Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco.
Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco.
JAMA Pediatr. 2020 May 1;174(5):487-498. doi: 10.1001/jamapediatrics.2020.0023.
Emerging evidence suggests that integrated care models are associated with improved mental health care access and outcomes for youths (children ≤12 years and adolescents 12-21 years) served in pediatric primary care settings. However, the key components of these complex models remain unexamined.
To identify and describe the key components of effective pediatric integrated mental health care models.
The PubMed, Embase, PsycINFO, and Cochrane Controlled Register of Trials electronic databases were searched for relevant peer-reviewed articles published between January 1, 1985, and April 30, 2019. Articles were restricted to those published in the English language. Eligible articles reported original data on youths 17 years or younger, implemented an integrated mental health care model in a pediatric primary care setting, and assessed the model's association with primary outcomes (eg, mental health symptom severity) and secondary outcomes (eg, functional impairment and patient satisfaction). Articles that specified some degree of systematic coordination or collaboration between primary care and mental health professionals were included in the final review. Two independent reviewers extracted data on study design, model type, model components, level of integration, and outcomes. Study quality was assessed using the Jadad scale. Data were analyzed between January 1, 2018, and May 31, 2019.
Eleven randomized clinical trials involving 2190 participants were included. Three studies focused on youths with depression, 3 on youths with attention-deficit/hyperactivity disorder, and 5 on youths with behavioral disorders. Most studies (9 of 11) implemented either the collaborative care model (n = 3), a slightly modified version of the collaborative care model (n = 2), or colocated care (n = 4). The most commonly reported components of effective pediatric integrated mental health care models were population-based care, measurement-based care, and delivery of evidence-based mental health services; all 3 components were present in studies reporting clinical improvement of mental health symptoms. Other model components, such as treatment-to-target or team-based care, were common in studies reporting specific outcomes, such as functional impairment.
This review is the first to date to systematically search and qualitatively synthesize information on the key components of effective pediatric integrated mental health care models. This knowledge may be especially useful for pediatric primary care administrators in the selection of an integrated care model for their setting.
新出现的证据表明，综合护理模式与改善儿科初级保健环境中服务的青少年（儿童≤12 岁和青少年 12-21 岁）的心理健康护理的可及性和结果相关。然而，这些复杂模式的关键组成部分仍未得到检验。
确定和描述有效的儿科综合心理健康护理模式的关键组成部分。
对 PubMed、Embase、PsycINFO 和 Cochrane 对照试验注册库电子数据库进行了检索，以查找 1985 年 1 月 1 日至 2019 年 4 月 30 日期间发表的相关同行评议文章。文章仅限于以英文发表的文章。符合条件的文章报告了 17 岁或以下青少年的原始数据，在儿科初级保健环境中实施了综合心理健康护理模式，并评估了该模式与主要结果（例如，心理健康症状严重程度）和次要结果（例如，功能障碍和患者满意度）之间的关联。纳入了在初级保健和心理健康专业人员之间存在某种程度的系统协调或协作的文章。两位独立的评审员提取了关于研究设计、模型类型、模型组成部分、整合程度和结果的数据。使用 Jadad 量表评估研究质量。数据分析于 2018 年 1 月 1 日至 2019 年 5 月 31 日进行。
纳入了 11 项涉及 2190 名参与者的随机临床试验。其中 3 项研究侧重于抑郁症青少年，3 项研究侧重于注意力缺陷/多动障碍青少年，5 项研究侧重于行为障碍青少年。大多数研究（11 项中的 9 项）实施了协作护理模型（n=3）、协作护理模型的略有修改版本（n=2）或共置护理（n=4）。有效儿科综合心理健康护理模式的最常见的组成部分是基于人群的护理、基于测量的护理和提供循证心理健康服务；在报告心理健康症状临床改善的研究中，这 3 个组成部分都存在。其他模型组成部分，如针对目标的治疗或团队护理，在报告特定结果（如功能障碍）的研究中很常见。
这是迄今为止首次系统地搜索和定性综合有关有效儿科综合心理健康护理模式的关键组成部分的信息。这一知识可能对儿科初级保健管理人员在为其环境选择综合护理模式时特别有用。
