An ever-growing body of evidence supports the efficacy of integrated care as a treatment approach; however, less is known about what specific components of integrated care are most effective. This is especially true of warm handoffs, which are an often discussed but understudied process in integrated care. A total of 246 patient charts were reviewed to determine if type of referral (warm handoff or traditional) increased the likelihood of follow-up with behavioral health services as well as factors that might impact this relationship. There were no significant differences between type of referral and likelihood of follow-up with behavioral health services. Only previous number of visits with referring provider significantly increased the likelihood of patients attending a subsequent behavioral health appointment. More research is needed to better understand the efficacy, if any, of the warm handoff as a component of integrated care.

Objectives: To examine the prevalence of parent-reported emotional and behavior problems in pediatric primary care clinics serving rural Appalachia using methods commensurate with studies of broader samples. Methods: Parents presenting to pediatric primary care clinics completed a rating scale (Pediatric Symptom Checklist) of psychosocial problems for their child. Results: Approximately 21% of all rating scales were in the clinically significant range. Across all parents, 63% identified the child’s physician as their most common source of help. In contrast, mental health professionals had been sought out by only 24% of the sample. Conclusions: These data replicate previous findings showing high rates of parent-rated psychosocial problems in pediatric primary care. Given the prevalence of these problems in primary care and parents’ frequent help seeking in this setting, more research is needed on innovative approaches to integrated care in rural settings.

Objectives Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not. Methods Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers' direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated. Results On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present. Conclusions The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.

No description available.

Objective: To examine parents’ perceptions of stigma regarding mental health services for their child, consider stigma in the context of novel service delivery settings (e.g., telehealth, primary care, and schools), and evaluate stigma with other factors known to influence service access. Methods: 347 caregivers of children with psychosocial concerns completed surveys regarding their perceptions of stigma, service delivery settings, and barriers to care. Results:Parents endorsed low levels of stigma around services. Greater perceived stigma was related to less willingness to seek services in a mental/behavioral health center or schools but not in other settings, even when other barriers were considered. Having a younger child and a history of prior services was associated with greater willingness to seek services. Conclusions: Stigma does appear to present as a barrier, but only for some parents. Providing mental health services to young children and their parents in some nontraditional settings may increase access.

Introduction: Nearly 60,000 children receive emergency services each year due to accidental medication ingestion. Since families regularly receive verbal anticipatory guidance about locking up medications during pediatric well child visits, primary care clinics are an opportune place to distribute lock boxes to families who need them. ETSU Pediatrics is an interprofessional outpatient clinic that serves a population with many social, medical, and psychological needs. ETSU Pediatrics partnered with a local non-profit organization to provide medication lock boxes free to charge to families who need one. However, it was not known whether more families would endorse a need for a lock box in response to a systematic effort to screen for this need. We hypothesized that more medication lock boxes would be administered if families were given a written screener asking explicitly about their need for a lock box. Method:ETSU Pediatrics added the question “To increase child safety, is your household in need of a lockbox for medications?” to an existing social determinants of health screener that is given annually to each patient during their well child visit. Social work students imbedded in the clinic gave out lock boxes to families who endorsed a need. Frequency counts of the number of medication lock boxes given out were compared 6 months before and after the initiation of the screener. Results: Out of the 2,018 well child visits that occurred in the 6 months after screener initiation, 5.5% (111) of families endorsed a need for a medication lock box. Of those 106 were given a lock box. This was a substantial increase in demand for lock boxes compared to the 6 months prior to screener initiation in which only 16 lock boxes were given out. Conclusions: Systematic screening for medication lock box need resulted in more lock boxes being administered to families over a 6-month period, compared to care as usual. An embedded interprofessional student team helped facilitate this process. These results show promise for other healthcare organizations aimed at reducing accidental medication ingestions in children.

In the context of health care delivery for senior citizens, this research utilizes three studies that examine the development and implementation of health policy and the factors that can directly or indirectly impact the effective delivery of health services to senior citizens. It utilizes three essays employing mixed methods (qualitative and quantitative) methods including semi structured interviews, multiple regression and partial least squares structural equation modelling to examine the extent to which the implementation of health services delivered attributes of primary and integrated care to seniors. The two essays identified methods, approaches and strategies of integrated care relevant to the development of policy that can be successfully implemented when the contextual issues that older people consider to be important in maintaining their functional capabilities and their motivation to improve health as perceived by them are addressed. Consequent upon the results from these studies, the third essay examines the methodological issues on integrated geriatric care implementation when guidelines for effective policy development identified were not followed. By highlighting the relationship between effective policy and patient satisfaction, these three essays' recommended approach enhances the theory of health design that confirms that theoretical models of primary care must incorporate the system, process and service delivery levels of care to optimize seniors health.

