Search

This paper describes the (Sin Exclusión) Transdisciplinary Autism Assessment and Resources ([S]TAAR) model and presents early metrics tracking efficiency and equity in access to high-quality comprehensive autism evaluations for young children. Retrospective chart reviews over one year (08/2018–08/2019) with n = 173 children were reviewed. Through care coordination with community providers, the model was developed to meet local needs by increasing throughput of children (

INTRODUCTION Despite increased prevalence and identification of pediatric behavioral health concerns, families face many barriers when attempting to access behavioral health services. System navigators, or individuals experienced in navigating the health system, help to engage families in services by helping individuals overcome barriers for accessing care. However, limited research to date has systematically reviewed the implementation and effectiveness of navigation models in pediatric populations. METHOD We systematically reviewed published studies examining navigation models for pediatric populations (up to age 18) referred to behavioral health services. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for studies that evaluated a navigation model and included service use outcomes. We aggregated data pertaining to characteristics of the study and navigation model, service use outcomes, and implementation outcomes. RESULTS Eight studies met inclusion criteria. Families who participated in navigation services were more likely to complete diagnostic assessments and received an increased dosage (e.g., time spent, services completed) of behavioral health treatments. There was notable variability across studies in terms of processes involved in the navigation models. DISCUSSION Findings indicate that system navigation is a promising method for improving service use for pediatric populations referred to behavioral health services. Future research may continue to examine the effectiveness and implementation of the model, to best understand its benefits and what processes may contribute to improved service outcomes. Public Significance Statement: This paper reviews the effectiveness of system navigator models, which are designed to engage children and families in behavioral health services. The interventions reviewed are associated with increased behavioral health service use in children and show promise as a method of overcoming barriers to accessing behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

INTRODUCTION Despite increasing evidence that use of the "common factors" and "common elements" approaches are effective in improving patient outcomes, and calls for pediatricians to address patient behavioral health concerns, little is known about pediatrician knowledge, perceptions, and use of these approaches. METHOD Pediatric chief residents from all 210 pediatric residency programs in the United States were surveyed to investigate their knowledge, attitudes, practices, and training related to use of engagement and treatment strategies that comprise the common factors and common elements approaches to delivering behavioral health care. RESULTS The usable response rate was 38%. Most respondents indicated they believe pediatricians should address behavioral health issues and that common factors and common elements would be useful and feasible in clinical practice. Most indicated low levels of familiarity with common factors and common elements and dissatisfaction with training in these areas. CONCLUSION Additional training and other implementation supports, such as dissemination of implementation guidelines and mechanisms for technical assistance, will be needed in order to increase pediatrician use of these approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The increasingly diverse and complex student population school psychologists serve necessitates a reconceptualization of the field with explicit emphasis on interprofessional, interagency collabora...

Objective Evidence-based treatments for mental health concerns include psychopharmacological and psychosocial approaches. Pediatrics organizations indicate psychopharmacology needs to be a component of training. This study investigated the status of training in psychotropic medication prescribing through a national survey of pediatric chief residents. Method Pediatric chief residents (one per residency program) completed a survey (response rate = 60.2%, 127/211) about their attitudes, knowledge, comfort, practice, and training around prescribing psychotropic medication in primary care. Quantitative data included descriptive statistics and correlational analyses to explore relationships between variables; qualitative data were examined through classical content analysis. Results Almost half of respondents reported prescribing sometimes or often. Frequency of prescribing varied by mental health condition, with highest frequency for attention-deficit/hyperactivity disorder. About two-thirds of respondents reported having at least some/average knowledge. About half of respondents reported being uncomfortable with prescribing; respondents were most uncomfortable with prescribing antianxiety, mood stabilizing, and antipsychotic medications, and with discontinuing medication; about half indicated their competence in progress-monitoring needed improvement. Concurrent psychosocial treatment was perceived as very useful, although often inaccessible to patients. Prescribing frequency was related to knowledge, comfort, progress-monitoring competence, and training quality; training quality was related to knowledge and comfort. Over 60% rated their training as not at all or only somewhat adequate. Conclusions Pediatric chief residents reported having knowledge of psychotropic medication issues, but experience a general discomfort, especially with discontinuing medication, and with medications other than stimulants. Most thought their training needed improvement in terms of comprehensiveness and clinical practice experiences.

