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Objective: The Pediatric Psychosocial Preventative Health Model (PPPHM) is a three-tier model of family psychosocial risk used to guide intervention approaches in pediatric healthcare settings. Screening all families to determine levels of risk supports equitable care. We review evidence from papers using the Psychosocial Assessment Tool (PAT), a brief caregiver-report measure of family psychosocial risk with scores that map to the PPPHM, to characterize the distribution of risk. We predict that across study samples the distribution of risk on the PPPHM will be approximately 60% universal (low), 30% targeted (moderate), and 10% clinical (high). Method: We conducted a scoping review searching PubMed, MEDLINE, Emcare, and PsycInfo for articles that reported PPPHM data using the PAT. Results: Forty-seven samples from 43 papers were included, reporting on patients with 17 conditions. PPPHM scores were highly consistent with median percentages of 55% universal, 34% targeted, and 11% clinical. There is evidence of higher levels of risk for samples using the Spanish version of the PAT, from weight management programs and with families who have children with autism spectrum disorder. Conclusions: The data demonstrate consistent patterns of psychosocial risk distributions on the PPPHM and support implementation of universal family psychosocial risk screening, followed by delivery of personalized care based on level of risk. Screening all families promotes health equity in pediatric health care settings by normalizing the importance of understanding psychosocial risk and resiliencies and assuring family input in the delivery of integrated psychosocial care. Public Significance Statement: When inclusive of all families, family psychosocial risk assessment promotes health equity and highlights the range of risk, supporting universal, preventative psychosocial care matched to specific risks. [ABSTRACT FROM AUTHOR]

Comments on the article by B. L. Duncan et al (see record 2021-76744-003). As a physician and a Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, the author asks several questions related to this randomized clinical trial. How do the research questions and findings in this paper resonate with your experience as a clinician? What Is one thing you might do differently in your practice after reading this paper? What factors might facilitate or hinder the uptake/implementation of this research in practice? What is one unanswered question that you would like to see pursued as a follow-up to this research? [ABSTRACT FROM AUTHOR]

Introduction: Integrated behavioral health care is an important pathway to providing whole person care. It is delivered through a transdisciplinary lens and team and funded through complex policies, billing codes, and systems. While the clinical practice of integrated behavioral health care has received attention in the research, less is known about how health care systems demonstrate and evaluate the utility, effectiveness, impact, and longevity of integrating behavioral health into primary care. Method: Health care professionals (N = 145) working in integrated settings were recruited to participate in a metaevaluation about their evaluation practices. Descriptive and regression analyses were used to summarize and evaluate findings on clinical, operational, and financial evaluation practices. Results: There were a variety of types of evaluation practices across the national sample, as well as understanding across professional roles. Findings from the survey, which included primary care providers, behavioral health clinicians, and administrators working in integrated care settings confirmed that there was a lack of knowledge about evaluation and resources necessary to engage in the evaluation of clinical, operational, and financial outcomes. Furthermore, administrators were more likely to know about evaluation practices compared to medical providers and behavioral health providers. The survey also highlighted that organizational barriers to implementing integrated care were an issue across programs. Discussion: Utilizing clinical, operational, and financial evaluation together provide a more comprehensive review of the implementation integrated behavioral health. Real-world implementers and evaluators should consider forming integrated and inclusive evaluation teams, including administrators, medical providers, behavioral health clinicians, patients, and families. Public Significance Statement Providing behavioral health services in primary care is a critical step in improving access to behavioral health care, including mental health and substance use treatment. This paper presents the result of a survey of professionals working in primary care with integrated behavioral health services. These healthcare professionals reported on how they determine success with providing integrated behavioral services, and offers recommendations for measuring outcomes to continue to build access to care. Keywords: program evaluation, integrated care, primary care behavioral health, implementation, measurement Supplemental materials: https://doi.org/10.1037/fsh0000683.supp This article was published Online First May 12, 2022., Primary care is the first and most frequent point of entry for people receiving health care services in the United States (Miller & Patel, 2011). As a system, primary health [...]

