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Integrating behavioral health into primary care ambulatory clinics can improve management of patients presenting with suicidality in medical practices. To date, financial outcomes associated with managing suicidality in integrated care have not been documented.This study sought to evaluate both course of treatment (e.g., the patient is discharged home and referred to emergency departments [EDs]) and financial outcomes (e.g., cost to medical center) for patients presenting with suicidality in integrated pediatric primary care.Medical record review was conducted across a 6-month period. Demographics, course of treatment, and financial data were collected. Financial data were extracted using EPSi software using a cost accounting model. We documented the amount in dollars billed to the patient/insurance company and the amount reimbursed to the medical center and then calculated net margins associated with each course of treatment.Participants were 103 youth (aged 7-24 years). The results demonstrate that the integrated model of care diverted 93% of participants from the ED and that the highlighted model of care yielded cost savings for the medical center. After reimbursement, patients seen in the ED for suicide evaluations cost the medical center an average of 16 times more than patients who were managed in the primary care setting.The results document the magnitude of cost savings associated with an integrated care model for treating high-risk youth.

Objective The need for behavioral health services, service utilization, and predictors of utilization was examined in children with moderate-to-severe traumatic brain injury (TBI) relative to a comparison group of children with orthopedic injury (OI) 6.8 years after injury. Methods A total of 130 children hospitalized for moderate-to-severe TBI (16 severe and 42 moderate) or OI (72) between the ages of 3 and 7 years, who were enrolled at the time of injury at 3 tertiary care children's hospital and one general hospital in Ohio, and completed a long-term follow-up 6.8 years after injury were included in analyses. Results Adolescents with TBI (moderate [38%] and severe [69%]) had significantly greater rates of need than those with OI (17%). Behavioral health services were utilized by 10% of the sample with no injury group differences (OI: 6%; moderate: 17%; severe: 13%). Early treatment and white race were associated with less service utilization; 77% had an unmet need, with no injury group differences (OI: 75%; moderate: 75%; severe: 82%). Rate of unmet need was greater among white than non-white children. Conclusion Children who sustain a TBI in early childhood experience persistent and clinically significant impairments even years after injury. Rates of unmet need were high for all injury groups. Findings underscore the importance of long-term monitoring to identify developing needs and prevent significant complications/deficits.

Objective To examine the prevalence of academic need, academic service utilization, and unmet need as well as factors associated with academic service utilization 6.8 years after traumatic brain injury (TBI) in early childhood. Methods Fifty-eight (16 severe, 14 moderate, 28 complicated mild) children with TBI and 72 children with orthopedic injury (OI) completed the long-term follow-up 6.8 years after injury in early childhood (ages 3-7 years). Injury group differences in rates of need for academic services, academic service utilization, and unmet need as well as factors associated with service utilization and unmet need were examined. Results Students with moderate and severe TBI had significantly greater rates of need than those with OI. A greater proportion of the severe TBI sample was receiving academic services at long-term follow-up than the OI and complicated mild groups however, among those with an identified need, injury group did not affect academic service utilization. Below average IQ/achievement scores was the only area of need predictive of academic service utilization. Rates of unmet need were high and similar across injury groups (46.2%-63.6%). Conclusion The need for academic services among patients who sustained a TBI during early childhood remains high 6.8 years post injury. Findings underscore the importance of continued monitoring of behaviors and academic performance in students with a history of early childhood TBI. This may be especially true among children with less severe injuries who are at risk for being underserved.

A number of studies have shown that school-age children and adolescents who sustain a traumatic brain injury (TBI) display persistent negative academic and behavioral sequelae, particularly in children with severe injuries.1–5 In addition, TBI has been shown to have a profound negative impact on both the caregiver and the family. In particular, severe TBI has been shown to be associated with both acute and long-term family burden and distress.6–18 Family impact of TBI is an important consideration for several reasons. Pediatric TBI can result in considerable financial, emotional, and social strain for families, contributing to caregiver burden and distress and potentially leading to a decline in overall quality of life for families. Increasing the quality and years of healthy life is a primary goal for Healthy People 2010, which recognizes the importance of examining how chronic illness conditions interferes with a person’s day-to-day life. The importance of examining family impact is underscored by more recent research indicating that recovery (academic and behavioral) after TBI in school-age children is influenced by the postinjury environment, including family functioning and interpersonal stresses and resources.3–5,14,15 Studies have suggested that the effects of the social environment are amplified after severe TBI, with greatest effects on the child’s social and behavioral functioning.5,6 Emerging behavior problems, in turn, adversely influence postinjury family functioning, contributing to greater dysfunction. Thus, there is growing evidence for reciprocal influences between child recovery and family adaptation over time after pediatric TBI.9 Although few studies have examined the impact of TBI in young children over time, existing data suggest that a TBI in a young child results in different and potentially more severe cognitive sequelae than is the case for older children because many of the skills that are critical for later development are emerging at this time.16–19 There are even fewer reports on the effects of TBI in young children on their caregivers and family.20 Stancin et al21 examined factors that affect parental burden and distress during the first few months after TBI in children ages 3 to 6 years. Results suggested that family and caregiver functioning was more adversely affected after TBI in young children than following an orthopedic injury, although differences were modest. Chronic life stresses and interpersonal resources accounted for significant variance in measures of acute injury-related burden and parent distress in parents of younger children. Longer term consequences of TBI on families of 3- to 12-year-old children were reported by Anderson et al.,22 who followed children 30-month post-TBI. They found that families of children with severe TBI consistently reported higher levels of family burden. Family burden was predicted by injury severity, degree of physical impairment, age at injury, and preinjury behavior. Although this study provided important longer term follow-up information about children with TBI, the age cohort was not specific to younger children, and there was no comparison group of children without brain injuries. By using a cohort described in a previous report of baseline functioning,21 this study examines subsequent family adaptation to a TBI in children under age 7 years in the 18-month postinjury compared with children who had an orthopedic injury. We hypothesize that TBI will have adverse effects on parent distress and family burden at follow-up, especially with severe TBI, and that impact will be moderated by family functioning and social resources.

We reviewed the current status of behavior screening methods, such as parental questionnaires, for identifying behavioral problems in children seen in pediatric settings. Information is organized around basic criteria for implementing screening procedures. We conclude that although use of parent-completed questionnaires, such as the Child Behavior Checklist and the Pediatric Symptom Checklist, can increase identification of child behavioral dysfunction in pediatric settings, it is unclear whether screening will cause a change in physician behaviors necessary to improve child functional outcomes. Clinical and research implications are discussed.