Attention-deficit/hyperactivity disorder (ADHD) is a common presenting concern in primary care. This study examined the relationship between pediatric residency training program characteristics and residents’ ADHD knowledge, attitudes, and comfort in providing ADHD services. Given the familiarity that pediatric chief residents have with the training and experiences within their residency programs, a 30-item survey was mailed to pediatric chief residents. A total of 100 residents returned their surveys (response rate 49.5%) and were included in the descriptive quantitative and thematic qualitative analyses. The majority of participants rated their ADHD knowledge as at least average. However, approximately half of the participants were comfortable with screening, and less than half were comfortable with managing stimulant medication or behavioral treatments. Participants emphasized the importance of interprofessional collaboration, clinical experiences, and integrated ADHD education throughout training. These results emphasize the importance of improved training in screening, diagnosing, and managing ADHD to increase resident comfort regarding these practices.

The transition to virtual and hybrid schooling given the COVID-19 pandemic in the United States has upended the education system and may be widening gaps in service disparities, particularly for children with disabilities. Schools often function as "de facto" service systems for most children with disabilities, particularly those from racially and ethnically minoritized, economically vulnerable, and bilingual populations. The impact of school closures on children with disabilities poses significant ramifications for the medical, behavioral health, and educational systems in which they are served, necessitating the need for pediatric clinicians to collaborate with schools in purposeful ways. This commentary (1) presents an overview of the current guidance for providing school-based services to children with disabilities during the COVID context with many schools operating in virtual or hybrid formats, (2) reviews potential service inequities exacerbated by school closures and lack of on-site services, and (3) offers recommendations for collaborating with school staff and community agencies in support of children and families with disabilities.

Optimal service delivery for students with autism spectrum disorder (ASD) often involves interdisciplinary care coordination between primary care clinicians, community-based providers, and school personnel such as school psychologists. Interdisciplinary care coordination includes communication and collaboration from multiple providers to facilitate comprehensive services that are accessible and continuous while promoting effective partnerships across the home, school, and community systems. Unfortunately, school psychologists report barriers to collaborating with providers outside the school setting around service delivery, including a mismatch in eligibility criteria for educational classifications verses medical diagnoses, lack of delineated roles and responsibilities of other providers, and a limited infrastructure around information sharing. This article (a) delineates roles and functions of school psychologists in coordinating care for students with ASD, (b) highlights potential barriers to care coordination from the perspective of school psychologists, and (c) provides practice considerations, objectives, and direct application activities to overcome barriers to care coordination.

This study used an experimental vignette design to examine whether school psychology students’ attitudes toward a teenager in a case vignette varied based on whether or not they believed the teen to be transgender. Transgender status was conveyed indirectly through names (e.g., by indicating that the student with the legal name “Anthony” had requested to be called “Alyssa”). It also examined whether attitudes toward transgender boys and transgender girls differed, and the degree to which transgender-related training and experience affected attitudes. A 2 (Gender Status: cisgender vs. transgender) × 2 (Gender Identity: male vs. female) ANOVA indicated that participants had more supportive attitudes toward a transgender teen experiencing issues in school related to a name change and a behavior concern than toward a cisgender teen with the same issues, F(1, 421) = 121.59, p

This guide helps primary care pediatricians, family doctors, nurse practitioners, and other professionals identify, treat, and prevent mental health problems as well as promote good mental health in their patients. Clinicians will gain insight into effective methods for helping patients and families share mental health concerns, learn about mental health issues, and develop positive attitudes about seeking treatment from specialty providers. Available for purchase at https://shop.aap.org/mental-health-strategies-for-pediatric-care-paperback/ (NOTE: This book features a full text reading experience. Click a chapter title to access content.)

In the United States, ethnic minority status and low socioeconomic status both confer greater risk of premature birth. These sociodemographic factors also contribute to a greater risk of postpartum depression, as does giving birth prematurely. Considering the known adverse effects of postpartum depression on children's development, NICU-based mental health services for these high-risk mothers is an important public health intervention. Although counseling and educational interventions in the NICU have been shown to decrease maternal depressive symptoms, these interventions require parental presence on the unit. Mothers of both low socioeconomic and ethnic minority status face systemic barriers that may prevent them from visiting their infants, such as lack of paid leave, transportation, and childcare. We propose directions for future research with the aim of increasing access to services. Directions include brief individual therapy, telehealth, and increasing the psychosocial support skills of other health professionals. Potential barriers to implementation are discussed.

