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Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care.

Publication ,  Journal Article
American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues, ...
Published in: J Am Acad Child Adolesc Psychiatry
February 2023

OBJECTIVE: The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD: A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS: The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION: Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.

Duke Scholars

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Published In

J Am Acad Child Adolesc Psychiatry

DOI

EISSN

1527-5418

Publication Date

February 2023

Volume

62

Issue

2

Start / End Page

91 / 119

Location

United States

Related Subject Headings

  • Primary Health Care
  • Mental Health
  • Mental Disorders
  • Humans
  • Health Personnel
  • Developmental & Child Psychology
  • Child
  • Adolescent
  • 5201 Applied and developmental psychology
  • 3213 Paediatrics
 

Citation

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American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. Electronic address: clinical@aacap.org, ., & American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues, . (2023). Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry, 62(2), 91–119. https://doi.org/10.1016/j.jaac.2022.06.007
American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. Electronic address: clinical@aacap.org, Heather J., and Heather J. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. “Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care.J Am Acad Child Adolesc Psychiatry 62, no. 2 (February 2023): 91–119. https://doi.org/10.1016/j.jaac.2022.06.007.
American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. Electronic address: clinical@aacap.org, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry. 2023 Feb;62(2):91–119.
American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. Electronic address: clinical@aacap.org, Heather J., and Heather J. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. “Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care.J Am Acad Child Adolesc Psychiatry, vol. 62, no. 2, Feb. 2023, pp. 91–119. Pubmed, doi:10.1016/j.jaac.2022.06.007.
American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. Electronic address: clinical@aacap.org, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry. 2023 Feb;62(2):91–119.
Journal cover image

Published In

J Am Acad Child Adolesc Psychiatry

DOI

EISSN

1527-5418

Publication Date

February 2023

Volume

62

Issue

2

Start / End Page

91 / 119

Location

United States

Related Subject Headings

  • Primary Health Care
  • Mental Health
  • Mental Disorders
  • Humans
  • Health Personnel
  • Developmental & Child Psychology
  • Child
  • Adolescent
  • 5201 Applied and developmental psychology
  • 3213 Paediatrics