Greenblatt Jeanne, Alfieri Nina L, Raghupatruni Preethi, Tomopoulos Suzy
Pritzker Department of Psychiatry and Behavioral Health, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, United States.
Department of Advanced General Pediatrics and Primary Care, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
Curr Probl Pediatr Adolesc Health Care. 2024 Dec;54(12):101714. doi: 10.1016/j.cppeds.2024.101714. Epub 2024 Dec 5.
Academy of Pediatrics advocates for a preventive approach to children's mental health (MH) care and pediatric primary care providers (PCPs) are in a unique position to promote the emotional health of their patients, integrate systems for screening and assessment of MH conditions and provide MH intervention and ongoing clinical follow-up. Integration of a behavioral health service into pediatric primary care has the potential to increase the clinical confidence and MH competency of PCPs and improve patient health outcomes through increased access to and delivery of quality MH care in the primary care setting.
This article describes the step-by-step process of developing and implementing a custom integrated behavioral health (IBH) program into two different academic pediatric primary care clinics located in New York, NY and Chicago, IL. The process of developing each clinic's: IBH needs assessment, setting of IBH priorities and defining and implementing initial and subsequent targeted educational and clinical interventions are described in detail. Specific consideration of each IBH program's issues related to physical space, staffing, funding, and billing is also addressed.
Each clinic had different pre-existing strengths, challenges, resources, and priorities but both settings desired having an IBH program that would simultaneously improve patient access to clinic-based counseling and psychiatry services while building MH clinical capacity among pediatric residents and attending PCPs.
Specific IBH educational and clinical interventions described in this article differed between the two settings, however, both IBH models were developed to provide pediatric residents and attendings with a combination of in-person and asynchronous clinical education and consultation and opportunities for mental health clinical skill modeling and guidance while also creating increased patient access to clinic-based MH services. This detailed review will be of benefit to pediatric clinics considering development of a customized IBH program.
美国儿科学会倡导采用预防性方法来提供儿童心理健康（MH）护理，而儿科初级保健提供者（PCP）处于促进患者情绪健康、整合MH状况筛查和评估系统以及提供MH干预和持续临床随访的独特位置。将行为健康服务整合到儿科初级保健中，有可能提高PCP的临床信心和MH能力，并通过在初级保健环境中增加获得优质MH护理的机会和提供此类护理，改善患者的健康结果。
本文描述了在位于纽约州纽约市和伊利诺伊州芝加哥市的两家不同的学术性儿科初级保健诊所中，开发和实施定制化综合行为健康（IBH）项目的逐步过程。详细描述了为每个诊所开展IBH需求评估、确定IBH优先事项以及定义和实施初始及后续有针对性的教育和临床干预措施的过程。还讨论了每个IBH项目在物理空间、人员配备、资金和计费方面的相关问题。
每个诊所都有不同的既有优势、挑战、资源和优先事项，但两个诊所都希望拥有一个IBH项目，既能改善患者获得基于诊所的咨询和精神病学服务的机会，又能增强儿科住院医师和主治PCP的MH临床能力。
本文中描述的特定IBH教育和临床干预措施在两个诊所有所不同，然而，两种IBH模式的开发目的都是为儿科住院医师和主治医生提供面对面和异步临床教育与咨询的组合，以及心理健康临床技能示范和指导的机会，同时增加患者获得基于诊所的MH服务。这一详细综述将对考虑开发定制化IBH项目的儿科诊所有所帮助。
