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The integration of mental health services in primary care settings has expanded rapidly in recent years with psychologists being at the forefront of efforts to promote healthy behaviors, reduce disease, and care for behavioral, emotional, and developmental needs to promote overall health and well-being for children and families (Asarnow, Kolko, Miranda,&Kazak, 2017; Stancin& Perrin, 2014). While there are many psychologists working in pediatric primary care (PPC), little is known about the specific activities that these psychologists engage in, the training they receive, or funding mechanisms that support their work. This study sought to address this gap in the literature through a survey of psychologists working in PPC. An anonymous online survey was disseminated to members of professional organizations and listservs who were identified as having interest in PPC. Psychologists (N-65) currently practicing in PPC completed the survey by reporting on clinical roles and practices, professional training, practice settings, and funding supports in PPC settings. Results indicate that psychologists assume a number of roles in PPC including providing individual and family therapy, conducting screenings for child mental health concerns, and providing consultation to medical colleagues. Many psychologists also provide supervision and offer educational opportunities for those in related fields, such as medicine and social work. Engagement in research activities was identified as a secondary activity. It was reported that a number of clinical activities were not billed for on a regular basis. Additional areas of research will be discussed along with implications for clinical services in PPC..

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Behavioral problems in children are common concerns in pediatric primary care. Time is an important factor for primary care providers (PCP) and it has been shown that pediatricians spend approximately five minutes longer providing care when behavioral concerns are presented, reducing the number of patients for which they can provide care. To date, no research has looked at the relationship between the quantity of behavioral concerns and PCP time demands, which is the aim of the present study. Using a sample of 516 children at a pediatric setting in rural southwest Virginia, data was recoded to classify children in one of two groups: those with behavioral concerns and those without. Using descriptive statistics, it was found that 96 children (18.6%) presented with at least one behavioral concern (with a range of 1 to 6 total behavioral concerns). Children with behavioral concerns were compared to children with medical-only concerns (with a range of 1-7 total medical concerns). When one concern was presented and it was behavioral, it took longer to address than when patients presented with up to four medical-only concerns. Regardless of the total number of concerns presented, PCPs spent 6.57 minutes longer with children presenting with at least one behavioral concern when compared to children in the medical-only group. More specifically, PCPs spent 5.07 additional minutes when one behavioral concern was presented and 9.03 additional minutes when two behavioral concerns were presented. Despite the quantity of behavioral concerns presented and the impact such concerns have on PCP’s time, results show that 100% of concerns raised were addressed at all times by PCPs within this clinic. Although from a consumer’s prospective, this is a desirable approach, such a model is not an especially time or cost efficient way for pediatricians to spend their time. As PCPs continue to address behavioral concerns, it is critical to develop and implement strategies (e.g., prioritizing concerns, identifying less time consuming concerns, scheduling follow up appointments) to address behavioral concerns more efficiently. Furthermore, incorporation of a full time on-site behavioral health provider might be an especially efficient way to maximize patient care while also relieving providers from the additional time burdens associated with the high prevalence of behavioral concerns within pediatric practices.

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This session will describe the evolution of the Pediatric Primary Behavioral Health Model in one clinic including the integration of behavioral health and social services into a residency training clinic. The implementation strategy used to develop this model will be described.

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