The American Academy of Pediatrics recommends that pediatricians be trained to collaborate with school personnel and has stated that inadequate collaboration across systems is a contributor to suboptimal health care. Mail-based surveys were used to target chief residents of all pediatric residency programs in the United States (N = 214). Participants completed a 25-item survey inquiring about training, attitudes, and practices in collaborating with schools. A 68.6% response rate was obtained. The majority of respondents (73.5%) view collaboration with school personnel as important or very important and believe it improves overall patient care. However, 30.7% of respondents reported to never have collaborated with school personnel, and 47.8% reported doing so only once or twice a year. Further, 41.3% of respondents felt that school collaboration is not feasible for most pediatricians due to barriers including limited time, scheduling issues, and knowing how to contact relevant school personnel. Most respondents reported that school collaboration was rarely addressed in residency training.

Objective: Pediatricians often function as front-line providers for pediatric behavioral health concerns given the shortage of child and adolescent psychiatrists and barriers to accessing other behavioral health specialists. This study identified pediatric residents’ attitudes, knowledge, comfort and practices regarding managing psychotropic medication regimens for children and adolescents with behavioral …

INTRODUCTION Although primary care clinicians often refer children and families to community-based mental health services, a sizable number of patients do not make it to their 1st appointment. Engagement interventions delivered in primary care that focus on reducing structural and perceptual barriers to accessing care hold promise to improve this referral-to-service gap. To date, no review to characterize and summarize the effectiveness of such engagement interventions has been completed. METHOD We conducted a systematic review of pediatric mental health service engagement interventions delivered in primary care over the past 20 years using MEDLINE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO. We narratively summarized the literature and conducted quality and risk of bias analyses. RESULTS Out of 948 records, 10 studies met inclusion criteria and were reviewed. A variety of engagement interventions were evaluated and demonstrated varying levels of effectiveness in improving service initiation, with the most promising approach being primary care mental health integration. Quality and risk of biases analyses demonstrated several methodological weaknesses of the included studies. DISCUSSION Currently, there is limited evidence for engagement interventions to improve the referral-to-service gap for children and families. More research is needed to develop and evaluate effective mental health engagement interventions, particularly for disadvantaged youth and families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Introduction Primary care is a common access point for children and adolescents with depression and suicidality concerns. In this setting, pediatricians typically function as front-line providers given barriers that patients face in accessing mental health clinicians. Method This study surveyed chief residents from all pediatric residency programs in the United States (N = 214) to evaluate (a) their attitudes, knowledge, practices, and comfort in managing depression and suicidality concerns in primary care, and (b) the relationship between residency training processes and pediatric residents' practices, knowledge, and comfort related to identifying and managing depression and suicidality. Results The usable response rate was 37.6%. The large majority of respondents are involved in evaluation and management of depression and suicidality; yet many respondents reported a lack of knowledge and comfort in these roles. Conclusions Recommendations for pediatric residency program training processes are discussed, including the potential added value of colocating mental health clinicians into the primary care continuity training clinic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Youth with autism spectrum disorder (ASD) have many and varied social, emotional, behavioral, and academic needs. In many cases, these children also have medical needs, adding to the level of care they require. Medical conditions commonly co-occur in children with ASD; some of the most common include epilepsy, gastrointestinal issues, sleep problems, and feeding disorders. The diagnosis and treatment of these conditions is often complicated by their ASD symptoms. The care and collaboration of professionals from multiple disciplines is needed to effectively conceptualize and treat these conditions. This chapter provides a review of common co-occurring medical conditions in children with ASD and highlights the need for interprofessional collaboration.

A systemic issue in traditional health service delivery models to children and adolescents is the difficulty in accessing quality developmental/behavioral health (D/BH) care. Contributors to this problem include the lack of available specialty D/BH specialists (e.g., child and adolescent psychiatrists and psychologists, developmental-behavioral pediatricians), as well as issues with insurance coverage and reimbursement when these services are paneled through behavioral health “carve-outs.” Given the difficulty in accessing these services, primary care physicians such as pediatricians and pediatric residents often become the de facto D/BH providers. However, a major barrier that these providers express in managing D/BH concerns is the lack of training they receive in medical school and residency. This chapter presents an organizational systems-level case study detailing how concerned stakeholders in a healthcare delivery system and training program have responded to problems pertaining to the need for improved care and resident training in D/BH. The case study intends to inform those who design, revise, and operate service delivery and training systems on a daily basis. To facilitate a more nuanced examination of implementation experiences, a simulated question and answer discussion is included at the end of this chapter.

This chapter introduces this book and its central purpose. Autism spectrum disorder, its associated symptoms, and rising prevalence warrant service provision from several disciplines and professions. The rationale and benefits of interprofessional care coordination are discussed. The following chapters in this book are written by professionals from diverse fields to encourage and improve readers’ interprofessional care coordination.