Comments on the original article by Staab et al. (see record 2022-14598-001) regarding the integration of primary care and behavioral health services in Midwestern community health centers. As a clinician, the author identifies with many of the findings in Staab et al.'s paper. Limited resources related to patient access were cited as a barrier to integration. In the academic medical center and the larger community, we have experienced too few behavioral health providers (BHPs) to meet the increasing demand for behavioral health (BH) services. There are long waitlists for BH care, and patients report difficulty accessing appropriate BH resources. A lack of funding within the health care system has been a barrier to hiring an adequate BH workforce to meet the demand of internal and external BH referrals. Integrated care requires a specific set of skills and training experiences to competently provide brief interventions and work as part of an interdisciplinary medical team in a fast-paced medical setting. The pool of qualified applicants for integrated care positions is limited, challenging recruitment efforts. Another factor reducing access within the integrated care setting is difficulty adhering to a short-term treatment model with patients who have severe mental health issues and long-term therapy needs, given their difficulty obtaining longer-term services. Unlike the majority of community health centers (CHCs) in this study, we have insufficient social work support to adequately meet all patients' care management needs. [ABSTRACT FROM AUTHOR]

Telehealth has become an integral part of integrated behavioral health (IBH) service delivery in light of the global pandemic. In order to accommodate the rapid changes in service delivery, integrated behavioral health settings have transformed to provide services via telehealth alongside in-person services. While traditionally believed to be an in-person model, this article demonstrates the potential for using telehealth technology to continue offering training and service delivery in an IBH setting in response to the COVID-19 pandemic and beyond. The purpose of this catalyst report is to describe an IBH service delivery and training model including creative adaptations to the model using telehealth and present an evaluation plan of health service psychology trainee experiences. A mixed-methods design will be used to capture student experiences and competency. Data methods will include interviews with participants (qualitative) and the Interprofessional Collaborative Competency Attainment Survey (quantitative). Keywords: telehealth, integrated behavioral health, health service psychologist, training, primary care, Behavioral health diagnoses are common in primary care settings with approximately a third of patients meeting criteria for a mental health disorder (Kessler et al., 2005). Thus, behavioral health services [...]

Objective: The pandemic exacerbated and intensified pediatric behavioral health and access needs in rural and underserved areas due to long-standing workforce shortages, lack of resources, and multigenerational poverty and trauma. Kansas is a predominantly rural and frontier state with 94% of counties designated as mental health professional shortage areas. Innovation: The Telehealth ROCKS (THR) program is among the first of its kind to increase the behavioral health workforce capacity by integrating trained school-based community health workers (CHWs) directly into rural communities. CHWs facilitate the coordination of behavioral health appointments and access to social determinants of health needs. Methods and Results: We plan to assess the implementation, clinical outcomes, quality of care, and access to care through a mixed-methods design to evaluate the process and impact of expanding the rural behavioral health workforce via CHWs. Preliminary program data suggest CHWs have supported over 90 students/families around social determinants of health in the first 6 months. Conclusion: The THR program aims to bring childserving systems of care together, cultivate relationships with rural communities, empower and increase workforce capacity in health care and education, and build trust to enhance acceptance and thus program sustainability. Keywords: pediatric behavioral health, rural communities, community health workers, telebehavioral health, Before the COVED-19 public health emergency, rural children experienced worse health outcomes than their urban peers (Probst et al., 2018), including increased risks for behavioral and developmental disorders (Kelleher & [...]

Introduction: While integrated behavioral health (TBH) is growing as a primary care practice paradigm, there are gaps in developing the workforce needed. In particular, there are few examples of cotraining curricula in IBH for family medicine residents with postdoctoral psychology fellows. Furthermore, even fewer programs incorporate a coleaming primary care practice environment featuring a targeted approach to care for patients with chronic illness using panel management and integrated care. Method: In this article, the authors describe a cotraining experience in an urban federally qualified health center supported by a 5-year Health Resources and Services Administration Title VII grant, within a social justice mission-driven academic department to prepare both family medicine (FM) residents and primary care psychology (PCP) postdoctoral fellows for IBH practice. The article will discuss the specific components of the shared/parallel curriculum, integration of social justice and population health principles and practices, and a structured approach for resident/fellow partnership. Results: The authors share the clinical and educational impacts of this integrated cotraining curriculum model as described by the FM residents and PCP fellows. The article describes workforce results measuring the diversity of the trainees and their postprogram jobs serving vulnerable populations. Discussion: The interdisciplinary cotraining between FM residents and PCP fellows presents an innovative approach to developing workforce capacity for integrated practice in medically underserved settings. This article describes the creation and implementation of a cotraining curriculum and provides recommendations for other programs and residencies preparing their residents and future PCP psychologists to practice and teach skills in integrated care. Keywords: integrated behavioral health, primary care psychology, health equity, family medicine residency, interdisciplinary training, An integrated behavioral health (IBH) model of care partners behavioral specialists with physicians and the medical team to deliver comprehensive, biopsychosocial care to patients during primary care visits. In an [...]