OBJECTIVE: Immigrants to the United States represent a variety of ethnocultural backgrounds, experiences, and languages. They face stressors unique to migration that may exacerbate or cause mental health concerns. Despite this increased risk, immigrants access treatment at rates far below their native-borne counterparts. Structural and cultural barriers to mental health service utilization expound this disparity. The present thesis proposes a novel system to provide psychosocial support for US immigrants seeking treatment at Massachusetts General Hospital (MGH).  METHODS: Recognizing the need for a new paradigm of care, an Immigrant Mental Health Center prototype was conceptualized using a Human-Centered Design approach. The foundations for this prototype align with the Patient-Centered Medical Home approach to integrated primary and mental healthcare. Narrative reviews informed the theoretical basis of the prototype. A brief review of the existing literature yielded five integrated care themes, forming the basis for prototype evaluation criteria. Communication materials for stakeholder meetings and expert advisory panels were prepared as the next step in the Human-Centered Design approach.  RESULTS: The prototype extended care to a diverse spectrum of US immigrants within the MGH healthcare network. It involved a multidisciplinary team of specialists, whole-patient orientation, a personal practitioner, increased accessibility, and viable internal (MGH) and external (community) linkages.  CONCLUSIONS: The next steps in the Human-Centered Design approach include iteratively designing solutions to co-optimize the prototype for implementation at the MGH Center for Immigrant Health. Recommendations for the iterative refinement stage include clarifying financial metrics and addressing structural barriers to treatment accessibility. A series of feasibility pilot trials and efficacy randomized-controlled trials precede implementation. Future directions include extending the target population to second or third-generation immigrants, attending to severe mental illnesses, and fostering inpatient mental healthcare linkages as a bridge to long-term care.

The care of people with Parkinson’s disease (PD) involves input from different healthcare professionals (HCPs). A literature search identified that the HCPs involved in PD multidisciplinary (MDT) clinics, including interdisciplinary team (IDT), varied both in the number and type of HCPs. None of the studies identified involved pharmacists. Pharmacists have shown benefits when working in MDTs for other long-term conditions (LTCs); however, their role in PD MDTs was identified as a gap in the literature. The aim of the study was to determine the role of pharmacists in a PD IDT. Patients attended a PD IDT clinic comprising PD nurse, physiotherapist, occupational therapist and pharmacist. A mixed methods convergent design was used to collect both qualitative and quantitative data. Qualitative focus group and interview data were analysed using The Framework Method. Quantitative data analysis involved counts of HCP interventions. Pharmacists can support PD IDTs as they have in other LTC MDTs by conducting holistic medication reviews. Three new roles were identified for pharmacists in PD IDTs as: 1) independent prescribing, 2) supporting HCPS in their roles by supporting staff knowledge, and 3) leading the PD IDT clinics. Quantitative data showed the pharmacist made a medication review intervention for all patients. HCPs and patients identified the roles and value of involving pharmacists in PD IDTs. The PD IDT clinics offer a holistic approach to patient care and a greater opportunity for patients to be involved. The findings identified a ‘review-shared care template’ for PD IDTs and recommends development of a ‘pharmacist’s PD competency framework’.

Yes / People with advanced dementia are frequently bed-bound, doubly incontinent and able to speak only a few words. Many reside in care homes and may often have complex needs requiring efficient and timely response by knowledgeable and compassionate staff. The aim of this study is to improve our understanding of health care professionals’ attitudes and knowledge of the barriers to integrated care for people with advanced dementia. In-depth, interactive interviews conducted with 14 health care professionals including commissioners, care home managers, nurses and health care assistants in the UK. Barriers to care for people with advanced dementia are influenced by governmental and societal factors which contribute to challenging environments in care homes, poor morale amongst care staff and a fragmentation of health and social care at the end of life. Quality of care for people with dementia as they approach death may be improved by developing collaborative networks to foster improved relationships between health and social care services.