Mental and behavioral health difficulties are prevalent among children, and research suggests that the vast majority of these children do not receive needed services. Treatment disparities are even larger among rural youth given the scarcity of qualified specialty mental health providers, increased barriers to care, and greater mental health-related stigma compared to their urban counterparts. Many parents seek help and resources from their child’s primary care provider (PCP); however, the comprehensive management of psychosocial and behavioral concerns are often not feasible in traditional primary care settings. Integrating behavioral health services into pediatric primary care clinics has the potential to increase access to needed services, improve comprehensiveness and quality of care for patients, and reduce burdens on PCPs. Research on integrated behavioral health (IBH) models have indicated that it is a cost-effective service leading to improved treatment outcomes compared to usual primary care and that parents and physicians are generally satisfied and interested in this service delivery model. However, little is known about parents’ attitudes toward IBH and factors that may influence the acceptability of this type of care. Previous research has identified several factors associated with parent acceptability of mental health services for their child including symptom severity, attitudes toward child therapy, parenting stress, stigma, perceived barriers to care, and past experiences with services. However, it is unclear how these factors influence attitudes toward IBH, especially in rural areas. The current study examined parents’ attitudes toward co-located and integrated models of care, identified factors that affect acceptability of IBH, and explored differences between rural and urban parents’ attitudes. Results demonstrated that both rural and urban parents hold generally favorable attitudes toward IBH models and that parent attitudes toward general child therapy was strongly associated with IBH acceptability. Demographic variables (e.g., parent age, child age, minority status, socioeconomic status), need characteristics (e.g., parenting stress, child psychosocial symptoms), and other enabling factors (e.g., mental health-related stigma, prior service use, barriers to care) were not predictive of parent IBH acceptability. Urban parents rated co-located models of care as more acceptable and reported higher levels of parent psychosocial symptoms, stigma, and barriers to care compared to rural parents. These findings support efforts to continue integrating behavioral health services into pediatric primary care and highlight parent therapy attitudes as an important target for intervention to improve parent IBH acceptability. Findings also shed light on the need for more mixed-method research to understand the impact rural identity has on the acceptability and use of behavioral health services.

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Integrated behavioral health care within primary care has become a popular style of health care delivery within the United States. However, individuals with a behavioral health concern face several barriers in using these services. The purpose of this quantitative study was to identify key factors accounting for individuals' utilization and intensity of behavioral health services. Andersen's behavioral model of health care use and the integrated theory of health behavior change served as the theoretical framework. It was hypothesized that gender, age, race, ethnicity, family size, payer type, poverty level, and certain preexisting medical conditions (obesity, diabetes, hypertension, and tobacco use) would determine behavioral health care utilization and intensity. A secondary data analysis of 315 individuals who used behavioral health services within primary care was performed; the study setting was at the Center for Health, Education, Medicine, and Dentistry, located in Lakewood, New Jersey. Among the individual variables examined, only a preexisting condition of hypertension reached statistical significance, showing that those individuals were more likely to attend multiple sessions, Ï?2 (1) = 5.77, p = .02. Payer type was also found to be predictive of behavioral health care intensity. Medicare recipients were more likely to attend multiple behavioral health care sessions (74%) than were Medicaid recipients (59%) and those who were uninsured (25%). By providing insights about the barriers faced by individuals, study findings may help patient advocates and health care professionals to provide individuals with better health care. This study has implications for positive social change, as study findings may assist the United States health care system in its shift toward an integrated behavioral health care style of health care delivery.