Introduction: There is a significant shortage of behavioral health providers trained in caring for patients with problematic substance use, particularly within integrated care settings. Method: An innovative addictions nursing subspecialty curriculum was designed by interdisciplinary faculty from psychiatric nursing, family nursing, counseling, and social work and informed by integrated care, addictions, and telehealth competencies. The subspecialty included prevention, treatment, and recovery approaches to care and encouraged enrollment of students from various health-related disciplines to enhance the students' experiences of integrated care for substance use treatment prior to completion of the program. Results: Subspecialty courses increased the number of advanced practice nurses in the behavioral health care workforce with enhanced knowledge of integrated telehealth substance use treatment. Discussion: Implementation of similar innovative curricula across health disciplines may significantly improve the care delivered to patients with problematic substance use in traditional medical settings. Keywords: addictions, substance use, advance practice nursing, integrated care, telehealth, Nationally, opioid use disorder (OUD) and other substance use disorders (SUDs) represent a widespread problem for children, adolescents, and transitional-age youths, as well as adults. Approximately 19.7 million people aged [...]

Culturally sensitive behavioral health services are scarce, particularly in rural and underserved areas. To expand integrated behavioral health care training for providers, specifically those working in rural communities and federally qualified health centers, an interprofessional teleconsultation program was developed. Given the desire to focus on culturally informed care training, this was done in partnership with a nonprofit community mental health agency which focuses on behavioral health within Latinx populations. The teleconsultation sessions were provided bimonthly using Zoom and included didactic components and case-based discussion using the Multidimensional Ecosystemic Comparative Approach (MECA; Falicov, 1995; Falicov, 2017). Participants represented a diverse, interprofessional group composed of behavioral health professionals (45.2%), primary care physicians (26.8%), family medicine residents (15.3%), and others (medical students and administrative staff [12.7%]). The program evaluation demonstrates that participants valued the teleconsultation sessions and articulated specific skills that they subsequently planned to integrate into their clinical practice to enhance care. This teleconsultation model allows interprofessional training across multiple types of organizations to enhance knowledge in providing integrated behavioral health care for Latinx populations. Keywords: behavioral health, interprofessional, teleconsultation, Latinx, The United States is facing a crisis regarding behavioral health delivery which is both equitable and inclusive to the diverse geographic and cultural makeup of US residents. Almost half of [...]

Introduction: Evidence suggests that the development and implementation of interprofessional skills can positively impact culturally congruent practice among providers and patients, improving access and quality of care. Exploring the relationship between interprofessional skills and culturally congruent practice within health profession education can inform curricular efforts that better prepare the emerging workforce to provide accessible, high-quality care. Method: This study examined if interprofessional skills predict culturally congruent practice behaviors in an interprofessional health care simulation with Master of Social Work and Master of Science in Nursing students (N = 79). Simple linear regressions were conducted to evaluate whether interprofessional skills, across five domains (team structure, leadership, situation monitoring, mutual support, and communication) in the Performance Assessment Communication and Teamwork, significantly predicted culturally congruent practice behaviors, overall and across three subscales (culturally specific care; cultural assessment; and culturally sensitive and professionally appropriate attitudes, values, and beliefs), in the Cultural Competence Clinical Evaluation Tool--Student Version. Results: Among the sample, the interprofessional skill domains of leadership, situation monitoring, and communication predicted culturally congruent practice behaviors overall. Additionally, results indicated that communication predicted culturally specific care; team structure, leadership, situation monitoring, mutual support and communication predicted cultural assessment; and communication, situation monitoring, and leadership predicted culturally sensitive and professionally appropriate attitudes, values, and beliefs. Discussion: Opportunities to learn and practice interprofessional skills within health profession curricula may predict Master of Social Work and Master of Science in Nursing students' culturally congruent practice behaviors; implications and limitations are discussed. Keywords: cultural congruent care, interprofessional education, simulation, Skill development in team-based health care and the ability to work interprofessionally improves patient outcomes and works toward eliminating health disparities (World Health Organization, 2010). A separate but related line [...]

