Abstract
Integrated behavioral health services have positive outcomes for patients and providers, but little is known about providers’ perspectives on implementing these services. This community-based participatory research collaboration with a Federally Qualified Health Center examined provider perspectives on implementing a collaborative psychiatry consultation program in pediatric primary care. We interviewed providers (N = 14) from psychiatry, social work, primary care, and psychology regarding their experiences implementing the program, and their recommendations for its sustainability. Providers described interdisciplinary integration arising from the program, with accompanying benefits (e.g., increased access to care for patients with complex diagnostic profiles, increased learning and role satisfaction among providers), and challenges (e.g., increased burden on primary care providers, potential patient discomfort with team-based care). Our results highlight the complexities of implementing collaborative psychiatry consultation in pediatric primary care, and suggest the importance of supporting primary care providers and patients within this context.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams, C. D., Hinojosa, S., Armstrong, K., Takagishi, J., & Dabrow, S. (2016). An innovative model of integrated behavioral health: School psychologists in pediatric primary care settings. Advances in School Mental Health Promotion, 9(3–4), 188–200. https://doi.org/10.1080/1754730X.2016.1215927.
Ader, J., Stille, C. J., Keller, D., Miller, B. F., Barr, M. S., & Perrin, J. M. (2015). The medical home and integrated behavioral health: Advancing the policy agenda. Pediatrics, 135(5), 909–917. https://doi.org/10.1542/peds.2014-3941.
Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L. (2015). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. JAMA Pediatrics, 169(10), 929–937. https://doi.org/10.1001/jamapediatrics.2015.1141.
Bird, S. R., Noronha, M., Kurowski, W., Orkin, C., & Sinnott, H. (2012). Integrated care facilitation model reduces use of hospital resources by patients with pediatric asthma. Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality, 34(3), 25–33. https://doi.org/10.1111/j.1945-1474.2011.00143.x.
Bridges, A. J., Andrews, A. R. I., Villalobos, B. T., Pastrana, F. A., Cavell, T. A., & Gomez, D. (2014). Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings. Journal of Latina/o Psychology, 2(1), 37–53. https://doi.org/10.1037/lat0000009.
Cole, A. M., Chen, F. M., Ford, P. A., Phillips, W. R., & Stevens, N. G. (2014). Rewards and challenges of community health center practice. Journal of Primary Care & Community Health, 5(2), 148–151. https://doi.org/10.1177/2150131913501519.
Connor, D. F., McLaughlin, T. J., Jeffers-Terry, M., O’Brien, W. H., Stille, C. J., Young, L. M., et al. (2006). Targeted child psychiatric services: A new model of pediatric primary clinician—child psychiatry collaborative care. Clinical Pediatrics, 45(5), 423–434.
Cooley, W. C., McAllister, J. W., Sherrieb, K., & Kuhlthau, K. (2009). Improved outcomes associated with medical home implementation in pediatric primary care. Pediatrics, 124(1), 358–364. https://doi.org/10.1542/peds.2008-2600.
Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th edn.). Thousand Oaks: Sage Publications.
Cunningham, P. J., & Freiman, M. P. (1996). Determinants of ambulatory mental health services use for school-age children and adolescents. Health Services Research, 31(4), 409–427.
Daley, J., Kellehear, A., & Gliksmann, M. (1997). The public health research: A methodological approach. London: Oxford University Press.
Foy, J. M., & American Academy of Pediatrics Task Force on Mental Health (2010). Enhancing pediatric mental health care: Report from the American Academy of Pediatrics Task Force on Mental Health. Pediatrics, 125(Suppl 3), 69–74. https://doi.org/10.1542/peds.2010-0788C.
Gomez, D., Bridges, A. J., Andrews, A. R., Cavell, T. A., Pastrana, F. A., Gregus, S. J., et al. (2014). Delivering parent management training in an integrated primary care setting: Description and preliminary outcome data. Cognitive and Behavioral Practice, 21(3), 296–309. https://doi.org/10.1016/j.cbpra.2014.04.003.
Guest, G., MacQueen, K. M., & Namey, E. E. (2013). Applied thematic analysis. Los Angeles: Sage.
Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19(1), 173–202. https://doi.org/10.1146/annurev.publhealth.19.1.173.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555. https://doi.org/10.1176/appi.ajp.159.9.1548.
Kim, W. J. (2003). Child and adolescent psychiatry workforce: A critical shortage and national challenge. Academic Psychiatry, 27(4), 277–282. https://doi.org/10.1176/appi.ap.27.4.277.
Kolko, D. J., & Perrin, E. (2014). The integration of behavioral health interventions in children’s health care: Services, science, and suggestions. Journal of Clinical Child & Adolescent Psychology, 43(2), 216–228. https://doi.org/10.1080/15374416.2013.862804.
