Stadnick Nicole A, Martinez Kassandra, Aarons Gregory A, Lee David A, Van Cleave Jeanne, Brookman-Frazee Lauren
Department of Psychiatry, University of California (NA Stadnick, GA Aarons, DA Lee, and L Brookman-Frazee), San Diego, La Jolla, Calif; University of California San Diego Dissemination and Implementation Science Center (NA Stadnick, GA Aarons, and L Brookman-Frazee), La Jolla, Calif; Child and Adolescent Services Research Center (NA Stadnick, K Martinez, GA Aarons, DA Lee, and L Brookman-Frazee), San Diego, Calif.
Child and Adolescent Services Research Center (NA Stadnick, K Martinez, GA Aarons, DA Lee, and L Brookman-Frazee), San Diego, Calif; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (K Martinez), San Diego, Calif.
Acad Pediatr. 2020 Nov-Dec;20(8):1140-1147. doi: 10.1016/j.acap.2020.03.006. Epub 2020 Mar 20.
Timely identification of mental health needs and linkage to services is critical to provide comprehensive care for children with autism spectrum disorder (ASD). Pediatric primary care is well-positioned to facilitate this process through integrated care approaches. As a first step toward mental health integration, this study applied the Exploration, Preparation, Implementation, and Sustainment framework to characterize determinants of implementing integrated care practices for ASD.
Sixty pediatric primary care providers and leaders from 3 organizations completed focus groups and surveys about identification of mental health needs in children with ASD and access to mental health services. Findings were integrated to examine convergence (ie, do the 2 methods confirm or find similar results) and expansion (ie, do the 2 methods provide insights beyond either method alone).
Results converged regarding 3 primary influences to integrated care practices for ASD: 1) limited specialized mental health referral options for ASD, 2) unique structural characteristics of the mental health system act as barriers to accessing care, and 3) caregivers differ in the degree to which they understand co-occurring mental health conditions and pursue recommended services. Qualitative results provided expansion by highlighting unique implementation considerations (eg, alignment with health care delivery priorities and values) based on primary care characteristics.
Findings confirm need for a tailored approach for linking children with ASD to appropriate mental health treatment. Results yield insight into the needs for organizational capacity to support integrated care and provide direction toward adapting an integrated mental health care model for children with ASD.
及时识别心理健康需求并与服务建立联系对于为自闭症谱系障碍（ASD）儿童提供全面护理至关重要。儿科初级保健通过综合护理方法，在促进这一过程方面具有优势。作为迈向心理健康整合的第一步，本研究应用探索、准备、实施和维持框架来描述实施ASD综合护理实践的决定因素。
来自3个组织的60名儿科初级保健提供者和负责人完成了关于识别ASD儿童心理健康需求和获得心理健康服务的焦点小组讨论和调查。整合研究结果以检验趋同性（即，两种方法是否确认或得出相似结果）和扩展性（即，两种方法是否提供了超越单一方法的见解）。
关于对ASD综合护理实践的3个主要影响，结果具有趋同性：1）ASD的专业心理健康转诊选择有限；2）心理健康系统独特的结构特征成为获得护理的障碍；3）照顾者在理解共病心理健康状况和寻求推荐服务的程度上存在差异。定性结果通过强调基于初级保健特征的独特实施考虑因素（例如，与医疗保健提供的优先事项和价值观保持一致）提供了扩展性。
研究结果证实需要采取量身定制的方法，将ASD儿童与适当的心理健康治疗联系起来。结果深入了解了支持综合护理所需的组织能力，并为调整针对ASD儿童的综合心理健康护理模式提供了方向。