Introduction: Professional counselors are becoming increasingly represented in the Primary Care Behavioral Health (PCBH) workforce. Accordingly, models for training these professionals to work in integrated health care settings are needed. Method: This article presents the results of 34 master's level counseling students' self-reported competencies in PCBH as a result of a PCBH training program. Results: Results indicated that students' self-perceived competence across all domains increased over time. Discussion: Implications for the function of self-reported skill development in students training as behavioral health consultants in primary care are discussed. Keywords: counseling, training, primary care, behavioral health, competency, Representation of professional counselors in the Primary Care Behavioral Health (PCBH) workforce is increasing. According to the Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2020, 10% [...]

Introduction: In urban areas, numerous barriers exist for children and families to access needed behavioral health care. Compounding the general deficit of behavioral health workers in the United States is lack of access to culturally responsive care. Additional challenges include inherent racism and oppression in our health and human service systems and siloed approaches to behavioral health care training and practice. Integrated care is an emerging field nationally, yet training and education in integrated care is limited. This article provides an overview of the Child/Adolescent Interprofessional Practice and Education (CAIPE) program, a novel training approach in its first year of implementation for behavioral health students that prioritizes trauma-informed and socialjustice oriented practice, integrated care, and interprofessional teamwork. Method: This study employs a mixed-methods approach to program evaluation. Data sources include program application materials (demographics and data related to clinical interests, student goals, and preparedness for interprofessional work). Data is also drawn from measures of student outcomes (self-efficacy navigating complex care patients, empathy, and complex care knowledge). Results: Baseline data are reported for demographics, students' goals and interprofessional interests, and student outcomes. Information is also presented relevant to trainings conducted in the grant's first year and planned for subsequent years. Preliminary data and implementation suggest that the program has drawn diverse trainees who are committed to interprofessional, integrated care for underserved youth. Discussion: Recruitment and program development challenges are discussed, along with grant goals' fit with students' interests and plans for future evaluation. Keywords: behavioral health, interprofessional education, program evaluation, integrated care, trauma, In Philadelphia, 43% of households are below the Self Sufficiency Standard (Pierce, 2019). Those experiencing poverty, particularly those identifying as Black, indigenous, Latino, mixed race, and Asian (Nygreen et al., [...]

As a behavioral health provider in a rural mountain community, I (Jodi Polaha) am routinely contacted for referrals: by my neighbors, by folks I know mostly through Facebook, or by [...]

Introduction: Group well-child care (GWCC) is an alternative to traditional pediatric well-child care designed to increase parental social support and peer learning. This mixed methods study explored the adaptation and implementation of GWCC to a virtual format during coronavirus disease 2019 (COVID-19 pandemic) among Spanish-speaking Latino immigrant families. Method: Interviews were conducted with eight providers and 10 mothers from May through September 2020. Qualitative analyses used a priori codes based on an implementation science framework. Quantitative data included demographics, the COVID-19 Impact Scale, and virtual group attendance. Bivariate analyses identified correlates of virtual visit attendance. Results: Eighty percent of mothers reported the pandemic had moderately or extremely impacted at least one major life domain such as daily life, food security, or family conflict. Of 27 mothers offered virtual groups, 67% attended. Mothers who attended virtual groups reported lower English proficiency (p = .087) and fewer friends and family members with COVID-19 (M = 1.0 vs. 5.1, p < .05) than those who did not attend. Women described virtual GWCC as acceptable and a source of social support. Some described differences in group dynamics compared with inperson groups and had privacy concerns. Providers noted scheduling and billing challenges affecting feasibility and sustainability. They reported that visits with good attendance were productive. Mothers and pediatric providers offered recommendations to improve feasibility and privacy and address sustainability. Discussion: Competing demands for those most impacted by COVID-19 may outweigh benefits of attendance. Virtual Spanish language GWCC appears acceptable and feasible for Spanish speaking Latina mothers. Thematic analysis and recommendations identify areas of improvement. Public Significance Statement This study suggests that virtual pediatric group well-child care (GWCC) was generally acceptable and a source of social support for Spanish speaking Latina mothers in the initial phase of the COVID-19 pandemic. Mothers and pediatric providers generated a list of recommendations to improve feasibility, privacy, and address sustainability of GWCC. Keywords: immigrant health, Latino health, pediatric integrated care, telehealth, two-generation approaches to health This article was published Online First June 16. 2022., There is concern that traditional well-child care models do not adequately meet the needs of families experiencing socioeconomic disadvantage (Schor, 2004). Group well-child care (GWCC) is one form of redesign [...]

