J.
Tisminetzky, Mayra
McLaughlin, Thomas J.
UMass Chan Affiliations
Center for Health Policy and ResearchDepartment of Quantitative Health Sciences
Department of Pediatrics
Department of Psychiatry
Document Type
Journal ArticlePublication Date
2012-04-25Keywords
Mental Health ServicesChild
Pediatrics
Mental health
Collaborative care
System enhancement
Health Services Research
Mental and Social Health
Pediatrics
Psychiatry
Psychiatry and Psychology
Metadata
Show full item recordAbstract
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/s10488-012-0413-0Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43869PubMed ID
22527709Related Resources
ae974a485f413a2113503eed53cd6c53
10.1007/s10488-012-0413-0
Scopus Count
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