Dr. Grimes and Dr. Webster are with the Department of Psychiatry and Dr. Hagan is with the Department of Pediatrics, Harvard Medical School, Boston. Dr. Grimes is also with the Children's Health Initiative, Cambridge Health Alliance, Cambridge, Massachusetts. Mr. Creedon is a Ph.D. candidate with the Heller School for Social Policy and Management at Brandeis University, Waltham, Massachusetts, and is also with IBM Watson Health, Cambridge. Dr. Coffey is with the Department of Psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City. Dr. Chow is with Precision Medicine Group, Boston.
Psychiatr Serv. 2018 Sep 1;69(9):986-992. doi: 10.1176/appi.ps.201600228. Epub 2018 Jul 25.
This study examined mental health service use outcomes for children receiving integrated care via a collaborative-practice model (CPM). The study hypothesis was that the delivery of intensively integrated clinical care within pediatrics, combined with community-based parent support from family support specialists (FSSs), would facilitate mental health or substance use disorder treatment access and engagement for youths at risk of experiencing disparities.
The study sample consisted of 228 children referred by pediatricians for outpatient child psychiatry evaluation within an urban safety-net hospital system in 2013. In the pilot clinic, 32 youths were referred to the CPM intervention. Among the remaining seven clinics, 196 youths were referred to usual care (control group). Differences in treatment access and engagement between the intervention and control groups were assessed using propensity-score weighted logistic regression models.
Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01).
Access and engagement were significantly higher for children receiving CPM than for usual care participants. This suggests that integrated CPM warrants further investigation as an approach for improving the odds that children and families will receive needed mental health or substance use disorder treatment.
本研究考察了通过合作实践模式（CPM）为接受综合护理的儿童提供心理健康服务的结果。研究假设是，在儿科中提供强化综合临床护理，结合家庭支持专家（FSS）的基于社区的家长支持，将为有风险出现差异的青少年提供心理健康或物质使用障碍治疗的机会，并促进其参与。
研究样本由 2013 年在城市安全网医院系统中由儿科医生转介接受门诊儿童精神病学评估的 228 名儿童组成。在试点诊所中，有 32 名青少年被转介到 CPM 干预组。在其余的七个诊所中，有 196 名青少年被转介到常规护理（对照组）。使用倾向评分加权逻辑回归模型评估干预组和对照组之间在治疗机会和参与方面的差异。
在其他因素不变的情况下，接受 CPM 干预的儿童获得精神病学评估的可能性是接受常规护理对照组儿童的四倍（调整后的优势比 [AOR]=4.16，p<.01）。CPM 组青少年的参与率（即参加随访预约）是对照组青少年的七倍（AOR=7.54，p<.01）。
接受 CPM 的儿童的获得机会和参与度明显高于接受常规护理的参与者。这表明，综合 CPM 值得进一步研究，作为一种提高儿童和家庭获得所需心理健康或物质使用障碍治疗机会的方法。