Purpose: Although many primary care clinics screen for behavioral health (BH) conditions using validated tools, it is not clear whether adult BH screening leads to better patient outcomes. Our objective was to determine the evidence base by reviewing effectiveness research for multiple strategies of BH screening in adult primary care identified in the Practice Integration Profile. Method: We conducted five rapid reviews of effectiveness research supporting BH screening strategies cited in the Practice Integration Profile. Each rapid review was conducted using an adapted REAL (Rapid Evidence Assessment of the Literature) methodology and a standardized search tailored for each screening strategy to identify evidence related to BH screening in primary care. Results: The database search yielded 931 references. Following eligibility review and extraction, we evaluated data from 20 references examining five screening strategies. Results demonstrated limited support for all five strategies and high risk of bias within most studies. Outcomes associated with various BH screening strategies were rarely the focus of study. Conclusions: There is an absence of robust, well-structured evidence supporting many of the BH screening strategies advocated for in primary care. Stakeholders may wish to understand how to ensure value when developing a robust screening program that will improve patient health outcomes. Future research should advance the science of BH screen selection, timing, and implementation by answering new questions about screening strategies. Public Significance Statement Primary care clinicians play an important role in screening patients for unmet health needs, including behavioral health concerns. Given the broad array of potential conditions that can be identified in primary care, the ability to focus on screening strategies with the greatest potential to improve patient-centered outcomes is a meaningful advance in care. The results of our rapid reviews suggest that although screening strategies were found to be important components in some studies, additional research is needed to identify evidence-based screening strategies. Keywords: behavioral medicine, delivery of health care - integrated, primary health care, rapid review, screening Supplemental materials: https://doi.org/10.1037/fsh0000700.supp This article was published Online First June 2, 2022., Patients frequently rely on primary care to address behavioral health (BH) conditions, including mental health and substance use problems, as well as chronic medical conditions with prominent behavioral components (Richman [...]

Background: A large theoretical and empirical literature indicates that parenting practices affect young people's well-being and resilience, but there is much still to learn about psychological mechanisms, especially beyond infancy/early childhood. A recent model of authentic self-esteem argues that it arises out of experiences of challenge situations shared with parents and that it can subsequently act as a protective factor that supports well-being and resilience among young people. The aim of the current study is to test (a) if parenting about challenges can predict 3 indices of adolescents' well-being, namely their social anxiety, disrupted classroom concentration, and ability to spontaneously generate resilient strategies; and more substantially, (b) if authentic self-esteem can mediate those associations if found. Method: Adolescents (N = 836) completed a questionnaire that measured all the study variables via self-report with the exception that unprompted open questions were used to gauge their ability to spontaneously generate resilient strategies. Results: Parental discussions of challenges did significantly predict all 3 well-being indices, and authentic self-esteem was found to mediate all these relationships. Discussion: These results support the view that parenting about challenges is a practice that supports well-being and resilience in adolescents. It appears to do so through promoting the development of authentic selfesteem, a capacity to evaluate the self in a positive manner in the context of challenges. The theoretical and practical significance of these findings are discussed. Public Significance Statement Parenting about challenges is a practice that supports well-being and resilience in adolescents. Findings suggest that parenting to help young people engage adaptively with challenges is a simple and effective way to support diverse aspects of well-being and that authentic self-esteem - internalized adaptive patterns of thinking about and engaging with their own challenges - is a mechanism through which it may do so. Keywords: parents, adolescents, social anxiety, disrupted concentration, authentic self-esteem This article was published Online First April 21, 2022., It is now well known that optimal parenting practices support the healthy development of infants, children and adolescents. Numerous studies show a wide range of positive outcomes among families raised [...]

The nation is facing a pediatric mental health crisis that is years in the making. The pandemic potentiated the crisis by isolating youth and compounding family stressors. In response, the US Surgeon General issued an advisory in late 2021 recommending actions that health care and other sectors should take to improve youth well-being. Integrated care has a critical role to play in both implementing and moving beyond the Surgeon General's recommendations. The Collaborative Family Healthcare Association's Pediatric Special Interest Group (SIG) meets monthly to provide support and learning experiences and to promote dissemination of innovations to address the pediatric mental health crisis. In this article, we share recommendations, informed by the conversations in the CHFA Pediatric SIG, to propel the Surgeon General's advice into actions. We prioritize and emphasize structural changes that are needed in the health care system and highlight practical and actionable steps individual providers can take to increase cross sector collaboration. Keywords: pediatrics, behavioral health, integrated care, Our youth are in crisis, and it started long before the COVID-19 pandemic. As leaders within the Pediatrics Special Interest group in the nation's leading integrated care organization (Collaborative Family [...]