Socialstyrelsen menar att primärvården står inför en utmaning att tillgodose tillgänglig psykologisk behandling till ett växande behov. Ett möjligt tillvägagångssätt skulle kunna vara Integrerad beteendehälsa som eftersträvar att kunna erbjuda korta psykologiska interventioner med hög tillgänglighet. Syftet med föreliggande studie var att jämföra två varianter av Integrerad beteendehälsa; ett sedvanligt upplägg med Brief Interventions och ett upplägg med utökad bedömning och möjligheten till vägledd självhjälp för ett specifikt problem. Det här med avseende på generella symtom och symtom specifika för just det problem som patienter erhållit självhjälp för, alternativt bedömts skulle ha passat för självhjälp avseende ett specifikt problem. Resultaten visade att den generella symtomnivån förbättrades för gruppen som helhet, samt inom respektive grupp. Den problemspecifika symtomnivån sjönk för både patienter som erhållit vägledd självhjälp och för patienter som erhållit Brief Interventions men vars problemprofil visat att de hade passat för en specifik självhjälpsmanual. Någon signifikant skillnad i symtomförändring, oavsett generell eller problemspecifik, kunde inte hittas. I diskussionen problematiseras bland annat den interna validiteten och den naturalistiska miljön lyfts som en styrka. / The national board of health and wellfare are stating that primary care faces a major challenge in providing available psychological treatment to an increasing need. One possible approach is Integrated Behavioral Health, which strives towards offering brief psychological interventions with great access. The purpose of the following study was to compare two different methods of Integrated Behavioral Health; an ordinary set up with Brief Interventions and one set up with extended assesment and the possibility of guided self-help treatment for a particular problem. This regarding general as well as specific symptoms for the particular problem the patient has received guided self-help for, or considered to have been suited for. The results showed that the general level of symptoms improved for all patients, merged into one group, and within the respective group. The level of the problem-specific symptom decreased for patients who received guided self-help and for patients who received Brief Interventions, but whose problem profile showed that they had fit for a specific self-help manual. No significant difference in symptom change, regardless of general or problem- specific, could be found. In the discussion, the internal validity is discussed, and the naturalistic environment is described as a strength.

Primärvården står i dagsläget inför utmaningar gällande omhändertagandet av psykisk ohälsa. Integrerad beteendehälsa (IBH) är en organisatorisk modell med potential att underlätta för hur evidensbaserad psykologisk behandling kan bedrivas i en primärvårdskontext. Syftet med föreliggande studie var att utvärdera en sedvanlig IBH-vårdmodell, kontextuell bedömning följt av fokuserade insatser, med en utökad bedömningsprocedur följt av valet att inleda fokuserade insatser eller vägledd självhjälp, samt de två behandlingsuppläggen fokuserade insatser (oavsett bedömningsförfarande) och vägledd självhjälp efter utökad bedömning. Effekter på vardaglig funktionsnivå, betydelsen av antal behandlingskontakter samt den kontinuerliga upplevelsen av problemets svårighetsgrad, tilltro till den egna förmågan att förändras och besökens hjälpsamhet undersöktes. 69 primärvårdspatienter randomiserades mellan de två vårdmodellerna. Resultaten indikerade på en signifikant förbättring i vardaglig funktionsnivå för samtliga patienter oavsett vårdmodell och behandlingsupplägg. Inget samband mellan antal sessioner och förbättring upptäcktes. Skillnader i utfall och patienternas kontinuerliga upplevelser av behandlingsinterventionerna diskuteras. / The primary healthcare system faces challenges concerning the treatment of mental health. Integrated behavioral health (IBH) is an organizational model with the potential to implement evidence-based psychological treatment in a primary care setting. The aim of this study was to compare a standard IBH treatment model, contextual assessment followed by brief interventions, with an extended assessment procedure followed by brief interventions or guided self-help, as well as the two different treatment plans brief interventions (regardless of assessment procedure) and guided self-help post an extended assessment procedure. Effects on everyday functioning and correlations between number of sessions and treatment effect are evaluated along with the continuous patient experience regarding the severity of the problem, confidence in ability to change and session helpfulness. 69 primary care patients were randomized between the two treatment models. The results indicated a significant improvement in everyday functioning regardless of treatment model or treatment plan. No significant correlation between number of sessions and improvement was found. Differences in treatment outcome and patient experience are discussed.

Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.