In the concluding chapter of the book, a brief review of preceding chapters is provided. The purpose of this chapter is to reflect on common themes throughout the chapters, and to highlight some key areas for future work in interprofessional care coordination (ICC) for autism spectrum disorder. Specifically, some current and future priorities may include (1) person-centered and family-centered care coordination, (2) innovative assessment and service management approaches, and (3) teaming and telehealth models that reduce barriers to accessing coordinated services.

While developmental and behavioral interventions are the primary treatment methods for youth with ASD, psychotropic medications are often prescribed by psychiatrists, developmental-behavioral pediatricians, and sometimes primary care clinicians (PCCs) to manage co-occurring disorders and symptoms. To maximize the effectiveness of these medications, collaborations across family, medical, community, and school systems are needed. However, there are numerous barriers unique to interprofessional collaboration around psychotropic prescribing for children with ASD. As such, this chapter aims to discuss these unique barriers, outline models of interprofessional care, and describe specific interprofessional and collaborative roles between prescribers and non-prescribers to support effective psychotropic management for children with ASD.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting 1 in 59 children in the United States. The benefits of early detection and intervention for ASD have been clearly documented. However, significant delays exist in access to early screening, diagnosis, and service provision. Despite the American Academy of Pediatrics’ guidelines recommending developmental screening for ASD at 18 and 24 months, less than 20% of children with ASD receive their diagnosis before age 3. For many, this diagnosis comes several years later, which further delays entry into support services. There are documented barriers to appropriate developmental screening occurring in primary care, largely due to the lack of time that primary care clinicians have to conduct this screening. Thus, there is a need to expand developmental screening to also occur in accessible community-based settings, such as the home, preschool, child care, and other community programs. This chapter provides the rationale for developmental screening to occur in community settings and describes several existing models that may be positioned to offer innovative solutions to overcome the limitations with families solely relying on the primary care clinic as a developmental screening source.

OBJECTIVE To identify perceptions of behavioral health (BH) training in pediatric residency programs, the degree of involvement from behavioral health providers (BHPs), and opportunities for and barriers to innovation in training. METHOD A tailored design methodology was used to target all pediatric residency program directors in the United States (N = 214). Participants were identified from the Electronic Residency Application Service website of the Association of American Medical Colleges and were asked to complete a 22-item item survey on BH training. RESULTS A 69.2% usable response rate (N = 148) was obtained. A total of 62.8% of directors described training in the developmental-behavioral pediatrics (DBP) rotation as optimal; 36% described BH training in the residency program as a whole (i.e., outside the DBP rotation) as optimal. Only 20.3% described "common factors" training as optimal, and the quality of training in this area was positively and significantly related to the quality of BH training in the residency program as a whole (χ = 35.05, p < 0.001). The quality of common factors training was significantly higher in programs that had embedded BHPs (i.e., psychologists and social workers) in the continuity clinic than programs that did not (χ = 7.65, p = 0.04). Barriers to quality training included instructional content, instructional methods, stakeholder support, and resources. CONCLUSION Despite substantial improvement in residency training in BH over the last decade, additional improvement is needed. Barriers to continued improvement include training content, training methods, support from faculty and administrator stakeholders, and resource issues. Strategies derived from implementation science have the potential to address these barriers.

Background Interagency collaboration between community and school settings is one mechanism to serve the complex needs of pediatric patients with autism spectrum disorder (ASD). Purpose We surveyed a national sample of community-based providers to examine their perspectives on interagency collaboration with school-based providers when serving pediatric patients with ASD. Method Medical and behavioral/mental health professionals practicing in community settings were recruited. Participants (N = 116) completed an online survey about their interagency collaboration experiences with schools. Results The majority of the sample reported engaging in interagency collaboration with school-based providers; however, the frequency was limited and was associated with the number of years working in the field. Community-based providers wanted more didactic and hands-on experiences in collaboration. Barriers and facilitators were related to schools' administration, school personnels’ training in ASD, information exchange, and delineating between identification systems. Discussion and conclusion Our findings highlight the importance of leadership support and the need for innovative training experiences to support school-community interagency collaboration.

Pediatric primary care providers such as pediatricians and pediatric residents tend to be the most accessible professionals when it comes to managing behavioral-health concerns such as social-emotional, behavioral, and developmental issues. However, pediatricians report they do not feel comfortable managing common behavioral-health issues. Many in the field have acknowledged that this stems from the inadequate training that pediatricians receive when they are residents. Opportunities exist for social workers (e.g., licensed clinical social workers) to train pediatric residents in behavioral-health care. Many social workers are uniquely positioned to provide this interprofessional education. With changes in the healthcare landscape emphasizing behavioral health integration in the patient-centered medical home, more social workers are practicing in these integrated care settings. The purpose of this article is to: (1) describe the current context of behavioral-health training for pediatric residents...