Lasalvia, A., Bonetto, C., Bertani, M., Bissoli, S., Cristofalo, D., Marrella, G., et al. (2009). Influence of perceived organisational factors on job burnout: Survey of community mental health staff. The British Journal of Psychiatry, 195(6), 537–544. https://doi.org/10.1192/bjp.bp.108.060871.
Lavigne, J. V. (2016). Introduction to the special section: Psychology in integrated pediatric primary care. Journal of Pediatric Psychology, 41(10), 1077–1080.
LeCompte, M. D., & Schensul, J. J. (1999). Analyzing and interpreting ethnographic data. Walnut Creek: Altamira.
Li, L. B., Williams, S. D., & Scammon, D. L. (1995). Practicing with the urban underserved: A qualitative analysis of motivations, incentives, and disincentives. Archives of Family Medicine, 4(2), 124–133.
Loeb, D. F., Bayliss, E. A., Binswanger, I. A., Candrian, C., & deGruy, F. V. (2012). Primary care physician perceptions on caring for complex patients with medical and mental illness. Journal of General Internal Medicine, 27(8), 945–952.
Miranda, J., Azocar, F., Organista, K. C., Dwyer, E., & Areane, P. (2003). Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatric Services, 54(2), 219–225. https://doi.org/10.1176/appi.ps.54.2.219.
Raney, L. E. (2015). Integrating primary care and behavioral health: The role of the psychiatrist in the collaborative care model. American Journal of Psychiatry, 172(8), 721–728. https://doi.org/10.1176/appi.ajp.2015.15010017.
Rapp, A. M., Chavira, D. A., Sugar, C. A., & Asarnow, J. R. (2017). Integrated primary medical-behavioral health care for adolescent and young adult depression: Predictors of service use in the youth partners in care trial. Journal of Pediatric Psychology, 42(9), 1051–1064. https://doi.org/10.1093/jpepsy/jsx057.
Ryan, G. W., & Bernard, H. R. (2000). Data management and analysis methods. In N. Denzin & Y. Lincoln (Eds.), The handbook of qualitative research (2nd edn., pp. 769–802). Thousand Oaks: Sage.
Sobo, E. J. (2009). Culture and meaning in health services research: A practical field guide. Walnut Creek: Left Coast Press.
Thomas, C. R., & Holzer, C. E. (2006). The continuing shortage of child and adolescent psychiatrists. Journal of the American Academy of Child & Adolescent Psychiatry, 45(9), 1023–1031. https://doi.org/10.1097/01.chi.0000225353.16831.5d.
VanderWielen, L. M., Gilchrist, E. C., Nowels, M. A., Petterson, S. M., Rust, G., & Miller, B. F. (2015). Not near enough: Racial and ethnic disparities in access to nearby behavioral health care and primary care. Journal of Health Care for the Poor and Underserved, 26(3), 1032–1047. https://doi.org/10.1353/hpu.2015.0083.
Walter, H. J., Kackloudis, G., Trudell, E. K., Vernacchio, L., Bromberg, J., DeMaso, D. R., et al. (2017). Enhancing pediatricians’ behavioral health competencies through child psychiatry consultation and education. Clinical Pediatrics. https://doi.org/10.1177/0009922817738330.
Williams, J., Shore, S. E., & Foy, J. M. (2006). Co-location of mental health professionals in primary care settings: Three North Carolina models. Clinical Pediatrics, 45(6), 537–543. https://doi.org/10.1177/0009922806290608.
Zallman, L., Joseph, R., O’Brien, C., Benedetto, E., Grossman, E., Arsenault, L., et al. (2017). Does behavioral health integration improve primary care providers’ perceptions of health-care system functioning and their own knowledge? General Hospital Psychiatry, 46(Supplement C), 88–93. https://doi.org/10.1016/j.genhosppsych.2017.03.005.
Acknowledgements
This research was supported by funding from St. Luke’s Episcopal Health Charities (now known as Episcopal Health Charities). We gratefully acknowledge the community providers and stakeholders who participated.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest.
Ethical Approval
This study was approved by the Institutional Review Board at the University of Texas at Austin. All participants provided informed consent per the approved IRB protocol for the study.
Rights and permissions
About this article
Cite this article
Rodríguez, E.M., Gulbas, L.E., George-Jones, J. et al. Interdisciplinary Perspectives on an Integrated Behavioral Health Model of Psychiatry in Pediatric Primary Care: A Community-Based Participatory Research Study. Community Ment Health J 55, 569–577 (2019). https://doi.org/10.1007/s10597-018-0330-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-018-0330-0