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儿童医疗保健中行为健康干预措施的整合:服务、科学及建议。

The integration of behavioral health interventions in children's health care: services, science, and suggestions.

作者信息

Kolko David J, Perrin Ellen

机构信息

a Department of Psychiatry , University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic.

出版信息

J Clin Child Adolesc Psychol. 2014;43(2):216-28. doi: 10.1080/15374416.2013.862804. Epub 2014 Mar 3.

Abstract

Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

摘要

由于将心理或行为健康服务纳入儿科初级保健是一项国家优先事项,因此有必要对医疗环境中应用的干预措施进行描述和评估。本文研究了基于多种模式的干预研究,这些模式将行为健康护理与全面的儿科护理相结合。本综述描述了应用于不同临床问题的多种方法,如简短的心理健康技能、临床指南和循证实践,以及该研究文献的实证结果。接下来,讨论了几个关键的治疗考量因素,以最大限度地提高这些干预措施的效率和效果。提供了一些克服关键服务障碍的实用建议,以增强医疗机构提供行为健康护理的能力。对于这些干预措施治疗内化和外化行为问题的可行性、可接受性和临床效用,有一定的实证支持。借鉴最近旨在简化治疗工作的框架(如共同要素),提供了扩展这项工作并解决方法学局限性的实用策略。儿科初级保健已成为为儿童和青少年提供心理健康服务的重要场所,部分原因在于其许多理想特征(如无污名化、本地环境、熟悉的医疗服务提供者)。进一步调整现有的服务模式,可能会促进与初级保健提供者合作提供有效的综合干预措施,以解决儿科医疗中的心理健康问题。

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