Many youth with autism spectrum disorder (ASD) may benefit from interdisciplinary care coordination. Communication and collaboration between the school and clinic settings is particularly important when youth with ASD are receiving both special education and clinic-based services. The responsibility of initiating coordinated care has historically been with the medical home (e.g., primary care clinicians), however, educational professionals (e.g., school psychologists) are also well positioned to assume a leadership role in care coordination. Little is known about the current state, feasibility, or effectiveness of school psychologists leading care coordination efforts. The current study utilizes a mixed-method approach to understand school psychologists' engagement in interdisciplinary collaboration across settings, a central tenet to coordinated care, in providing services to youth with ASD.

Introduction Attention-deficit/hyperactivity disorder (ADHD) in children and adolescents is commonly managed in primary care. Changes in United States health care have led to the integration of behavioral health services within a patient's "medical home" to improve access to, engagement in, and continuity of quality health care. Despite proliferation of these integrated care models, no studies have specifically examined models for managing ADHD in children and adolescents within primary care. Method We searched PsycINFO, MEDLINE, and Google Scholar databases, and found 8 studies describing 6 integrated care models (i.e., combined psychosocial and medication treatments with coordination of care between primary care clinicians and behavioral health clinicians). We reviewed characteristics (i.e., settings, target populations, providers, levels of integration, evaluation and treatment approaches, and methods of interprofessional collaboration) and outcomes (i.e., access, outcomes, and acceptability) of these models. Results The 6 integrated care models demonstrate the potential to improve access to and acceptability of ADHD care for children and adolescents. The models also demonstrate that behavioral health clinicians can integrate at various levels within primary care to achieve superior clinical outcomes compared with nonintegrated models. Discussion We identified 6 effective integrated care models for addressing ADHD in children and adolescents that may be adaptable to local needs and internal capacities. We discuss results of these models with regard to their implications for clinical practice and research. (PsycINFO Database Record

Research continues to elucidate the finding that children’s functioning is composed of numerous interdependent influences such as physical and psychological health, and ecological contexts which are inextricably linked. However, our nation’s healthcare delivery system has not traditionally followed this framework in adequately addressing whole-person needs within a holistic framework. This care has often been fragmented (i.e., physical health providers functioning separately from behavioral health providers) and not coordinated among the numerous systems (e.g., family, school, healthcare) in which children interact. This chapter aims to highlight the importance of using a broader systems orientation and social-ecological framework in pediatric healthcare delivery.

This chapter synthesizes the evidence for use of interdisciplinary, collaborative care in pediatric behavioral health. In addition, the importance of multi-tiered integrated healthcare service delivery is addressed, as well as current barriers to this approach. The chapter calls for further development of models of professional training and professional functioning in integrated care, as well as the organizational structures and processes, and implementation strategies that will support these. Several areas for further development are emphasized as a means of increasing the uptake of integrated pediatric behavioral healthcare. These include increasing cross-systems understanding, common factors training, collaboration with parents and families, cross-system progress monitoring, eHealth/mHealth approaches, and financial issues. In addition, actions that can be taken at a number of levels that represent the systems that affect pediatric behavioral health service delivery are addressed. These levels include graduate and professional education, the individual practitioner, service delivery setting management/administration, researchers, professional organizations, and the state and federal level.

The purpose of this study was to empirically investigate Nationally Certified School Psychologists' (NCSP) training in and use of evidence-based interventions (EBIs) for child behavior concerns as well as their reported implementation barriers. A modified Tailored Design Method (TDM; Dillman, Smyth, & Christian, 2009) using up to four mail-based participant contacts was used to obtain survey data (72% usable response rate; n = 392) from a randomly selected national sample of 548 currently practicing NCSPs. Lack of time was rated as the most serious barrier to behavioral EBI implementation, followed by a lack of necessary resources, and financial constraints. Nearly three-quarters (71%) of respondents reported a perceived inadequacy of graduate program training in behavioral EBIs, with a statistically significant difference found between respondents who attended American Psychological Association (APA)-accredited/National Association of School Psychologists (NASP)-approved programs and those who did not. These findings highlight the significant barriers school psychologists encounter when attempting to implement behavioral EBIs within applied practice, as well as the importance of graduate program training in implementation science. Implications for training, practice, and research are discussed.